How soon after taking prednisone can I take ibuprofen?

In this article:

• Prednisone and ibuprofen
• Timing
• What to do if you’ve taken both
• Safer ibuprofen alternatives
• The bottom line

In this article

• Prednisone and ibuprofen
• Timing
• What to do if you’ve taken both
• Safer ibuprofen alternatives
• The bottom line

Prednisone is a corticosteroid that helps manage allergic reactions, immune system disorders, inflammatory conditions, and hormonal issues. This prescription drug is converted to prednisolone in the body by liver enzymes and works by suppressing an overactive immune system and lowering inflammation. It is also sometimes prescribed as a replacement hormone for individuals with low cortisol levels, a hormone naturally produced by the adrenal glands. 

Ibuprofen, sold under the brand names Advil and Motrin, belongs to a class of medications known as nonsteroidal anti-inflammatory drugs (NSAIDs), which block the production of prostaglandins, thereby lowering pain and inflammation. They also treat fever. If you take prednisone, especially for chronic or long-term conditions, you might wonder whether it’s safe to reach for ibuprofen when pain flares up.

The answer isn’t always simple. Just because ibuprofen is an over-the-counter (OTC) drug doesn’t mean it’s risk-free. While both medications reduce inflammation, taking them too close together can raise your chances of developing stomach bleeding, irritation, ulcers, or other side effects. It’s safest to talk to your healthcare provider before combining the two, but if they allow you to take both, wait a few hours between doses.

Can I take ibuprofen with prednisone?

“Mixing prednisone and ibuprofen isn’t automatically unsafe, but it does increase the risk of certain side effects,” says John Abroon, MD, a board-certified internist based in New York, New York. It’s always safest to combine them only under the guidance of a healthcare provider.

Ibuprofen and prednisone both work to lower inflammation. Because both medications lower inflammation, they are commonly used to treat conditions characterized by chronic musculoskeletal pain and inflammation, such as lupus (an autoimmune condition) and rheumatoid arthritis. While there is no strict warning against taking both together, “you must do so with great caution because of the interaction and complementary effects they have,” says David Cutler, MD, a board-certified family medicine provider at Providence Saint John’s Health Center in Santa Monica.

“Ibuprofen acts quite quickly, reducing pain and fever in less than an hour. After 2 hours, half of the drug has been metabolized, and after 8 hours, there is little residual effect,” Dr. Cutler explains. “Prednisone, on the other hand, may take hours to take effect, and these effects can last for a day or more.” These interactions, plus their effects on the body, require special attention when taking these drugs together.

Ibuprofen and prednisone together can cause potential side effects in the following ways.

• Gastrointestinal bleeding and ulcer: Taking ibuprofen and prednisone together can cause an increased risk of severe gastrointestinal toxicity that can cause peptic ulcers or bleeding in your upper gastrointestinal tract. Evidence suggests almost a fourfold increase in peptic ulcer risk when corticosteroids are used with NSAIDs. These gastrointestinal issues may present with symptoms like abdominal cramps, black tarry stool, and blood in the vomit or stool. 
• Kidney effects: According to Dr. Cutler, both medications can reduce kidney function, particularly in older adults, individuals with dehydration, and those who already have a pre-existing kidney condition. Combining them may impair kidney function. 
• Cardiovascular risks: Both ibuprofen and prednisone can cause adverse cardiovascular effects, such as atrial fibrillation—an abnormal heart rhythm that can increase the risk of blood clots and stroke—and combining both drugs may intensify these effects. 
• Fluid retention and elevated blood pressure: Dr. Cutler notes that prednisone can cause the body to retain salt and water, while NSAIDs, such as ibuprofen, can also lead to fluid retention and elevated blood pressure. When you use both together, they may worsen swelling, high blood pressure, or heart failure in at-risk individuals.
• Immune and healing effects: Prednisone suppresses inflammation and the immune system; ibuprofen also affects inflammation. “While this isn’t a direct ‘dangerous’ interaction, using both may mask infection or injury symptoms, delaying diagnosis or recovery,” Dr. Cutler says, adding that ibuprofen does decrease pain and swelling from ankle sprains but has been shown to delay healing.
  

Other factors may exacerbate these adverse effects, including:

• The use of anticoagulants (blood thinners) or antiplatelet drugs
• The use of medications classified under selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs)
• Alcohol consumption 
• Smoking
• Older age
• Having pre-existing medical conditions like heart issues, liver or kidney problems, or gastrointestinal conditions

How long should I wait after taking prednisone to take ibuprofen?

If your healthcare provider says it’s okay to take both, taking prednisone and ibuprofen with food and spacing the doses several hours apart can help minimize irritation and some other adverse effects, Dr. Abroon explains. The timing between doses wouldn’t be the same for everyone. “A healthcare provider would look at the dose of prednisone being taken, how long the course is, and th​​e person’s general health,” he says.

If you have a history of certain medical conditions, such as stomach ulcers, reflux, high blood pressure, heart conditions, or kidney issues, you will likely need a longer gap between medicines or an alternative pain relief option entirely, such as acetaminophen. Your provider may also ask about other medicines you are taking that can further raise the risks. In other words, the period of time to wait between the two medications is personalized rather than a one-size-fits-all rule.

It is essential that you take these medications under the guidance of your healthcare provider. Dr. Cutler advises that you should never take either drug with alcohol or with other medicines that may cause stomach irritation. If you notice any signs of intestinal irritation or bleeding, stop taking the medication and contact your healthcare provider immediately.

What to do if you’ve taken both

If you have already taken both medications, do not panic. It doesn’t necessarily mean you are in immediate danger. However, monitoring for warning signs of adverse effects is essential.

Dr. Abroon notes that certain symptoms can indicate internal irritation or stomach bleeding and should prompt immediate medical advice, including:

• Stomach pain
• Nausea
• Black stools
• Swelling
• Easy bruising
  

If you have taken both drugs without checking with your healthcare provider first, call them for medical advice. Be sure to mention any pre-existing medical conditions, like gastrointestinal issues or kidney and heart conditions.

Safer alternatives to ibuprofen while on prednisone

If you are on prednisone, you may occasionally need a medication for fast pain relief to manage common things, like a headache. There are other options with a lower risk of interacting with prednisone to consider, such as:

• Other analgesics and antipyretics: Drugs like Tylenol (acetaminophen) act to relieve pain (analgesic) and fever (antipyretic). However, unlike NSAIDs, it does not target inflammation. 
• Opioids: They block pain signals between the body and the brain. Examples of opioids include oxycodone and Percocet (oxycodone and acetaminophen). They have no known interaction with prednisone. However, they are potent pain relievers that should be taken only when prescribed by your healthcare provider. Opioids are typically only prescribed for moderate to severe pain that cannot be controlled with other medicines, and doctors generally prescribe them at the lowest effective dose for the shortest period of time.
• Physical therapy: Physical therapy, like exercise and massage, can help condition muscles, relieve stress, and manage pain. Exercise may involve simple, everyday activities, such as walking, dancing, and swimming.
• Mindfulness-based approaches: Practices like meditation, combined with deep breathing, can help minimize stressful thoughts, redirect your attention away from pain, and be relaxing. 
• Other alternative and complementary therapies: Alternative therapies, such as yoga, the use of supplements, and acupuncture, may be helpful in some cases. Acupuncture practitioners believe that stimulating specific points in the body can help manage some pain conditions.
  

Be sure to discuss every alternative option with your healthcare provider, as not all the options will be ideal for you.

The bottom line

Prednisone and ibuprofen can be taken together—only if approved by your healthcare provider—but there is a significant risk of adverse effects for some people. Both medications can interact and increase the risk of stomach irritation, gastrointestinal bleeding, and ulcers, as well as other effects related to the kidneys and cardiovascular system.

It may be safer to wait some hours after taking prednisone before you take ibuprofen. However, your healthcare provider will ultimately advise you on whether you should take both medications together. However, your healthcare provider will ultimately advise you on whether you should take both medications together, how long you should wait in between doses, and how long to continue treatment.