The short answer
- Endone (oxycodone) + Nurofen: generally fine together, and commonly prescribed that way for short-term pain.
- Panadeine Forte or co-codamol + Nurofen: usually fine, because they contain paracetamol and codeine but no ibuprofen. Just don’t add Panadol on top.
- Nurofen Plus already contains ibuprofen and codeine. Don’t add more ibuprofen or another codeine product.
Why opioids and ibuprofen are prescribed together
Opioids such as oxycodone (Endone, OxyNorm), codeine and tramadol act on opioid receptors in the brain and spinal cord. Ibuprofen reduces inflammation and prostaglandins where the injury is. Combining them, usually with regular paracetamol too, gives better pain control than any one medicine alone, and lets doctors keep the opioid dose and duration as low as possible. This “multimodal” approach is standard after surgery, fractures and dental procedures. The basics of each painkiller are in the pain relief guide.
There is no direct chemical interaction between oxycodone or codeine and ibuprofen. Each keeps its own dosing schedule.
What is in your painkiller?
| Product |
Contains |
Add Nurofen? |
Add Panadol? |
| Endone (AU), OxyNorm |
Oxycodone 5 mg (immediate release) |
Usually yes |
Usually yes |
| Targin, OxyContin |
Modified-release oxycodone (Targin with naloxone) |
Usually yes |
Usually yes |
| Panadeine Forte (AU, prescription) |
Paracetamol 500 mg + codeine 30 mg |
Usually yes |
No |
| Co-codamol 8/500 (UK pharmacy), 15/500, 30/500 |
Paracetamol 500 mg + codeine |
Usually yes |
No |
| Nurofen Plus (UK pharmacy) |
Ibuprofen 200 mg + codeine 12.8 mg |
No |
Yes |
| Tramadol (Tramal, Zydol) |
Tramadol |
Usually yes |
Usually yes |
| Tapentadol (Palexia) |
Tapentadol |
Usually yes |
Usually yes |
In Australia, all codeine-containing medicines have been prescription-only since 1 February 2018; in the UK, low-strength codeine combinations are sold only in pharmacies, in packs limited to 3 days’ treatment.
How to take them together safely
- Follow the prescription label for the opioid: dose, interval and how many days. Opioids for acute pain are usually needed for only a few days.
- Take ibuprofen with food at the usual dose (200–400 mg every 6–8 hours, maximum 1,200 mg a day over the counter, or as prescribed).
- Keep paracetamol regular if prescribed, counting any paracetamol inside combination products.
- Taper the opioid first: as pain eases, drop the opioid and keep paracetamol and ibuprofen for a few more days.
- Prevent constipation: drink fluids and consider a laxative (senna or macrogol) from the start.
- No alcohol, sleeping tablets, benzodiazepines or gabapentinoids unless your prescriber has planned for it. They add to drowsiness and can slow breathing; see tramadol and gabapentin.
- Don’t drive until you know how the opioid affects you.
Who needs extra care?
Ibuprofen isn’t suitable for people with stomach ulcers, kidney disease, heart failure, uncontrolled blood pressure, those on blood thinners, or in pregnancy (see who shouldn’t take Nurofen). After spinal fusion and some bone surgery, surgeons may restrict it.
Codeine is converted to morphine by the liver enzyme CYP2D6. People who are “ultra-rapid metabolisers” can get dangerously high morphine levels from normal doses, while poor metabolisers get little effect. Codeine must not be given to children under 12, and should be avoided while breastfeeding.
Oxycodone and other opioids need care in older people, people with sleep apnoea, lung disease, kidney or liver problems, and anyone with a history of substance use.
Call an ambulance if someone taking opioids is very hard to wake, has slow or shallow breathing, blue lips or pinpoint pupils. Naloxone (Nyxoid, Prenoxad, Narcan) reverses opioid overdose; in Australia it is available free from pharmacies without a prescription under the Take Home Naloxone program.
Frequently asked questions
Can I take Endone and an anti-inflammatory at the same time?
Yes, they can be taken at the same time; there is no need to space them. Take the anti-inflammatory with food and stay within both medicines’ prescribed limits.
Can I take ibuprofen with Panadeine Forte?
Usually yes. Panadeine Forte contains paracetamol and codeine, not ibuprofen. Don’t take Panadol or other paracetamol products with it.
Can I take co-codamol and Nurofen together?
Yes, standard Nurofen can be added to co-codamol for most adults. Don’t combine co-codamol with Nurofen Plus, because that would double the codeine.
Can I take Nurofen with tramadol?
Yes, there is no direct interaction, and they are often prescribed together. Tramadol has its own cautions (seizures, serotonin interactions with antidepressants), so follow the prescription.
Sources and further reading
CanforaMedicine Guide
