Is it safe to take tramadol and ibuprofen together?

In this article:

• Tramadol and ibuprofen
• Potential risks
• When might a doctor prescribe both
• Usage instructions
• Alternatives
• The bottom line

In this article

• Tramadol and ibuprofen
• Potential risks
• When might a doctor prescribe both
• Usage instructions
• Alternatives
• The bottom line

Tramadol is a prescription opioid pain medication that acts on the central nervous system, altering how the body feels and responds to pain. It is typically prescribed to relieve severe short-term or persistent pain. 

Ibuprofen (also known as Advil and Motrin), on the other hand, is an analgesic typically used to manage mild to moderate pain. It belongs to a class of medication called non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs reduce pain, fever, and swelling by blocking certain enzymes in the body that help produce chemicals responsible for inflammation and fever.

Sometimes, healthcare providers prescribe both medications to be taken together, depending on the type and cause of pain and other factors like a person’s medical history. Only take tramadol and ibuprofen together if a healthcare professional specifically prescribes the combination.

Save up to 80% on Tramadol with SingleCare

Different pharmacies offer different prices for the same medication. SingleCare helps find the best price for you.

Tramadol 50 mg (30 Tablets)

23663 - Hampton, VA

$9.91

i Price with signup

Get free coupon

$11.40

i Price with signup

Get free coupon

See Tramadol prices at all pharmacies

Can you mix tramadol and ibuprofen?

“Ibuprofen, an over-the-counter medication, and tramadol can often be taken together safely. However, what is safe or recommended depends on the individual,” says Jeffrey H. Chester, DO, medical director of the Ohana Luxury Addiction Treatment Center, in Kona, Hawaii. 

Ibuprofen and tramadol work through different mechanisms. Tramadol acts on opioid receptors. Tramadol helps relieve pain by increasing the levels of certain brain chemicals—serotonin and norepinephrine—that help block pain signals. Ibuprofen inhibits prostaglandins, reducing inflammation. They’re sometimes used together because they target pain differently, Dr. Chester says.

While both medications are generally considered safe to use together, there are some important considerations.

According to Dr. Chester, your healthcare provider may consider the following before recommending a tramadol and ibuprofen therapy for you:

• Your kidney function, especially if you have diabetes
• If you have a history of gastrointestinal bleeding
• Whether you have a personal or family history of substance use disorder, as there is a risk of dependence and a potential for misuse with opioid medication 

Providers also consider age and other medications you are taking before prescribing any of these two, adds James J. Chao, MD, a board-certified healthcare provider and Chief Medical Officer at VedaNu Wellness in San Diego, California.

Dr. Chao explains that, for instance, if you take blood thinners, SSRIs, SNRIs, or any medication that affects serotonin levels, you should be watched more closely, as tramadol can cause serotonin syndrome in rare circumstances. Ibuprofen can decrease the effectiveness of certain blood pressure medications. It can also harm your kidneys when given with ACE inhibitors or water pills (diuretics). 

“Simply put, patients should not automatically assume that because these two medications are frequently prescribed, it is safe for them to take,” Dr. Chao says. 

These are not all of the considerations. You should speak with your healthcare provider for personalized medical advice. 

Risks of combining tramadol and ibuprofen

“While there isn’t a direct drug interaction between these medications, there is a concern for additive side effects,” says Dr. Chao.

• This means you may experience more side effects, or an amplification of each medication’s side effects, when you take both together.
• ​​Tramadol is known to cause dizziness, nausea, constipation, and sedation, while ibuprofen can cause irritation of the GI tract, risk of bleeding, and kidney injury. When taken together, you increase your chances of stomach upset or GI bleeding, especially if you are older than 60 or have a previous ulcer. 
• Another side effect of tramadol is seizure activity at high doses. If stomach symptoms cause dehydration, it may also increase the risk of seizures (i.e., lower your seizure threshold).

When might a healthcare provider prescribe both

A healthcare provider may prescribe both medications if you have moderate pain caused by both inflammation and the way your brain and spinal cord process pain signals (i.e., central pain).

“For instance, after a 2-hour hand reconstructive surgery, there is an inflammatory component to your pain, but also nerve irritation causing central sensitization. I might prescribe ibuprofen to mitigate the inflammatory response and tramadol for central pain,” Dr. Chao explains. There are benefits to combining medications to help minimize opioid use. But, of course, your doctors would take your medical history into account before prescribing these medications.

How to safely manage pain when using both

Here are some strategies to help you safely combine tramadol and ibuprofen for pain relief.

Follow provider instructions

Ensure you follow the dosing guidelines carefully, including timing. Don’t take more than the daily recommended limits, and also don’t take the medications for longer than directed.

Avoid alcohol intake

It’s important you avoid drinking alcohol when taking these medications. Alcohol has a potential tramadol interaction risk, as its central nervous system effects can amplify those of tramadol. When taken together, you may experience increased sedation, drowsiness, and dizziness. Additionally, alcohol can increase the risk fo a gastrointestinal bleed with ibuprofen, and could damage the kidneys or the liver.

Be aware of potential side effects

It also helps to understand the side effects that may occur while on these drugs. This can help prevent anxiety as well as complications, as you will be better at identifying and reporting dangerous reactions. 

Pair with dietary and lifestyle approaches

Some dietary and lifestyle approaches can also help improve pain sensation, increase the tolerability of these medications, and generally improve quality of life. For instance, Dr. Chao advises staying well hydrated to help your kidneys process the NSAID, while Dr. Chester suggests taking your medication with food. “Taking ibuprofen with food may help reduce stomach irritation and gastrointestinal effects,” he says.

You may want to speak to your healthcare provider about the role of dietary and lifestyle approaches, such as:

• The Mediterranean diet, which is considered anti-inflammatory
• Behavioral sleep interventions
• Resistance training exercises
• Tai chi
• Supplements like glucosamine and curcumin 

Always consult with your provider

If something feels off while you are on these medications or you start experiencing symptoms that don’t go away within a couple of days, it’s important that you inform your healthcare provider.

According to Dr. Chao, symptoms like severe abdominal pain, black stools, confusion, or extreme sleepiness are significant reasons to seek medical attention. Also, “call your provider to discuss your pain if it is not controlled after taking your medications as directed,” he advises.  

Alternatives to combining tramadol and ibuprofen

Alternative therapies for managing pain will vary from person to person, depending on the cause or type of pain the person is experiencing and other factors like their state of mental health, medical history, and current medications. For mild pain, the common OTC pain reliever Tylenol (acetaminophen) often suffices.

As an alternative to tramadol and ibuprofen, your provider may consider the following:

• NSAIDs: “Sometimes, topical anti-inflammatories or oral NSAIDs can be helpful by themselves,” Dr. Chester says. NSAIDs like ibuprofen and naproxen particularly work well when you are experiencing pain accompanied by inflammation, for example, for people with arthritis and bursitis or during postoperative recovery. They are relatively affordable and often the first line of treatment for mild and moderate pain and inflammation.
• Corticosteroids (steroids): Similar to NSAIDs, corticosteroid medications like Deltasone (prednisone) and Decadron (dexamethasone) also relieve pain and inflammation; however, the two medication classes work differently. Corticosteroids mimic the action of the hormone cortisol and work by reducing the production of inflammatory chemicals and suppressing the immune system. Notably, these medications are associated with a higher risk of serious adverse effects, including depression, weight gain, mania, and increased blood sugar. 
• Anticonvulsants or antidepressants: For neuropathic pain (pain caused by nerve damage due to a medical condition or injury), these may be more appropriate. Common examples of medications in these classes that your healthcare provider may prescribe include Cymbalta (duloxetine), Neurontin (gabapentin), and Lyrica (pregabalin).
• Surgery: Sometimes, surgery to address the root cause of your pain may be a better treatment approach.
• Muscle relaxants: These medications lower muscle tension and can be used to manage musculoskeletal pain. Examples include Robaxin (methocarbamol), Zanaflex (tizanidine), and Flexeril (cyclobenzaprine).
• Non-pharmacological approaches: Non-pharmacological therapies are also up for consideration. They can include heat or ice therapy, acupuncture, and physical therapy, Dr. Chester says. There are also high-tech therapies now being researched and developed for relieving chronic pain, such as spinal cord stimulation, transcutaneous electrical nerve stimulation, and using radio waves to short-circuit pain signals (radiofrequency ablation).
  

“In many chronic pain cases, a multifactorial approach that combines medication, physical therapy, and behavioral strategies is more effective and safer long-term than opioid use,” Dr. Chester adds.

The bottom line

Tramadol may be combined to manage painful and inflammatory conditions. While this is generally safe for most people, it may not be ideal for everyone. They should only be taken together under the supervision of your prescribing provider.