10 Ibuprofen Interactions You Should Know About

Ibuprofen (Advil, Motrin) is often a go-to medication to ease aches and pains for many people. This may be because it’s available both over the counter (OTC) and with a prescription. It’s also rated as one of the most popular OTC pain relievers.

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). It can treat pain, fever, and inflammation (swelling). It’s available OTC in tablet, capsule, and liquid forms.

But before taking ibuprofen, you may want to discuss the possibility of interactions with your healthcare provider. Ibuprofen interactions can cause symptoms like bleeding, stomach ulcers, and increased blood pressure.

So what are some common ibuprofen interactions to be aware of? We’ll discuss a few you should know — and how to handle them — below.

1. Blood thinners

Ibuprofen has mild blood-thinning effects. So, when you combine it with other medications that thin your blood, there is a higher chance of bleeding. This could be mild, like gum bleeding after brushing your teeth. Or it could be serious, like bleeding in your brain.

There are several blood thinners that can interact with ibuprofen. These include anticoagulants, such as warfarin (Coumadin, Jantoven), apixaban (Eliquis), and rivaroxaban (Xarelto). Other blood thinners include antiplatelet medications, like clopidogrel (Plavix) and ticagrelor (Brilinta).

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It’s best to avoid this interaction. If you’re taking blood thinners, your healthcare provider may recommend a different pain medication, like acetaminophen (Tylenol).

2. Aspirin

Aspirin is an OTC medication that can treat mild pain and fever. It’s commonly taken at low doses (81 mg per day) for heart protection because of its blood-thinning effects. Like ibuprofen, aspirin is also considered an NSAID.

Combining aspirin with ibuprofen can be dangerous. This can raise the risk of serious bleeding or stomach ulcers. These are both side effects of either medication alone. But taking them together makes it more likely for these effects to happen.

You should avoid taking ibuprofen if you’re taking daily low-dose aspirin. If you’re trying to choose between them, check with your healthcare provider. They can recommend which one might be better and safer based on your health conditions.

3. Other NSAIDs

More of something isn’t necessarily better. And that’s true when it comes to taking NSAIDs together. Because most NSAIDs work similarly, they have similar risks and side effects. Taking ibuprofen and another NSAID could raise your risk of serious bleeding, kidney problems, and ulcers. This combination should be avoided.

Other common NSAIDs include:

• Diclofenac (Cambia)

• Indomethacin

• Meloxicam (Mobic)

• Naproxen (Aleve, Naprosyn)

You should also keep an eye out for OTC combination products that include pain relievers. Cold medicines and menstrual cramp relief medications often include NSAIDs. Be sure to check the list of ingredients on OTC products before taking them.

4. ACE inhibitors and ARBs

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are two types of blood pressure medications that work in a similar way. They both treat high blood pressure and other heart conditions. Examples of ACE inhibitors include lisinopril (Zestril) and ramipril (Altace). Examples of ARBs include losartan (Cozaar) and irbesartan (Avapro).

Both ACE inhibitors and ARBs can interact with ibuprofen. Ibuprofen can make these medications less effective at lowering blood pressure. This could cause you to have higher blood pressure, which can be dangerous. Combining ibuprofen with ACE inhibitors or ARBs can also cause kidney problems.

In some cases, it may be OK to take ibuprofen with ACE inhibitors or ARBs. Always check with your healthcare provider first. They may do some extra monitoring of your kidneys or ask you to check your blood pressure more often.

5. Diuretics

Diuretics (“water pills”) are medications that help remove extra fluid from the body. They can also be prescribed to help lower blood pressure. There are lots of different types of diuretics. Common examples include hydrochlorothiazide (Microzide), furosemide (Lasix), and spironolactone (Aldactone).

Ibuprofen can interact with diuretics. Ibuprofen causes diuretics to be less effective at removing fluid from the body. This combination can also cause kidney damage.

You may need to use an ibuprofen alternative if you’re taking a diuretic. But if you need to take ibuprofen for a certain health condition, your healthcare provider may say it’s OK. In this case, they may check your kidney function more often. 

6. Bisphosphonates

Bisphosphonates help prevent bone loss. They’re most often used to treat osteoporosis. Examples of bisphosphonates include alendronate (Fosamax) and ibandronate (Boniva).

Bisphosphonates have a chance of causing ulcers in the stomach or esophagus. This is why you should remain sitting upright or standing for 30 to 60 minutes after a dose. Combining ibuprofen with bisphosphonates can raise the risk of stomach-related side effects.

You may be able to take ibuprofen for short periods of time if you’re taking bisphosphonates. Your healthcare provider can help determine your unique risks. If you have a higher risk of ulcers or stomach bleeding, they may ask you to avoid ibuprofen.

Even with a provider’s OK to take ibuprofen, you’d still need to separate the medications. Take bisphosphonates first thing upon waking. Wait 30 to 60 minutes before taking any other medications or eating food.

7. Lithium

Lithium (Lithobid) is commonly used to treat bipolar disorder. Combining lithium with ibuprofen can cause higher levels of lithium in the body. This can cause lithium toxicity. Symptoms of lithium toxicity include tremors, nausea, and confusion.

It’s best to avoid combining ibuprofen with lithium. If you’re taking lithium, your healthcare provider will likely suggest taking a different pain reliever.

8. Methotrexate

Methotrexate (Trexall) can treat conditions like rheumatoid arthritis and some forms of cancer. Ibuprofen interacts with methotrexate by causing higher methotrexate levels in the body. This is dangerous because methotrexate toxicity can damage many areas of the body. This includes the liver, kidneys, and bone marrow.

It’s best to avoid combining ibuprofen with methotrexate, especially at high doses or for a long time. Your healthcare provider may suggest using a different pain medication. If ibuprofen is necessary to treat a health condition, your provider will closely monitor you for signs of methotrexate toxicity.

9. Cyclosporine

Cyclosporine (Sandimmune) is a medication that lowers immune system activity. The oral form can be used to help prevent rejection after an organ transplant. It can also interact with ibuprofen.

Both cyclosporine and ibuprofen can cause kidney damage. Taking them together can raise the risk of kidney problems.

You should avoid this interaction if possible. If you need to take cyclosporine and ibuprofen, your healthcare provider will likely check your cyclosporine levels more often. They’ll likely also recommend taking the lowest ibuprofen dosage possible and staying well-hydrated.

10. Alcohol

Alcohol has many effects on the body. It can sometimes irritate the stomach and intestines. And when combined with ibuprofen or other NSAIDs, this risk is even higher. Ibuprofen is one of the medications you shouldn’t combine with alcohol. This interaction can lead to stomach bleeding or ulcers.

If you’re going to drink alcohol, talk to your healthcare provider about what may be a safe amount to drink. They might suggest that you stop taking ibuprofen for a while. Or if you have a higher risk of stomach bleeding or ulcers, they may ask you to avoid alcohol completely.

When should I contact my healthcare provider about an ibuprofen interaction?

If you're concerned about ibuprofen interactions, check with your healthcare provider or pharmacist. Provide them with a current medication list. Include all prescription medications, OTC products, and supplements. You may not need a medication change. But your healthcare provider can help you know how to handle any interactions safely.

Not all ibuprofen interactions are harmful. Some may just need extra monitoring. But some interactions can be serious, and you might need to change medications.

Talk to your healthcare provider if you’re having symptoms of an ibuprofen interaction. This may include bleeding, stomach pain, or higher blood pressure. 

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Written by:

Austin Ulrich, PharmD, BCACP

​​Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. Ulrich’s experience includes direct patient care in hospital and community pharmacies.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

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