Dexketoprofen × Ibuprofen

The dexketoprofen label lists other NSAIDs among the combinations that are not recommended and explains why: giving several NSAIDs together potentiates the risk of gastrointestinal ulcers and bleeding through a synergistic effect. Dexketoprofen acts fast and ibuprofen covers the hours that follow, leaving the mucosa without protective prostaglandins for most of the day.

Epigastric pain, nausea, black stools, vomiting blood. Reduced urine output, oedema and high blood pressure if the kidney was already compromised or the patient takes diuretics or ACE inhibitors. Pain may not improve despite the double dose, because the target is already saturated.

Pick one of the two. Dexketoprofen is reserved for short courses of severe acute pain, and ibuprofen is withdrawn during that time, including self-medication for headache or period pain. To reinforce analgesia, add paracetamol, which does not share the mechanism.