11 Ibuprofen Interactions You Should Know About

Ibuprofen (Advil, Motrin) is a nonsteroidal anti-inflammatory drug (NSAID). It’s often a go-to medication to treat pain, fever, and inflammation (swelling). It’s available both over the counter (OTC) and with a prescription in tablet, capsule, and liquid forms.

Before taking ibuprofen, you may want to discuss potential interactions with your healthcare team. Ibuprofen interactions can cause symptoms such as bleeding, stomach ulcers, and high blood pressure.

Here, we’ll discuss what you should know about ibuprofen interactions.

Ibuprofen (Advil, Motrin) interactions at a glance

Regardless of whether you get ibuprofen OTC or with a prescription, it’s important to check for possible interactions. OTC ibuprofen carries the same risks as prescription ibuprofen since it has the same active ingredient. But the likelihood of side effects can depend on what dosage of ibuprofen you take.

While this isn’t a complete list, the following medications and substances can interact with ibuprofen:

• Angiotensin-converting enzyme (ACE) inhibitors, such as ramipril (Altace)

• Angiotensin II receptor blockers (ARBs), such as losartan (Cozaar)

• Aspirin

• Blood thinners, such as rivaroxaban (Xarelto)

• Other NSAIDs, such as celecoxib (Celebrex)

• Diuretics (water pills), such as hydrochlorothiazide (Microzide)

• Selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft)

• Bisphosphonates, such as alendronate (Fosamax)

• Lithium (Lithobid)

• Methotrexate (Trexall, Xatmep)

• Cyclosporine (Sandimmune)

• Alcohol

Here we'll dive deeper into 11 ibuprofen interactions and how to manage them.

1. Other NSAIDs

All NSAIDs work similarly, so they have similar risks and side effects. For this reason, combining different NSAIDs isn’t recommended. Taking ibuprofen and another NSAID could raise your risk of serious side effects such as bleeding, kidney problems, and ulcers. 

Other common NSAIDs include:

• Celecoxib

• Diclofenac (Cambia)

• Ketorolac

• Meloxicam

• Naproxen (Aleve, Naprosyn)

Talk to your healthcare professional about your treatment options. They’ll help you choose the best NSAID based on your specific situation.

Keep in mind: OTC products such as cold medicines and menstrual cramp relief medications often include NSAIDs. Be sure to check the list of ingredients on OTC products before taking them with ibuprofen.

2. 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. The bleeding could be mild, such as bleeding gums after you brush your teeth. Or it could be serious, such as bleeding in your brain.

There are several blood thinner medications that can interact with ibuprofen. This includes anticoagulants, such as warfarin (Jantoven), apixaban (Eliquis), and rivaroxaban, and antiplatelet medications, such as clopidogrel (Plavix) and ticagrelor (Brilinta).

It’s best to avoid combining ibuprofen with these blood thinners. If you’re taking one already, your healthcare professional may recommend a different pain medication, such as acetaminophen (Tylenol).

3. Aspirin

Aspirin is an OTC NSAID that works similarly to ibuprofen to treat mild pain and fever. Combining aspirin with ibuprofen is generally not recommended. It can raise the risk of serious bleeding and stomach ulcers. These side effects are possible with either medication on its own. But taking them together makes it more likely for these effects to occur.

At a low dosage (81 mg per day), aspirin works as a blood thinner to prevent heart attack or stroke in people who are at risk. Ibuprofen temporarily attaches to the same spot on platelets that aspirin targets. If you take the medications too close together, ibuprofen can get in the way and prevent aspirin from working as well. Experts recommend taking low-dose aspirin at least 2 hours before ibuprofen to avoid this interaction. Keep in mind this strategy only works if you take ibuprofen occasionally.

If you’re trying to choose between aspirin and ibuprofen, speak with your healthcare team. They can tell you which one might be better and safer based on your symptoms and medical history.

4. ACE inhibitors and ARBs

ACE inhibitors and 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. Examples of ARBs include losartan and irbesartan (Avapro).

Ibuprofen can make it harder for ACE inhibitors and ARBs to lower blood pressure. In some cases, this can lead to high blood pressure that’s life-threatening. Combining ibuprofen with ACE inhibitors or ARBs can also increase the risk of kidney problems.

If you take an ACE inhibitor or ARB, talk to your healthcare team before taking ibuprofen. They will likely suggest a different pain reliever. If they do say it’s OK to take ibuprofen, they may want to keep a closer eye on your kidney function and ask you to check your blood pressure more often.

5. Diuretics (water pills)

Diuretics, or water pills, are medications that help remove extra fluid from the body. They can also be prescribed to help lower blood pressure. Common examples include hydrochlorothiazide, furosemide (Lasix), and spironolactone (Aldactone).

Ibuprofen can make it more difficult for diuretics to remove extra fluid from your body. This interaction can also raise your risk of kidney damage. If you need to take ibuprofen for a certain health condition, your healthcare professional may say it’s OK. But they may want to check your kidney function more often. If ibuprofen isn’t necessary, your healthcare professional will likely recommend an alternative pain reliever.

6. SSRI antidepressants

SSRIs are commonly used to treat anxiety, depression, and other mental health conditions. Examples include escitalopram (Lexapro) and sertraline.

Both ibuprofen and SSRIs can raise your risk of bleeding. Taking these medications together can increase your risk of bleeding — especially bleeding in the gastrointestinal (GI) tract  —  even more. Taking ibuprofen occasionally may be OK for some people taking an SSRI. But regular use or high dosages of ibuprofen are generally not recommended with an SSRI.

If you’re taking an SSRI, check with your healthcare team before taking ibuprofen. They can determine whether this combination is safe for you. If you have a history of GI problems, they may recommend another option for pain relief.

7. Bisphosphonates

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

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

You may be able to take ibuprofen for short periods of time if you’re taking a bisphosphonate. Your healthcare professional can determine whether the potential benefits are worth the risks. If you have a higher risk of ulcers or stomach bleeding, they may ask you to avoid ibuprofen.

If your healthcare professional says it’s OK to take ibuprofen, you’ll need to make sure you don’t take the medications too close together. Take your bisphosphonate right when you wake up. Then, wait 30 to 60 minutes before taking ibuprofen (and any other medications) or eating food.

8. Lithium

Lithium 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 can include:

• Confusion

• Tremors (shaking)

• Nausea and vomiting

• Diarrhea

• Fatigue

• Fast heart rate

• Slurred speech

• Blurry vision

Severe lithium toxicity can cause potentially life-threatening side effects. These can include seizures, trouble breathing, and heart rhythm problems.

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

9. Methotrexate

Methotrexate can treat conditions such as rheumatoid arthritis and some forms of cancer. Ibuprofen can cause methotrexate levels to build up in your body. High levels can lead to methotrexate toxicity, which may cause serious damage to your liver, kidneys, and bone marrow.

If you’re taking methotrexate, it’s best to avoid taking ibuprofen, especially at high dosages or for a long time. Your healthcare professional may suggest using a different pain medication. If ibuprofen is needed to treat a health condition, your prescriber will monitor you for signs of methotrexate toxicity.

10. Cyclosporine

Cyclosporine is a medication that lowers immune system activity. The oral form can be used to help prevent rejection after an organ transplant.

Both cyclosporine and ibuprofen can cause kidney damage. So taking them together can increase the risk of kidney problems.

It’s best to avoid this combination if possible. If you need to take cyclosporine and ibuprofen, your healthcare professional will likely check your cyclosporine levels more often. They’ll also likely recommend taking the lowest ibuprofen dosage possible and staying well hydrated to lower the risk of kidney damage.

11. Alcohol

It's best to limit or avoid alcohol while taking ibuprofen. Both alcohol and ibuprofen can irritate the stomach and intestines. Combining them raises the risk of stomach ulcers and bleeding, especially if you drink heavily or take ibuprofen regularly.

Also, alcohol can also contribute to dehydration. And taking ibuprofen while you're dehydrated may increase the risk of kidney damage.

If you plan to drink alcohol while taking ibuprofen, talk to your healthcare professional about how much, if any, is OK for you 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 or take an ibuprofen alternative.

When should you contact your healthcare team about an ibuprofen interaction?

If you're concerned about ibuprofen interactions, check with your healthcare professional or pharmacist. Be sure to share an up-to-date medication list to help them manage potential interactions ahead of time. Include any prescription medications, OTC products, and supplements that you take.

Talk to your healthcare team if you’re having symptoms of an ibuprofen interaction, such as bleeding, stomach pain, or high blood pressure. They can help you manage interactions safely. Seek emergency care right away if you’re experiencing any side effects that feel life-threatening, such as trouble breathing or changes in heart rhythm.

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Written by:

Sheila McAdoo, PharmD

Sheila McAdoo, PharmD, is a licensed pharmacist in Virginia and New York. She has worked in the pharmacy industry for 14 years.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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