How to Use Combiflam for Pain Relief: Dosage & Safety

Combiflam is a prescription painkiller that puts two medicines into one tablet: ibuprofen 400 mg and paracetamol 325 mg. It is meant for short-term use in mild to moderate pain, and to bring down fever. The tablet is taken at fixed intervals for a few days at most.

People who ask how to use Combiflam are usually asking two things: how often can I take it, and how long before I should worry. Those answers matter more here than with a plain paracetamol tablet, because this one carries two active medicines at once. This guide follows the medicine's own Indian prescribing information, so the numbers and warnings below are the ones your doctor is working from.

What follows is general information, not a personal prescription. Your own doctor's instructions always come before anything written here.

Combiflam is a fixed-dose combination tablet. Each tablet contains ibuprofen 400 mg and paracetamol 325 mg.

Ibuprofen is a non-steroidal anti-inflammatory drug, or NSAID — a group of painkillers that also reduce swelling. Paracetamol is a plain pain and fever reliever that does not reduce swelling. In this tablet the two are combined so that a single dose does both jobs.

The name Combiflam covers more than one product, and they are not interchangeable. This article is about the tablet.

• Product: Combiflam tablet (the product this article covers); What each dose contains: Ibuprofen 400 mg + paracetamol 325 mg per tablet; Who it is meant for: Adults and adolescents aged 12 and above who weigh at least 40 kg
• Product: Combiflam Suspension; What each dose contains: Ibuprofen 100 mg + paracetamol 162.5 mg per 5 ml; Who it is meant for: Children from 6 months of age, when a doctor prescribes it
• Product: Combiflam Plus; What each dose contains: Paracetamol 650 mg + caffeine 50 mg per tablet. It contains no ibuprofen; Who it is meant for: Adults and children over 12 years

Because Combiflam Plus contains no ibuprofen at all, it is a different medicine with different limits. Check the name and the strength printed on your pack before you take anything.

In India, Combiflam is a prescription medicine. Its prescribing information states that it is for the use only of a registered medical practitioner, a hospital or a laboratory.

The two ingredients lower pain in different ways, which is why they are combined.

Ibuprofen works on an enzyme called cyclooxygenase, or COX. There are two main forms of this enzyme, COX-1 and COX-2, and ibuprofen blocks both of them. These enzymes are needed to make prostaglandins — chemicals the body releases around an injury or an infection. Prostaglandins make pain nerve endings more sensitive, and they drive swelling and fever. When fewer prostaglandins are made, pain eases and swelling and temperature come down.

Paracetamol works differently. It is only a very weak blocker of the COX enzymes, and most of its pain-relieving action comes from a substance the body makes from it, called AM404. AM404 acts on two receptors in the brain and spinal cord — the TRPV1 receptor and the cannabinoid CB1 receptor — and dampens the way pain signals travel. Because it acts mainly in the nervous system rather than in the tissues, paracetamol relieves pain and fever but does not reduce swelling.

The label lists mild to moderate pain and inflammation in these situations:

• Period pain
• Headache, including migraine
• Pain after surgery
• Toothache
• Pain in muscles, joints and the tissues around them
• Soft tissue injuries such as sprains and strains

It is also used to bring down fever.

Combiflam is not a long-term medicine. It is meant for a short time only, and it is not suitable for ongoing conditions such as arthritis that need regular daily treatment. It also does not treat whatever is causing the pain. One more point worth knowing: ibuprofen can hide the signs of an infection and delay treatment, so it should not be used during chickenpox, and if it is being taken for fever or pain during an infection, that infection needs to be watched.

This medicine should be taken only on your doctor's advice, and in the amount they have written for you. If their instructions differ from the label, theirs is the one that applies.

The label's limits for adults and adolescents who weigh at least 40 kg:

• Start with one tablet.
• Leave at least 6 hours between one tablet and the next.
• No more than 3 tablets in any 24-hour period.
• Do not use it for more than 4 days for pain, or more than 3 days for fever, unless a doctor has told you to.

The tablet is meant to be swallowed whole with a glass of water. It should not be crushed, split or chewed unless a doctor or pharmacist has said it is fine.

If your stomach is sensitive, take it with food. There is one trade-off to know about: when the tablet is taken just after a meal, relief may start a little later. If that happens, do not take another tablet before the correct gap has passed.

Alcohol is best avoided for the whole time you are taking Combiflam. Alcohol adds to the stomach and nervous-system effects of ibuprofen, and regular drinking raises the chance of paracetamol harming the liver.

Some people feel tired or dizzy at higher doses, and more so with alcohol. If that happens, avoid driving or operating machinery until you feel normal again.

If you miss a dose: take it as soon as you remember. If it is almost time for your next tablet, skip the missed one and carry on as usual. Never take two tablets to make up for a missed one.

If you take too much: paracetamol is the main concern, because too much of it can damage the liver, sometimes badly, and the early signs are easy to miss. Nausea, vomiting, loss of appetite, paleness and belly pain usually appear in the first 24 hours; yellowing of the skin or eyes, sweating, unusual tiredness and unusual bleeding can follow. Get medical help immediately, even if the person seems completely well. Ibuprofen overdose can cause headache, dizziness, belly pain, vomiting, gut bleeding, and kidney or liver problems.

In India, go to the nearest hospital emergency department straight away and carry the strip or pack with you. For an ambulance call 108. For any emergency call 112. Do not wait for symptoms to appear before getting help.

These are the situations in which the label says Combiflam must not be used at all:

• Allergy to ibuprofen, paracetamol or any other ingredient in the tablet
• A past allergic reaction — asthma, wheezing, a runny nose, hives or swelling — after taking aspirin or another NSAID
• A history of bleeding or perforation in the stomach or gut while taking an NSAID
• An active peptic ulcer, or a history of repeated ulcers or stomach bleeding
• Bleeding in the brain, or any other active bleeding
• Severe liver failure
• Severe kidney failure
• Severe heart failure
• Severe dehydration from vomiting, diarrhoea or not drinking enough
• Children under 12 years, and adolescents who weigh less than 40 kg
• The last three months of pregnancy
• Certain unexplained disorders of blood formation

In these situations Combiflam may still be prescribed, but your doctor needs to know about them first.

Age. A liquid version exists for children from 6 months, and a doctor decides the amount. Older adults get stomach bleeding and kidney effects from NSAIDs more often, so they are watched more closely.

Kidney and liver. No change in dose is needed for mild to moderate liver or kidney problems. Severe problems make the tablet unsuitable. Also tell your doctor if you have G6PD deficiency, Gilbert's syndrome, are malnourished, or drink alcohol regularly — paracetamol is handled differently by the body in all of these.

Heart and blood pressure. Talk to your doctor before starting if you have high blood pressure or heart failure. NSAIDs can cause the body to hold on to fluid, raise blood pressure and, in some people, make heart failure worse. If you have uncontrolled high blood pressure, heart failure, ischaemic heart disease, peripheral arterial disease or a previous stroke, the tablet is used only after careful consideration, and high daily doses of ibuprofen need to be avoided.

Pregnancy. Combiflam is not the right choice for most of pregnancy. Ibuprofen must not be used in the last three months, because it can harm the unborn baby's heart and kidneys. The label says it should not be used in the first and second three-month periods either, unless it is clearly necessary — and even then it is used at the lowest effective dose for the shortest time, with a scan to check the amniotic fluid if treatment goes beyond two days. Paracetamol on its own can be used in pregnancy when a doctor says it is needed, at the lowest dose for the shortest time. In September 2025 the US Food and Drug Administration began a label change reflecting studies that link paracetamol use in pregnancy with a possible higher chance of neurological conditions such as autism spectrum disorder or ADHD in children, while stating that a causal link has not been established. The same announcement notes that an untreated high fever can harm the baby too, and that it remains reasonable to use paracetamol in some situations in pregnancy. If you are pregnant, let your doctor make this decision.

Breastfeeding. The amounts of paracetamol and ibuprofen that pass into breast milk are low, and no harmful effects in babies are known. For short-term use at the recommended dose, breastfeeding does not usually need to be interrupted — but check with your doctor first, because it depends on your dose and on your baby.

Fertility. Medicines that block the COX enzyme can affect ovulation and temporarily reduce fertility in women. This reverses once the medicine is stopped. If you are trying to conceive, mention it to your doctor.

Other conditions worth mentioning. Asthma or a history of allergic reactions, hay fever or nasal polyps, stomach problems such as an ulcer, hiatus hernia or inflammatory bowel disease, lupus or mixed connective tissue disease, a recent major operation, or any current infection.

Taking it too often. Painkillers taken on most days can backfire. Using headache medicines regularly can make headaches more frequent and worse, and habitually taking combination painkillers over years can cause lasting kidney damage. Needing Combiflam often is a reason to see a doctor, not a reason to keep taking it.

Most people who take Combiflam for a few days have no trouble, or only mild stomach upset. The common effects come from the ibuprofen; the serious ones are rare.

• Heartburn, indigestion, belly pain — Black or tarry stools, or blood in vomit
• Nausea, vomiting, wind, diarrhoea or constipation — Severe pain in the upper belly
• Dizziness, headache, sleeplessness, tiredness — Yellowing of the eyes or skin, dark urine, pale stools
• Skin rash or itching — A spreading rash with blisters, or mouth ulcers
• Slight blood loss in the gut — Swelling of the face, lips, tongue or throat, or trouble breathing

Two risks sit behind that table and are worth stating plainly.

The first is heart and blood-vessel risk. In the United States, prescription ibuprofen labels carry an FDA boxed warning, most recently updated in July 2026: NSAIDs raise the risk of serious heart and blood-vessel events such as heart attack and stroke, which can be fatal, and the risk may increase the longer they are taken. They are also not to be used for pain around the time of coronary artery bypass graft surgery.

The second is gut risk. The same warning covers bleeding, ulcers and perforation of the stomach or intestines, which can be fatal and can happen without any warning symptoms. The Indian prescribing information for Combiflam covers both of these problems in its warnings section rather than in a boxed format, and adds one detail specific to this tablet: at the ibuprofen doses it provides, up to 1200 mg a day, studies do not suggest an increased risk of these heart and blood-vessel events. It is higher daily doses of ibuprofen, around 2400 mg, that are linked to a small added risk.

A serious allergic reaction can develop even on the first tablet. A rare reaction called Kounis syndrome can cause chest pain along with an allergic reaction. Both need emergency care.

If you have been taking Combiflam for a long time, tell your doctor about unusual tiredness, a sore throat with mouth ulcers and fever, nosebleeds or bleeding under the skin, or a fall in how much urine you pass. These can point to problems with the blood or the kidneys.

Everything below matters more than usual here, because Combiflam already contains two medicines. Tell your doctor or pharmacist about every other medicine you take, including anything bought without a prescription.

• Other paracetamol products. These are never taken together. Cold and flu remedies, combination painkillers and many fever tablets contain paracetamol, and adding Combiflam on top can lead to an accidental paracetamol overdose.
• Other NSAIDs. These are avoided. The group includes aspirin, ibuprofen and naproxen bought separately, and prescription NSAIDs. Two together raise the risk of stomach ulcers and bleeding.
• Blood thinners and antiplatelet medicines. Warfarin, other antivitamin K medicines, aspirin and clopidogrel. Paracetamol can increase the bleeding risk with warfarin, and ibuprofen adds to it.
• Corticosteroids such as prednisolone, and SSRI antidepressants. Both raise the risk of bleeding in the gut.
• Methotrexate. Ibuprofen can raise its blood levels, making its toxic effects more likely.
• Lithium, digoxin and phenytoin. Ibuprofen can raise the blood levels of all three.
• Ciclosporin and tacrolimus. Higher risk of kidney damage.
• Diuretics, ACE inhibitors, beta-blockers and angiotensin-II blockers. Ibuprofen can reduce their effect, and in people who are dehydrated or elderly this combination can worsen kidney function. Potassium-sparing diuretics can also push potassium levels up.
• Antiepileptics such as phenobarbital, phenytoin, carbamazepine and topiramate, and also rifampicin. These increase the chance of paracetamol harming the liver.
• Flucloxacillin. This combination has been linked to a build-up of acid in the blood, especially in people who are already unwell.
• Quinolone antibiotics. NSAIDs may increase the risk of convulsions.
• Zidovudine. More bleeding into joints and muscles in people with HIV and haemophilia.
• Sulphonylureas for diabetes. Blood glucose should be checked as a precaution.
• Colestyramine, metoclopramide and domperidone. Colestyramine reduces how much paracetamol is absorbed, so leave a gap of more than 2 hours. Metoclopramide and domperidone do the opposite and speed absorption up.
• CYP2C9 inhibitors such as fluconazole and voriconazole. Ibuprofen levels rise, so a lower ibuprofen dose may be needed.
• Mifepristone. NSAIDs should not be used for 8 to 12 days after it, as they can reduce its effect.

Keep the tablets in the strip or container they came in, tightly closed. Store them at room temperature, away from heat and moisture — not in a bathroom or on a sunny windowsill. Keep all medicines out of the sight and reach of children, and check the expiry date on the pack before each dose. If you have tablets left over, keep them out of reach of children and pets, and do not flush them down the toilet or throw them loose into a bin.