On the whole the concurrent use of
NSAIDs with
paracetamol is beneficial and without serious adverse effects. However, one epidemiological study found that
paracetamol alone, and particularly when combined with NSAIDs, was associated with an increased risk of
gastrointestinal bleeding, but other studies have not found such an effect. Diflunisal raises
paracetamol levels by 50% but does not alter the total bioavailability.
The interaction with
diflunisal has not been shown to be clinically significant but the manufacturers advise caution because of the risks of increased
paracetamol levels. There is no evidence to suggest that the concurrent use of
paracetamol and any
NSAID should be avoided.