From the Guidelines
I strongly advise against taking Tylenol, ibuprofen, and Vicodin "around the clock" due to the high risk of adverse effects, including acetaminophen overdose, stomach bleeding, kidney damage, respiratory depression, and opioid dependence. A safer approach would be alternating acetaminophen (Tylenol) and ibuprofen, with limited use of Vicodin (hydrocodone/acetaminophen) only as needed for breakthrough pain. For adults with normal liver and kidney function, acetaminophen could be taken at 650-1000mg every 6 hours (not exceeding 3000mg daily), while ibuprofen could be taken at 400-600mg every 6 hours (not exceeding 2400mg daily), staggered between acetaminophen doses. Vicodin should only be used as prescribed, typically 1-2 tablets every 4-6 hours as needed for severe pain, and only for short durations due to addiction risk, as recommended by the CDC clinical practice guideline for prescribing opioids for pain 1.
This approach provides continuous pain relief through different mechanisms while minimizing risks. Acetaminophen works centrally to reduce pain signals, ibuprofen reduces inflammation, and Vicodin combines an opioid with acetaminophen for more severe pain. The American College of Physicians and American Academy of Family Physicians also recommend a multimodal approach to pain management, including nonpharmacologic and pharmacologic therapies, as outlined in their clinical guideline for the management of acute pain from non-low back, musculoskeletal injuries in adults 1.
Key considerations for this approach include:
- Alternating acetaminophen and ibuprofen to minimize the risk of adverse effects
- Limiting the use of Vicodin to only as needed for breakthrough pain
- Monitoring for signs of opioid use disorder and addressing concerns with the patient
- Providing patient education on the risks and benefits of opioid therapy, as well as alternative pain management options
- Encouraging patients to report any severe or uncontrolled pain, and to arrange for timely reassessment and management.
By following this approach, patients can receive effective pain management while minimizing the risks associated with taking multiple medications continuously.
From the Research
Medication Schedule
To create a pain control medication schedule that includes Tylenol (acetaminophen) around the clock, ibuprofen around the clock, and Vicodin (hydrocodone and acetaminophen) around the clock, consider the following:
- Tylenol: 650-1000 mg every 4-6 hours as needed, not to exceed 4000 mg in 24 hours 2
- Ibuprofen: 200-400 mg every 4-6 hours as needed, not to exceed 1200 mg in 24 hours 2
- Vicodin: 5-10 mg hydrocodone and 325-650 mg acetaminophen every 4-6 hours as needed, not to exceed 5 doses in 24 hours 3
Considerations
When creating a medication schedule, consider the following:
- Patient's medical history and current health status
- Potential interactions between medications
- Risk of adverse effects, such as gastrointestinal bleeding with NSAIDs or liver damage with acetaminophen
- Patient's individual needs and response to medication
Alternative Options
For patients who may not require opioid medication, consider alternative options:
- Combination therapy using a nonopioid pain reliever, such as ibuprofen or acetaminophen, with a small amount of opioid 4
- Nonopioid therapy, such as NSAIDs or acetaminophen, for acute pain management 5
Dosage and Frequency
The dosage and frequency of medication should be tailored to the individual patient's needs:
- Tylenol and ibuprofen can be taken around the clock, but the dosage and frequency should be adjusted based on the patient's response to medication
- Vicodin should be taken as needed, but not to exceed 5 doses in 24 hours 3