Scientific article
English

A randomized, controlled trial validates a peripheral supra-additive antihyperalgesic effect of a paracetamol-ketorolac combination

Published inBasic & clinical pharmacology & toxicology, vol. 109, no. 5, p. 357-364
Publication date2011
Abstract

The combination of paracetamol with non-steroidal anti-inflammatory drugs (NSAIDs) is widely used; however, the nature and mechanism of their interaction are still debated. A double-blind, pharmacokinetic/pharmacodynamic, randomized, cross-over, placebo-controlled study was carried out in human healthy volunteers. The aim was to explore the existence of a positive interaction between paracetamol 1 g and ketorolac 20 mg administered intravenously on experimental pain models in human beings. The effects of the paracetamol-ketotolac combination were compared with similar doses of respective single analgesic and to placebo on the sunburn model (UVB-induced inflammation), cold pain tolerance and the nociceptive flexion reflex. The kinetics of the plasma concentrations of paracetamol and ketorolac were measured using 2D-liquid chromatography-mass spectrometry. Thirteen volunteers were screened, and 11 completed the study. Ketorolac significantly decreased primary hyperalgesia to heat stimuli compared with paracetamol (p < 0.014). The combination performed better than paracetamol (p < 0.001) and placebo (p < 0.042), increasing heat pain threshold by 1.5°C. The combination radically reduced primary hyperalgesia to mechanical stimulation (39%) compared with placebo (p < 0.002) and single agents (paracetamol p < 0.024 and ketorolac p < 0.032). The combination also reduced, slightly although significantly, the intensity of pain (10%) for the cold pressor test (versus placebo: p < 0.012, paracetamol: p < 0.019 and ketorolac p < 0.004). None of the treatments significantly affected the central models of pain at this dosage level. No pharmacokinetic interactions were observed. These results suggest a supra-additive pharmacodynamic interaction between paracetamol and ketorolac in an inflammatory pain model. The mechanism of this interaction could mainly rely on a peripheral contribution of paracetamol to the effect of NSAIDs.

Keywords
  • Acetaminophen/administration & dosage/pharmacokinetics
  • Adult
  • Analgesics/administration & dosage
  • Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
  • Antipyretics/administration & dosage/pharmacokinetics
  • Cross-Over Studies
  • Double-Blind Method
  • Drug Combinations
  • Gas Chromatography-Mass Spectrometry
  • Humans
  • Hyperalgesia/drug therapy
  • Inflammation/drug therapy
  • Ketorolac/administration & dosage/pharmacokinetics
  • Male
  • Middle Aged
  • Pain/drug therapy
  • Radiodermatitis/drug therapy/pathology
  • Young Adult
Citation (ISO format)
ING LORENZINI, Kuntheavy et al. A randomized, controlled trial validates a peripheral supra-additive antihyperalgesic effect of a paracetamol-ketorolac combination. In: Basic & clinical pharmacology & toxicology, 2011, vol. 109, n° 5, p. 357–364. doi: 10.1111/j.1742-7843.2011.00733.x
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Article (Published version)
accessLevelRestricted
Identifiers
Journal ISSN1742-7835
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