Ibuprofen interactions to avoid

Drug interactions | Food interactions | Other interactions | Avoiding interactions | When to see a doctor

Ibuprofen is an over-the-counter (OTC) medication commonly used to relieve pain, reduce inflammation, and lower fever. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that decreases the production of prostaglandins, which cause inflammation. Ibuprofen is available under different brands and in other forms. Ibuprofen is typically used to treat various conditions like headaches, dental pain, menstrual cramps, arthritis, and muscle aches. 

While the use of ibuprofen has several benefits, it does come with several precautions, especially regarding side effects and drug interactions. Combining ibuprofen with certain medications may increase the risk of adverse effects, some of which can be serious. It’s recommended to consult a healthcare provider about other prescribed medications before trying ibuprofen.

Keep reading to learn more about ibuprofen interactions and how to prevent them. 

Ibuprofen drug interactions

Like most medications, ibuprofen can have serious interactions with various medications. Here are some of the most common ones that can interact with ibuprofen. 

Blood-thinning medications

Blood thinners, such as anticoagulants and antiplatelet drugs, are prescribed to prevent blood clots and reduce the risk of heart attacks and strokes. Ibuprofen can affect the way platelets work and increase the effects of blood thinners. Taking ibuprofen with blood thinners may increase the risk of bleeding, especially in the stomach and intestines. Common blood thinners include:

• Coumadin (warfarin)
• Plavix (clopidogrel)
• High- and low-dose aspirin 

Certain antidepressants

Some antidepressants, particularly SSRIs, can interact with ibuprofen, increasing the risk of bleeding. If you’re taking an SSRI, a healthcare provider may recommend alternative pain relief options. Examples of SSRIs that may increase the risk of bleeding with ibuprofen include:

• Prozac (fluoxetine)
• Zoloft (sertraline)
• Citalopram (Celexa)

Other NSAIDs

Combining ibuprofen with other NSAIDs can increase the risk of side effects, such as stomach ulcers, bleeding, and kidney problems. Multiple NSAIDs can amplify each other’s effects on the stomach lining and kidneys. Therefore, it’s recommended to avoid taking multiple NSAIDs at the same time. Other common NSAIDs include:

• Aleve (naproxen)
• Voltaren (diclofenac)
• Celebrex (celecoxib)

Blood pressure medications

Ibuprofen can interfere with the effectiveness of various blood pressure medications, including ACE inhibitors, ARBs (angiotensin II receptor blockers), and beta blockers. In other words, ibuprofen may reduce the blood pressure-lowering effects of these medications. In addition, combining ibuprofen with ACE inhibitors or ARBs may also increase the risk of kidney damage. Examples of blood pressure medications include:

• Zestril (lisinopril)
• Vasotec (enalapril)
• Cozaar (losartan)
• Tenormin (atenolol)
• Lopressor (metoprolol)

Lanoxin (digoxin)

The blood levels of digoxin, a medication used to treat heart conditions like atrial fibrillation and heart failure, may be increased when taking ibuprofen. This interaction may increase the side effects of digoxin.

Eskalith (lithium)

Lithium, a mood stabilizer for conditions like bipolar disorder, can interact with ibuprofen, leading to increased lithium levels in the blood. As a result, there may be a risk of lithium toxicity while taking ibuprofen and lithium. If you’re taking these two drugs together, you may need regular blood tests to monitor lithium levels.

Rheumatrex (methotrexate)

Ibuprofen can reduce the clearance of methotrexate, a drug often prescribed for certain cancers and autoimmune diseases like rheumatoid arthritis. As a result, taking these medications together may lead to higher levels of methotrexate in the blood. Using these medications together may require monitoring for methotrexate toxicity.

Sandimmune (cyclosporine)

Cyclosporine is an immunosuppressant commonly used in organ transplant patients. Taking it with ibuprofen may increase the risk of toxic effects on the kidneys. As a result, the interaction may lead to added strain on the kidneys and a higher risk of kidney damage.

This may not be a complete list of drugs that can interact with ibuprofen. Consult a healthcare provider for more information about potential drug interactions. 

Ibuprofen food interactions

It is generally safe to take ibuprofen with or without food. Taking ibuprofen on an empty stomach may lead to faster absorption and quicker pain relief. However, some people experience stomach discomfort or irritation while taking ibuprofen without food. Therefore, taking ibuprofen with food or a glass of milk may be recommended to reduce the risk of stomach irritation.

Ibuprofen and alcohol

It’s recommended to avoid taking ibuprofen and alcohol together. Drinking alcohol, especially in large amounts over time, can increase the risk of stomach bleeding and liver problems. Because ibuprofen can have similar effects, combining ibuprofen and alcohol may have the potential to irritate the stomach lining. Avoid the daily use of alcohol in combination with ibuprofen. 

Other ibuprofen interactions

Ibuprofen does not only interact with certain prescription medications but also some herbal supplements. Combining ibuprofen with certain herbal supplements that have blood-thinning effects could increase the risk of bleeding. These herbal supplements may include: 

• Ginger
• Garlic
• Ginkgo biloba
• Turmeric
• Ginseng
• Dong Quai
• Feverfew
• Bromelain
• Cinnamon

If you’re taking herbal supplements and are considering the use of ibuprofen, you may want to consult a healthcare provider first. This is not a complete list of herbal supplements that can thin the blood. 

Other considerations

Other precautions may be needed in people with certain health conditions. Consider the following before taking ibuprofen:

• Hypersensitivity: Ibuprofen should be avoided in people with known allergies to ibuprofen or other NSAIDs.
• High blood pressure: Ibuprofen may increase blood pressure and affect the blood pressure-lowering effects of medications. People with hypertension may need to use ibuprofen with caution.
• Heart failure: People with heart failure should use ibuprofen with caution, as it may worsen their condition. That’s because ibuprofen may increase fluid retention in some people. 
• Liver toxicity: Long-term or excessive use of ibuprofen may lead to liver damage. Watch for signs or symptoms of liver toxicity, such as jaundice, abdominal pain, and dark urine. Consult a healthcare provider if these symptoms occur.
• Kidney toxicity: Ibuprofen may negatively affect kidney function. Monitoring for kidney issues is recommended, especially for individuals with pre-existing kidney conditions.
• Asthma: Those with asthma should be aware that NSAIDs like ibuprofen may trigger asthma attacks in sensitive individuals.
• Pregnancy: Ibuprofen is generally not recommended during pregnancy, especially around 20 weeks or later, due to potential risks to the unborn baby.
• Anemia: Ibuprofen can sometimes lower hemoglobin or hematocrit levels in your blood. These are important components that help carry oxygen. A decrease in these levels may worsen anemia, a condition in which an individual doesn’t have enough red blood cells.

With these precautions in mind, you could help prevent serious side effects and ensure ibuprofen is used safely.

How to minimize ibuprofen interactions

Drug interactions with ibuprofen are generally avoidable, especially with the right knowledge and awareness. Before deciding to take ibuprofen, you can take several steps to reduce the risk of drug interactions.

• Take the lowest effective dose: Starting with the lowest dose that provides relief may help decrease the risk of side effects from interactions. It’s typically recommended to use ibuprofen at the lowest effective dose for the shortest possible duration.
• Keep a regular schedule: Taking ibuprofen as directed by the label or a healthcare provider can help ensure the drug is taken effectively and safely. If the dosage is once every four to six hours, don’t take another dose sooner than recommended. 
• Read labels on nonprescription products: Check the labels of OTC cold and pain medications. Many products contain ibuprofen and other NSAIDs as added ingredients. Therefore, you’ll want to avoid taking medications with overlapping ingredients that can increase the risk of an interaction.
• Be alert for any unusual symptoms: Watch for any unusual symptoms of an interaction, such as dizziness, bleeding or bruising more easily, or severe headaches. 

• Consult a healthcare provider: Before starting ibuprofen, especially when taking other medications, you may want to consult a healthcare provider. They can recommend any necessary changes to current medications.
• Keep a medication list: A detailed list of all medications, including dosages and frequencies, can help your healthcare provider review and manage potential interactions.

By taking proactive steps and closely monitoring your health, you can often reduce the risk of drug interactions with ibuprofen. 

When to talk to a healthcare provider about ibuprofen interactions

While ibuprofen can be a helpful and effective medication, knowing when to consult a healthcare provider may be beneficial. Here are some general situations where you should speak with a healthcare provider before taking ibuprofen. 

• You take other medications: If you’re taking other drugs, including OTC products and prescription medications, you can review potential interactions with a doctor or pharmacist to prevent an interaction.
• You take supplements: Using supplements or herbal products with ibuprofen could increase the risk of side effects. If you regularly take supplements, discuss them with your healthcare provider. 
• You have pre-existing Conditions: Those with conditions involving the liver or kidneys may need to consult a healthcare provider before taking ibuprofen. In addition, individuals with a personal or family history of heart disease should consult their healthcare provider before taking ibuprofen or other NSAIDs.

This overview is not exhaustive. Different factors can affect the severity and risk of a drug interaction with ibuprofen. Always consult a healthcare provider before taking ibuprofen if you take other medications. Seek medical attention if you experience serious side effects that develop or worsen.