Prescription ·Strong evidence ·Reviewed May 2026
A widely used nonselective NSAID with analgesic, anti-inflammatory, and antipyretic properties. Ibuprofen is first-line therapy for mild-to-moderate pain, inflammatory conditions, dysmenorrhea, and fever. Available over-the-counter and by prescription at higher doses.
The bottom line
Evidence rating strong. Most-documented uses: relief of mild-to-moderate pain, reduction of inflammation, fever reduction. 11 sources indexed (2018–2024), with 10 interaction records on file.
Core mechanism
Non-selectively inhibits cyclooxygenase enzymes COX-1 and COX-2, reducing the synthesis of prostaglandins and thromboxanes from arachidonic acid. By decreasing prostaglandin E2 and prostaglandin I2, ibuprofen reduces inflammation, pain sensitization, and fever. COX-1 inhibition also reduces the protective prostaglandin production in the gastric mucosa, contributing to GI side effects.
Take with food or milk to reduce GI irritation; avoid alcohol use8
NSAIDs reduce renal clearance of methotrexate, potentially leading to toxic methotrexate accumulation. This can cause severe bone marrow suppression, hepatotoxicity, and nephrotoxicity.
Recommendation: Avoid concurrent use, especially with high-dose methotrexate. If low-dose methotrexate (for RA) is combined with occasional NSAID use, monitor CBC and renal function closely.
NSAIDs increase bleeding risk with warfarin through dual mechanisms: antiplatelet effects and GI mucosal damage. Ibuprofen also inhibits CYP2C9, potentially increasing warfarin levels.
Recommendation: Avoid concurrent use when possible. If necessary, use the lowest NSAID dose for the shortest duration. Consider acetaminophen as an alternative. Monitor INR more frequently.
NSAIDs increase the bleeding risk when combined with DOACs through antiplatelet effects and GI mucosal irritation. While DOACs have fewer food/drug interactions than warfarin, NSAID co-use remains a significant risk factor.
Recommendation: Minimize concurrent use. If pain relief is needed, prefer acetaminophen. If NSAID is necessary, use the lowest dose for the shortest time and monitor for bleeding signs.
Both ibuprofen and fish oil have antiplatelet effects. Combined use may modestly increase GI bleeding risk. However, the interaction is generally mild at moderate fish oil doses.
Recommendation: Low-to-moderate fish oil (1-2g/day) is generally safe with occasional ibuprofen. Monitor for GI symptoms with chronic use of both.
Alcohol increases the chance of stomach bleeding while taking ibuprofen. The combination is most concerning with repeated ibuprofen dosing, binge drinking, older age, prior ulcers, or other medicines that affect bleeding. Symptoms can appear as severe stomach pain, black stools, vomiting blood, dizziness, or weakness.
Recommendation: Avoid heavy drinking while using ibuprofen, and do not use ibuprofen to treat hangover symptoms after substantial alcohol intake. Use the lowest effective ibuprofen dose for the shortest time and stop the combination if any bleeding symptoms occur.
Ibuprofen can reduce kidney potassium excretion, and potassium supplements can push serum potassium higher. This is most important if you have kidney disease, diabetes, dehydration, older age, or also take an ACE inhibitor, ARB, or potassium-sparing diuretic. Severe hyperkalemia can cause weakness, palpitations, dangerous arrhythmias, or collapse.
Recommendation: Do not use potassium supplements with repeated ibuprofen dosing unless your clinician has advised it. If the combination is necessary, check kidney function and serum potassium, and avoid ibuprofen during dehydration, vomiting, diarrhea, or poor fluid intake.
Ginkgo biloba may add antiplatelet effects to ibuprofen and has a published case of fatal intracerebral bleeding with ibuprofen. Ibuprofen also increases GI bleeding risk through NSAID mucosal injury. The combination is especially concerning with high-dose ginkgo, repeated ibuprofen use, older age, head injury risk, or other bleeding-risk medicines.
Recommendation: Avoid combining ginkgo supplements with repeated ibuprofen dosing. If you have used both and develop severe headache, neurologic symptoms, black stools, vomiting blood, or unusual bruising, seek urgent care.
Nattokinase has fibrinolytic and anticoagulant effects that may add to ibuprofen-related bleeding risk. Ibuprofen can irritate the GI tract and transiently impair platelet function. The combination is most concerning with high-dose nattokinase, repeated ibuprofen use, prior ulcers, surgery, or other blood-thinning medicines.
Recommendation: Avoid nattokinase while using ibuprofen regularly. Stop nattokinase at least 1-2 weeks before procedures unless your clinician gives different instructions, and seek care for bleeding symptoms.
Concentrated garlic extract may add antiplatelet activity to ibuprofen's bleeding risk. This is most relevant with high-dose garlic products, repeated ibuprofen use, upcoming procedures, ulcer history, or other blood-thinning medicines. Culinary garlic in food is much less concerning than supplement-dose extract.
Recommendation: Avoid high-dose garlic extract while using ibuprofen regularly. Stop garlic extract before procedures if your surgical team recommends it, and watch for nosebleeds, bruising, black stools, or vomiting blood.
Concentrated turmeric/curcumin may add antiplatelet effects to ibuprofen's bleeding risk. Ibuprofen also increases upper GI injury risk, especially with repeated use. The concern is highest with high-dose curcumin products, ulcer history, older age, procedures, or other blood-thinning medicines.
Recommendation: Avoid high-dose curcumin supplements while using ibuprofen regularly. If both are used, keep ibuprofen exposure short and watch for bruising, nosebleeds, black stools, or vomiting blood.
Numbered references. Citations throughout the page link here.
Kim DH, Stybayeva G, Hwang SH. Effect and safety of perioperative ibuprofen administration in pediatric tonsillectomy: A systematic review and meta-analysis. American journal of otolaryngology. 2024
da Silva HDS, Franco ES, Lima LCAS et al.. Therapeutic Efficacy and Safety of Paracetamol versus Ibuprofen in Patent Ductus Arteriosus in Newborns: A Systematic Review. Arquivos brasileiros de cardiologia. 2024
Network meta-analysis found ibuprofen (400 mg) among the most effective oral analgesics for post-dental extraction pain, providing superior pain relief compared to acetaminophen and comparable to combination NSAID regimens.
Shamsaee E, Huws A, Gill A et al.. Ibuprofen efficacy, tolerability and safety in obese children: a systematic review. Archives of disease in childhood. 2023
Pankey AN, Chandar A, Isaacson G. Safety of Ibuprofen in Children With G6PD Deficiency: A Systematic Review. The Laryngoscope. 2022
Mitra S, Florez ID, Tamayo ME et al.. Association of Placebo, Indomethacin, Ibuprofen, and Acetaminophen With Closure of Hemodynamically Significant Patent Ductus Arteriosus in Preterm Infants: A Systematic Review and Meta-analysis. JAMA. 2018
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