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Ibuprofen contraindications & interactions

Only 12% of consumers are aware ibuprofen may interfere with the cardioprotective benefits of aspirin.1

Ask patients about aspirin heart therapy before recommending ibuprofen

  • Your patients may not realize that their choice of OTC pain reliever may have consequences, depending on their health conditions and other therapies, including aspirin heart therapy regimen. Your guidance can help.

  • Below is a list of potential drug interactions and contraindications to consider before recommending ibuprofen. It is not a substitute for the full OTC Drug Facts label. Patients should always read and follow the product label for additional product information.

1. Coexisting medical conditions to consider before recommending OTC ibuprofen

CARDIOVASCULAR RISKS

  • Patients with cardiovascular (CV) disease are at increased risk for cardiovascular events (myocardial infarction, stroke) when taking a non-aspirin NSAID such as ibuprofen or naproxen sodium2.

  • For patients on an aspirin heart therapy regimen, ibuprofen may interfere with the cardioprotective benefit of aspirin3.

Recent FDA NSAID label updates with respect to CV risks4:

  • For any patients taking a non-aspirin NSAID—including ibuprofen or naproxen sodium—the risk of heart attack, heart failure, and stroke increases.

  • Patients are now urged to ask their healthcare professional before using OTC NSAIDs if they have had a stroke in the past.

  • Patients are also encouraged to stop use and ask a healthcare professional if they have symptoms of heart problems or stroke, including chest pain, trouble breathing, weakness in one part or side of the body, slurred speech, or leg swelling.

  • Click here for a visual of the updated NSAID label.

GASTRITIS OR ULCERS

  • Patients over age 60 and patients with existing GI risks who take ibuprofen or any other NSAID are at higher risk of developing serious GI toxicities such as an ulcer or bleeding.

RENAL DYSFUNCTION

  • Patients with renal dysfunction who take ibuprofen or other NSAIDs may develop chronic kidney disease5. NSAID-related renal adverse events may be dependent on dose and duration of therapy, and can include reduced glomerular filtration, nephritic syndrome, and chronic renal failure6.

LIVER DISEASE OR LIVER CIRRHOSIS

  • Ibuprofen and all other NSAIDs are metabolized in the liver and can pose risks for individuals with hepatic problems7.

HYPERTENSION

  • NSAIDs, including ibuprofen, may be associated with modest increases in blood pressure. The adverse effect of NSAIDs on blood pressure may have the most clinical significance in the elderly, among whom the prevalence of arthritis, hypertension, and NSAID use is high8,9.

ASTHMA

  • In some adult patients with asthma, ibuprofen and other NSAIDs that inhibit cyclooxygenase-1 can exacerbate the condition10.

2. Concomitant medications and potential ibuprofen interactions

OTHER NSAIDS

  • More than 900 OTC and prescription medicines contain an NSAID. Taking OTC ibuprofen when there is frequent chronic use of other NSAIDs can increase the risk of serious side effects, including GI bleeding and cardiovascular problems2.

ANTICOAGULANTS/ANTIPLATELET MEDICATIONS

  • Co-administration of NSAIDs and anticoagulants can increase the risk of GI bleeding. Antiplatelet medications have GI bleeding risks, which may be compounded by the use of NSAIDs such as ibuprofen9,11.

CORTICOSTEROID USE

  • The chance of severe stomach bleeding is higher when corticosteroid drugs are used with NSAIDs, including ibuprofen. This may be due to steroids decreasing the production of protective gastric mucus and delayed healing of NSAID-induced erosions12,13.

ANTIHYPERTENSIVE AGENTS

  • Ibuprofen and other NSAIDs may be associated with modest increases in blood pressure. NSAIDs may blunt the effects of common classes of antihypertensive medicine, including diuretics.

3. Other considerations

DO NOT USE

  • If you have ever had an allergic reaction to any other pain reliever/fever reducer.

  • Right before or after heart surgery.

ALCOHOL USE

  • If patients consume three or more alcoholic drinks every day while taking ibuprofen or any other NSAIDs, the risk of GI bleeding increase.

IBUPROFEN INDICATIONS

  • Like other OTC pain relievers, ibuprofen temporarily relieves minor aches and pains due to headache, backache, the common cold, minor pain of arthritis, toothache, menstrual cramps, and muscular aches, and temporarily reduces fever.

Get downloadable patient counseling tools

TEACH · REMIND · REASSURE

Patient counsel on OTC pain relievers

TEACH

  • Your patients may not realize that certain OTC pain relievers can have health consequences, based on their health conditions and other medicines they take. They also may not know that ibuprofen is an NSAID.

REMIND

  • Check the active ingredients in all medicines they take, both prescription and OTC. Look for “NSAID” on labels.

  • Take ONLY 1 medicine that contains an NSAID at a time.

  • The OTC and prescription dosages of ibuprofen are different. A dose they were once prescribed may be different than the dose you are recommending now.

  • If they’re not sure which pain reliever to choose or how to use it, consult you or another healthcare professional first.

REASSURE

  • When taken as directed, ibuprofen can provide safe, effective pain relief.

  • Choosing an OTC pain reliever carefully—and using it as directed—is important to their health.

References: 1. Data on file. McNeil Consumer Healthcare, 2016. 2. Antman EM, Bennett JS, Daugherty A, Furberg C, Roberts H, Taubert KA. Use of nonsteroidal anti-inflammatory drugs: an update for clinicians: a scientific statement from the American Heart Association. Circulation. 2007;115(12):1634-1642. 3. Catella-Lawson F, Reilly MP, Kapoor SC, et al. Cyclooxygenase inhibitors and the antiplatelet effects of aspirin. N Engl J Med. 2001;345(25):1809-1817. 4. Food and Drug Administration. FDA strengthens warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or strokes. Safety Announcement. July 9, 2015. https://www.fda.gov/Drugs/DrugSafety/ucm451800.htm. Accessed May 31, 2017. 5. National Kidney Foundation. Pain medicines (analgesics). https://www.kidney.org/atoz/content/painmeds_analgesics. Accessed May 19, 2016. 6. Decloedt E, Maartens G. Drug-induced renal injury. CME. 2011;29(6):252-255. 7. Chandok N, Watt KDS. Pain management in the cirrhotic patient: the clinical challenge. Mayo Clin Proc. 2010;85(5):451-458. 8. Calhoun DA, Jones D, Textor S, et al. Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension. 2008;51:1403-1419. 9. Bhatt DL, Scheiman J, Abraham NS, et al. ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use. Circulation. 2008; 118(8):1894-1909. 10. Peterson GM. Selecting nonprescription analgesics. Am J Ther. 2005;12:67-79. 11. Risser A, Donovan D, Heintzman J, Page T. NSAID prescribing precautions. Am Fam Physician. 2009;80(12):1371-1378. 12. Guslandi M. Steroid ulcers: any news? World J Gastrointest Pharmacol Ther. 2013;4(3):39-40. 13. Hernández-Díaz S, García Rodríguez LA. Steroids and risk of upper gastrointestinal complications. Am J Epidemiol. 2001;153:1089-1093.