Would adding diclofenac provide additional analgesia for my severe dental pain while I am already taking ibuprofen 800 mg every 8 hours and amoxicillin 500 mg every 8 hours?

No, Adding Diclofenac to Your Current Ibuprofen Regimen Would Not Help and Is Explicitly Contraindicated

You should not add diclofenac while taking ibuprofen 800 mg every 8 hours, as concomitant use of multiple NSAIDs is contraindicated due to increased gastrointestinal toxicity without additional analgesic benefit. 1

Why Combining NSAIDs Is Dangerous

The FDA drug label for diclofenac explicitly states that "the concomitant use of diclofenac potassium tablets with other NSAIDs or salicylates is not recommended due to the increased risk of gastrointestinal toxicity, and little or no increase in efficacy." 1 This is not a theoretical concern—combining NSAIDs significantly increases your risk of:

• Gastrointestinal bleeding and ulceration without providing meaningful additional pain relief 1
• Renal toxicity, particularly if you have any volume depletion or take other medications 1
• Cardiovascular complications, as both drugs affect similar pathways 2

What You Should Do Instead

Option 1: Switch from Ibuprofen to Diclofenac (Preferred for Dental Pain)

Consider replacing your ibuprofen with diclofenac 50 mg every 8 hours, as diclofenac has demonstrated superior efficacy specifically for dental pain. 3, 4

• Diclofenac 50 mg every 8 hours produced significantly lower pain scores at 2,4, and 24 hours compared to ibuprofen 400 mg every 6 hours in patients with dental pain 3
• Diclofenac showed faster onset of action (within 30 minutes) and higher rates of complete pain relief in dental pain studies 4
• Maximum daily dose is 150 mg (three 50 mg doses), which should not be exceeded 5

Option 2: Add Acetaminophen to Your Current Ibuprofen

If you prefer to continue ibuprofen, add acetaminophen 1000 mg every 6-8 hours instead of diclofenac. 6

• Combining diclofenac with acetaminophen provided superior and prolonged analgesia compared to either drug alone in dental surgery patients 6
• This same principle applies to ibuprofen—NSAIDs and acetaminophen work through different mechanisms and can be safely combined 7
• Acetaminophen does not increase gastrointestinal or renal risks when added to NSAIDs 6

Option 3: Consider Opioid Combination for Severe Pain

If your pain remains severe despite maximum NSAID therapy:

• Tramadol with acetaminophen or codeine with acetaminophen are appropriate for moderate to moderately severe dental pain 7
• However, adding codeine to NSAID-acetaminophen combinations increases side effects without proportional benefit 6

Critical Safety Warnings

Do not take diclofenac if you:

• Are already taking ibuprofen or any other NSAID 1
• Have active peptic ulcer disease or history of GI bleeding 5
• Have severe heart failure, liver failure, or significant cardiovascular disease 5
• Are taking anticoagulants (warfarin, aspirin >81mg daily) without close monitoring 5, 1
• Consume ≥2 alcoholic beverages per day 8

Monitoring Requirements If You Switch to Diclofenac

• Use the lowest effective dose for the shortest duration necessary 9
• Maximum duration for acute dental pain should be limited to 3-7 days 5
• If you have risk factors (age >60, history of ulcers, cardiovascular disease), add a proton pump inhibitor for gastroprotection 5
• Monitor for warning signs of GI bleeding (black stools, abdominal pain) or cardiovascular events (chest pain, shortness of breath) 5, 1

The Bottom Line

Your current regimen of ibuprofen 800 mg every 8 hours plus amoxicillin is appropriate for severe dental pain. If inadequate, switch to diclofenac 50 mg every 8 hours (replacing, not adding to ibuprofen) and add acetaminophen 1000 mg every 6-8 hours. 3, 6 This combination provides superior analgesia compared to either NSAID alone while avoiding the dangerous practice of combining two NSAIDs. 1, 6