Alternating Schedule for Motrin 800mg and Tylenol 650mg After Dental Extraction
For optimal pain control after dental extraction, take acetaminophen 1000mg every 6 hours combined with ibuprofen 600-800mg every 6-8 hours in a staggered fashion, rather than strictly alternating them, as this multimodal approach provides superior analgesia compared to either medication alone. 1, 2
Recommended Dosing Schedule
The most effective regimen involves scheduled (not "as needed") dosing of both medications in staggered intervals to maintain consistent pain control: 1, 2
Specific Timing Protocol
- Acetaminophen 1000mg: Take at 6 AM, 12 PM, 6 PM, and 12 AM (every 6 hours) 2
- Ibuprofen 800mg: Take at 9 AM, 5 PM, and 1 AM (every 8 hours) 1, 2
This staggered approach ensures you receive pain medication every 3 hours while avoiding overlap and maintaining therapeutic levels of both drugs throughout the day. 2
Alternative Simplified Schedule
If the above timing is difficult to follow, use this pattern:
- Hour 0: Ibuprofen 800mg
- Hour 3: Acetaminophen 1000mg
- Hour 6: Ibuprofen 800mg
- Hour 9: Acetaminophen 1000mg
- Hour 12: Repeat cycle 1, 2
Duration and Tapering
- Continue this scheduled regimen for 3-5 days post-extraction, as pain typically peaks within the first 48-72 hours 2
- Most patients require minimal to no opioids by day 3-4 when this multimodal approach is optimized 2
- After day 5-7, transition to "as needed" dosing rather than scheduled dosing 1, 2
- Taper ibuprofen first (due to NSAID side effect profile), then stop acetaminophen last 1
Evidence Supporting Combined Therapy
The combination of ibuprofen and acetaminophen provides superior pain relief compared to either drug alone in dental extraction pain: 3, 4, 5
- Fixed-dose combinations demonstrated significantly better pain control than comparable doses of monotherapy in multiple randomized trials 4, 5
- Time to meaningful pain relief occurs within 45-60 minutes with combined therapy 5, 6
- Duration of pain relief exceeds 8-9 hours with the combination 5, 6
- The CDC specifically references this combination for dental extractions as an alternative to opioids 1
Critical Safety Considerations
Maximum Daily Doses
- Acetaminophen: Do not exceed 4000mg (4 grams) in 24 hours 2, 7
- Ibuprofen: Do not exceed 3200mg in 24 hours (though 2400mg is the typical maximum for this indication) 2
Contraindications to Ibuprofen
Avoid or use extreme caution with ibuprofen if you have: 1, 8
- Active peptic ulcer disease or history of GI bleeding
- Renal insufficiency (creatinine clearance <50-60 mL/min)
- Uncontrolled hypertension or heart failure
- Allergy to NSAIDs or aspirin
Contraindications to Acetaminophen
Reduce dose or avoid acetaminophen if you have: 2, 7
- Liver disease (maximum 2-3 grams daily instead of 4 grams)
- Chronic alcohol use (>3 drinks daily)
- Concurrent use of other acetaminophen-containing products
Common Pitfalls to Avoid
- Don't use "as needed" dosing initially: Scheduled dosing for the first 3-5 days prevents pain from breaking through, which is harder to control than preventing it 1, 2
- Don't wait until pain is severe: Start the regimen immediately after the local anesthetic wears off 2
- Don't accidentally double-dose acetaminophen: Many combination pain medications (like Percocet, Vicodin) already contain acetaminophen; if prescribed these for breakthrough pain, reduce your standalone acetaminophen dose accordingly 7
- Don't continue NSAIDs beyond 7-10 days without medical consultation due to cardiovascular and GI risks with prolonged use 1
When Opioids May Be Needed
Reserve opioids strictly for breakthrough pain only if the above regimen is insufficient: 1, 2