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Can I take ibuprofen with blood pressure medications?

Medically reviewed by Carmen Pope, BPharm. Last updated on May 6, 2024.

Official answer

by Drugs.com

Be careful when taking ibuprofen with blood pressure medicines because the combination may cause serious kidney damage in some people, particularly older adults or people who are dehydrated. The risk is higher if you also take a diuretic (water pill), in addition to your blood pressure medications. People taking blood pressure medications AND diuretics should avoid taking ibuprofen.

If you take blood pressure medications, then you should always talk to your healthcare provider before taking ibuprofen. Do not just buy it from a supermarket or drug store without telling your healthcare provider you are taking it. This is so that they can monitor the effects it has on your kidneys. Ibuprofen can also counteract the effects of blood pressure medications, so your healthcare provider will need to check your blood pressure regularly as well.

The interaction between blood pressure medications and ibuprofen happens because your kidneys rely on prostaglandins for blood flow and ibuprofen reduces prostaglandin levels in the body. In some people this can seriously affect blood flow through the kidneys and cause an acute kidney injury, with symptoms such as passing less urine or more dilute urine than usual, feeling sick or vomiting, leg swelling, or pain in your abdomen or the middle of your back. In general, the combination of ibuprofen and blood pressure medications is not recommended, but if there is a good reason to use it, ibuprofen should be used at the lowest recommended dosage for a few days only under medical supervision (not self-prescribed)

Blood pressure medications, such as ACE inhibitors or ARBs; diuretics; and NSAIDs all decrease kidney function. Prescribing two of these drugs together increases the risk (called the double whammy) but the risk is greatest when all three are prescribed at once (called the triple whammy).

Ibuprofen, and other NSAIDs, can also decrease the blood pressure-lowering effects of other blood pressure medications, such as alpha-blockers, calcium antagonists, and beta blockers meaning that your blood pressure could increase. NSAIDs can also reduce the effects of diuretics, which can exacerbate heart failure. This may put you at increased risk of a heart attack or stroke. Adjusting medication dosages (such as increasing the dose of the blood pressure medication because ibuprofen is making it less effective), is not good prescribing practice and is likely to increase the risk of side effects, including kidney damage. If ibuprofen is making your blood pressure medication less effective, then you should stop taking ibuprofen.

List of blood pressure medications that can interact with ibuprofen

ACE inhibitors or ARBs

Examples of ACE inhibitors or ARBs that can interact with ibuprofen include:

Diuretics

Examples of diuretics that can interact with ibuprofen include:

Combination ACE inhibitors/ARBs with diuretics

List of NSAIDs that can interact with blood pressure medications

Ibuprofen is not the only NSAID that can interact with blood pressure medications and diuretics. Examples of other NSAIDs include:

Related questions

Why does ibuprofen interact with blood pressure medications and diuretics?

Ibuprofen and other NSAIDs work by reducing prostaglandin production (these are hormone-like substances that control processes such as inflammation, blood flow, pain, and the formation of blood clots) and this is how NSAIDs reduce pain fever and inflammation. But prostaglandins are also important for maintaining blood flow through the kidneys (these are called renal prostaglandins) when kidney blood flow is reduced by other factors (such as old age, dehydration, or other medications that also reduce blood flow through the kidneys).

In the kidney, prostaglandins keep a major blood vessel that goes into the kidneys (the renal afferent arteriole) open when hormones that narrow blood vessels are released by the body. The renal afferent arteriole is responsible for feeding blood into the main filtering unit of the kidneys, called the glomerulus.

NSAIDs temporarily stop the production of renal prostaglandins by blocking cyclooxygenase (COX) which is the major enzyme responsible for converting arachidonic acid to prostaglandins. Decreased levels of prostaglandins prevent the compensatory response described above from happening, which causes the renal afferent arteriole to narrow and blood flow to the kidneys to decrease. This reduces kidney function and increases the risk of acute kidney injury (AKI). In addition, AKI can also occur due to an inflammatory reaction inside the kidneys caused by an immune system reaction to NSAIDs called acute interstitial nephritis (AIN), which typically occurs within 3 to 7 days of taking regular NSAIDs. AIN accounts for about 15% of all cases of AKI.

Who is at greatest risk of kidney problems from ibuprofen and other NSAIDs?

People with certain medical conditions rely on renal prostaglandins to maintain kidney blood flow. These conditions include:

  • Coronary artery disease or atherosclerosis (the build up of fatty plaques inside blood vessels)
  • Diabetes
  • Increasing age (particularly over the age of 65)
  • High blood pressure that is not well controlled by medications
  • Medications, such as ACE inhibitors or ARBs
  • Kidney disease
  • Poor kidney function
  • Dehydration due to water or salt loss (dehydration), blood loss, or use of diuretics
  • Cirrhosis
  • Heart failure
  • Sepsis
  • Use of the triple whammy (ACE inhibitor or ARB plus diuretic plus NSAIDs). This increases the risk significantly. The greatest risk for AKI is in the first 30 days of use.

Certain ethnicities, such as Indo-Asians, Pasifika, or Māori, are also at increased risk.

How do you treat AKI from NSAIDs?

Kidney function will recover in most patients if the NSAID is stopped soon enough. Steroids (such as prednisone) may help improve those with AIN who do not improve. Do not restart NSAIDs in these patients.

Consider withholding other medications that can also affect kidney blood flow or that require dosage adjustments with declining renal function, such as metformin, gabapentin, or opioids.

What are some alternatives to ibuprofen?

Acetaminophen is the best alternative to ibuprofen if you want to buy something over the counter to manage your pain. Weak opioids, such as codeine or tramadol may be used for severe or chronic pain. Corticosteroids may be given in short courses.

Topical NSAIDs may also be appropriate because of the risk of AKI is lower, although it can occur, particularly with extensive use. Fluid replacement should be given.

Ibuprofen alternatives for people with arthritis

For arthritis sufferers with high blood pressure seeking alternatives to ibuprofen, consider these options:

  • Topical treatments like diclofenac gel (Motrin Arthritis Pain, Voltaren Arthritis Pain) offer localized relief without affecting blood pressure or kidneys.
  • Acetaminophen (Tylenol, Excedrin) can alleviate pain but doesn't address swelling or inflammation.
  • Weight management can ease arthritis symptoms; discuss strategies with your doctor.
  • Regular exercise such as yoga or walking helps maintain joint mobility.
  • Non-pharmacological approaches like physical therapy, splints, massage, or acupuncture can also provide pain relief.

Symptoms of acute kidney injury

If you have been taking ibuprofen (or another NSAID) plus a blood pressure medication plus a diuretic and you develop the following symptoms, ring your doctor immediately:

  • Dizziness
  • Drop in blood pressure when going from sitting or lying down to standing
  • Facial swelling
  • Fainting
  • Fatigue or tiredness
  • Reduce urination or passing more dilute urine than normal
  • Skin rash
  • Thirst.

Also, ring your doctor if you have vomiting or diarrhea or become dehydrated.

Laboratory changes indicative of AKI include:

  • An increase in serum creatinine of 26.5μmol/L or more in 48 hours or at least 1.5 times baseline within 7 days
  • Reduced urine output (< 0.5 mL/kg/h for six hours).

I have been prescribed the triple whammy. What can I do?

  • Talk to your doctor or pharmacist about alternatives
  • Discuss your risk with your health professional
  • Use the lowest effective dose for the shortest possible time
  • Keep up a good fluid intake, particularly if feeling unwell or in hot weather; aim for pale-colored urine
  • Avoid inadvertently taking other NSAIDs, including topical NSAIDs. Take acetaminophen as an alternative

If you become unwell or develop diarrhea or vomiting, ring your doctor.

Watch out for signs of dehydration, such as increased thirst, or dry mucous membranes.

Seek medical attention immediately if your condition deteriorates.

References
  • Lucas, G. N. C., Leitão, A. C. C., Alencar, R. L., Xavier, R. M. F., Daher, E. F., & Silva Junior, G. B. D. (2019). Pathophysiological aspects of nephropathy caused by non-steroidal anti-inflammatory drugs. Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e. Latino-Americana de Nefrologia, 41(1), 124–130. https://doi.org/10.1590/2175-8239-JBN-2018-0107
  • Salort-Llorca, C., Mínguez-Serra, M. P., & Silvestre-Donat, F. J. (2008). Interactions between ibuprofen and antihypertensive drugs: incidence and clinical relevance in dental practice. Medicina oral, patologia oral y cirugia bucal, 13(11), E717–E721.
  • Avoiding the triple whammy in primary care: ACE inhibitor/ARB + diuretic + NSAID https://bpac.org.nz/2018/triple-whammy.aspx
  • Brater, D. C., Harris, C., Redfern, J. S., & Gertz, B.J. (2001). Renal effects of COX-2-selective inhibitors. American Journal of Nephrology, 21(1), 1–15. https://doi.org/10.1159/000046212 https://www.uptodate.com/contents/nsaids-and-acetaminophen-effects-on-blood-pressure-and-hypertension/print
  • Tip Sheet: High Blood Pressure and Pain Relievers. Updated Nov 14, 2022. WebMD https://www.webmd.com/hypertension-high-blood-pressure/features/tip-sheet-high-blood-pressure-pain-relievers
  • NSAIDs and Acute Kidney Injury. Medsafe https://www.medsafe.govt.nz/profs/PUArticles/June2013NSAIDS.htm
  • Ishiguro, C., Fujita, T., Omori, T., Fujii, Y., Mayama, T., & Sato, T. (2008). Assessing the effects of non-steroidal anti-inflammatory drugs on antihypertensive drug therapy using post-marketing surveillance database. Journal of epidemiology, 18(3), 119–124. https://doi.org/10.2188/jea.je2007413

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