Can I take ibuprofen if I take blood pressure tablets?

Ibuprofen can raise your blood pressure and weaken your treatment: here is when to ask and which alternatives exist.

If you take blood pressure tablets, the sensible thing is not to take ibuprofen without checking first. Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) that can raise blood pressure, make your treatment work less well and, combined with certain blood pressure medicines, affect the kidneys. A single dose is not usually a disaster, but your pharmacist can tell you in two minutes whether it suits you or whether there is a better option.

Ibuprofen is sold without prescription in many forms, so it seems harmless. In this article we explain what the leaflet says, which combinations to watch and how to decide safely the next time your back or head hurts.

Why can ibuprofen affect blood pressure?

Ibuprofen reduces the production of prostaglandins, substances that, among other things, help the kidneys get rid of salt and water. That is why it can cause fluid retention and raise blood pressure. The Spanish leaflet says so explicitly: this type of medicine can cause fluid retention, especially in people with heart failure or high blood pressure.

The leaflet also asks you to talk to your doctor or pharmacist before taking it if you have high blood pressure, heart or kidney problems, and reminds you that anti-inflammatories such as ibuprofen are linked to a small increase in the risk of heart attack or stroke, especially at high doses.

Which blood pressure tablets need the most care?

The ibuprofen leaflet lists medicines that lower blood pressure among its interactions: ACE inhibitors (such as captopril or enalapril), beta blockers (such as atenolol) and angiotensin II receptor blockers (such as losartan). It also mentions diuretics, because the combination can increase the risk of kidney toxicity.

Bear in mind that many tablets combine two active ingredients in one (for example, an ARB with a diuretic). If you are not sure what yours contain, check the box or ask at the pharmacy.

What is the "triple whammy" and why does it matter?

Pharmacists and kidney specialists use the term "triple whammy" for taking an NSAID, a diuretic and an ACE inhibitor or ARB at the same time. Together they can reduce kidney filtration and cause acute kidney injury, particularly in older or dehydrated people. A prescribing bulletin from the Castilla-La Mancha Health Service (SESCAM) describes this risk and recommends avoiding the combination.

The risk rises if you have diarrhoea, vomiting, a fever or it is very hot, because you lose fluids. The ibuprofen leaflet itself warns that kidney failure can occur with dehydration. So if you are in that situation and take blood pressure tablets, check before taking any anti-inflammatory.

So what can I take for pain?

Pharmacists often suggest paracetamol as the first option for mild or moderate pain; the NHS, for example, advises trying paracetamol before ibuprofen if you can take it. But paracetamol also has a maximum dose and its own precautions, so confirm which one suits you and how much you can take.

• Before buying, always say at the pharmacy that you take blood pressure medication, even if they do not ask.
• If your doctor allows an NSAID, use the lowest effective dose for the shortest possible time, as the leaflet says.
• Do not combine two different anti-inflammatories (for example, ibuprofen and naproxen) or take them "just in case".
• If the pain lasts several days or you often need painkillers, book an appointment: the cause should be treated.
• If you measure your blood pressure at home, note whether it rises on the days you take anti-inflammatories and mention it at your appointment.

To learn more about this group of medicines, read what NSAIDs are and how they work.

A practical example: Marta and her sore knee

Take the case of Marta, 58, an office administrator, who takes one tablet of losartan with hydrochlorothiazide every morning for her blood pressure. One Monday she wakes up with a swollen knee after a long walk and has ibuprofen in her medicine cabinet.

Instead of taking it straight away, Marta stops at the pharmacy on her way to work and explains what she takes. The pharmacist reminds her that her tablet combines an ARB and a diuretic, and that adding ibuprofen would make the triple combination. She recommends paracetamol at the right dose, ice and relative rest, and advises her to drink enough water and see her GP if it has not improved in three or four days.

Marta writes in her medication list that she should not take anti-inflammatories without asking, so she remembers next time and can show it at any pharmacy.

How can IMA Health help you?

When you take several medicines every day, it is easy to lose track of what each tablet contains and what it should not be mixed with. At IMA Health we coordinate with a specialised pharmacy that prepares your medication by day and time of each dose, we deliver it to your home and we provide personalised follow-up. That way your treatment is in order and you have a team to ask before adding something new, such as a painkiller.

If you have just started blood pressure medication, you may also find our guide on the first weeks after a high blood pressure diagnosis useful.

Sources

• CIMA (AEMPS): leaflet for Ibuprofeno Cinfa 400 mg (in Spanish)
• SESCAM: prescribing bulletin on the NSAID, diuretic and ACE inhibitor or ARB combination (in Spanish)
• NHS: Taking ibuprofen with other medicines
• NHS: Ibuprofen for adults

This article is for information only and does not replace advice from your doctor or pharmacist.