Combogesic® 325 contains a combination of ibuprofen and acetaminophen. The purpose of this study is to compare the pain relief effects of Combogesic® 325mg and acetaminophen and to evaluate the safety of Combogesic® 325mg in adolescents between the ages of 12 and \<18 years. What will the study involve for participants? * Participants will be randomly allocated to one of 3 treatment groups: * 3 tablets of Combogesic® 325, * 2 tablets of Combogesic® 325 and 1 tablet of placebo or * 2 tablets of acetaminophen1000mg and 1 tablet of placebo * Participants will take 3 tablets every 6 hours with a maximum of 4 doses in 24 hours * Participants and study doctor will be blinded to the treatment group * If pain is not sufficiently controlled, opioids may be used as supplementary pain relief at the discretion of the study doctor. * Participants will complete a patient diary to assess their pain * Participants will rate the study drug at the end of the treatment. It is expected that Combogesic® tablets (either 2 or 3 tablets per dose) will provide a greater reduction in pain compared to acetaminophen (1000 mg) treatment.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
180
The active ingredients of Combogesic® tablets are acetaminophen 325 mg and ibuprofen 97.5 mg.
Each tablet contains acetaminophen 500mg.
Placebo tablets do not contain any active ingredients
Nemours Children's Health
Orlando, Florida, United States
Time-adjusted summed pain intensity difference (SPID) calculated from the visual analogue scale (VAS) pain intensity scores 6 hours after first dose of study medication
SPID will be derived from the 100 mm Visual Analogue Scale which is the tool used for patients to rate the intensity of their pain on a horizontal 100mm line with 0 on one end and 100 on the other end (0 being no pain and 100 being the worst pain unimaginable). The primary analysis will compare three tablets of Combogesic® against acetaminophen
Time frame: From start of exposure to study drug until 6 hours after first dose
Time-adjusted SPID0-6 (for 2 tablets of Combogesic vs. acetaminophen) and Time-adjusted SPID0-12, SPID0-18 and SPID0-24 for both doses.
Time frame: From start of exposure to study medication up to 24 hours
The time to onset of pain relief after the first dose of study drug defined as (i) perceptible, (ii) meaningful and (iii) complete pain relief using the three stopwatch method.
Time frame: From start of exposure to study medication up to 24 hours
The maximum VAS pain scores up to 24 hours after the first dose of study medication.
100 mm Visual Analogue Scale is the tool used for patients to rate the intensity of their pain on a horizontal 100mm line with 0 on one end and 100 on the other end (0 being no pain and 100 being the worst pain unimaginable)
Time frame: From start of exposure to study medication up to 24 hours
The pain intensity (PI) and pain intensity difference (PID) at 6, 12, 18, and 24 hours after first dose.
100 mm Visual Analogue Scale which is the tool used for patients to rate the intensity of their pain on a horizontal 100mm line with 0 on one end and 100 on the other end (0 being no pain and 100 being the worst pain unimaginable). The PID will be measured by the difference between the baseline score and the score at 6, 12, 18, and 24 hours after first dose.
Time frame: From start of exposure to study medication up to 24 hours
Pain relief as measured on a 5-point categorical scale at 6, 12, 18, and 24 hours after first dose.
Patients will be asked to rate their pain in their patient diary with the following questionnaire. Please rate your pain relief: 0= no pain relief; (the pain is the same, or worse, than the starting pain) 1. a little pain relief; (the pain is less than half gone) 2. some pain relief; (the pain is about half gone) 3. a lot of pain relief; (the pain is more than half gone) 4. complete pain relief; (the pain is completely gone)
Time frame: From start of exposure to study medication up to 24 hours
Peak pain relief
Time frame: From start of exposure to study medication up to 24 hours
Time to peak pain relief
Time frame: From start of exposure to study medication up to 24 hours
Total pain relief (TOTPAR) (calculated as a time-weighted average) over 0-6 hours (TOTPAR-6), over 0-12 hours (TOTPAR-12), over 0-18 hours (TOTPAR-18), and over 0-24 hours (TOTPAR-24).
Time frame: From start of exposure to study medication up to 24 hours
The response rates (response rate to be defined as the percentage of participants who reduce their pain intensity scores by at least 50% compared with the baseline VAS measure).
Time frame: From start of exposure to study medication up to 24 hours
Time to response
Time frame: From start of exposure to study medication up to 24 hours
The time to requirement for rescue medication.
Time frame: From start of exposure to study medication up to 24 hours
The percentage of participants using rescue medication at 6, 12, 18, and 24 hours after first dose.
Time frame: From start of exposure to study medication up to 24 hours
Total Dose (mg) of primary (oxycodone) and secondary (morphine) rescue medication over 24 hours
Time frame: From start of exposure to study medication up to 24 hours
Total oral Morphine Milligram Equivalent (MME) dose of all rescue medication over the 24 hour study period
Time frame: From start of exposure to study medication up to 24 hours
The categorical global evaluation of study drug.
Each patient will rate the study medication using a questionnaire of: How do you rate the study medication? 1 = Poor; 2 = Fair; 3 = Good; 4 = Very Good; 5 = Excellent The patient's global evaluation of the study drug will be summarized by the number and percentage of subjects within each category.
Time frame: From start of exposure to study medication up to 24 hours
To compare treatment-emergent adverse event (TEAE) rates over the course of treatment and at a follow up call 7 days after last dose.
Time frame: From start of exposure to study medication until 7 days after last dose
The incidence of specific NSAID and acetaminophen adverse effects from the first dose of study drug until Day 7.
Adverse effects include GI ulceration or bleeding, indigestion/stomach pain, post-operative bleeding, bronchospasm, skin reactions, water retention, renal failure, thromboembolic events, and evidence of clinical hepatitis
Time frame: From start of exposure to study medication until 7 days after final dose
To characterize the pharmacokinetic profile of two different doses of Combogesic® 325 (T1/2- Time required for the plasma drug concentration to decrease by one half)
This will be defined from the plasma concentration versus time data using non-compartmental methods
Time frame: Approximately 15 minutes before first dose of study medication until 6 hours after first study medication administration and before second dose
To characterize the pharmacokinetic profile of two different doses of Combogesic® 325 (Extrapolated AUC(0-∞)- The area under the plasma concentration versus time curve, from zero to infinity)
This will be defined from the plasma concentration versus time data using non-compartmental methods
Time frame: Approximately 15 minutes before first dose of study medication until 6 hours after first study medication administration and before second dose
To characterize the pharmacokinetic profile of two different doses of Combogesic® 325 (Cmax- Maximum measured plasma concentration)
This will be defined from the plasma concentration versus time data using non-compartmental methods
Time frame: Approximately 15 minutes before first dose of study medication until 6 hours after first study medication administration and before second dose
To characterize the pharmacokinetic profile of two different doses of Combogesic® 325 (Tmax- Time to maximum measured plasma concentration)
This will be defined from the plasma concentration versus time data using non-compartmental methods
Time frame: Approximately 15 minutes before first dose of study medication until 6 hours after first study medication administration and before second dose
To characterize the pharmacokinetic profile of two different doses of Combogesic® 325 (AUC(0-t) - The area under the plasma concentration versus time curve from time zero to the last measurable concentration)
This will be defined from the plasma concentration versus time data using non-compartmental methods
Time frame: Approximately 15 minutes before first dose of study medication until 6 hours after first study medication administration and before second dose
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