Is it safe to take Motrin (ibuprofen) with blood pressure medication and hydroxychloroquine?

From the Guidelines

Taking Motrin (ibuprofen) with blood pressure medication and hydroxychloroquine is not recommended due to potential interactions that may increase blood pressure and reduce the effectiveness of blood pressure medications. Ibuprofen can potentially reduce the effectiveness of many blood pressure medications, such as ACE inhibitors, ARBs, beta-blockers, and diuretics, and may cause blood pressure to increase 1. Additionally, ibuprofen can increase the risk of kidney problems when taken with certain blood pressure medications. Regarding hydroxychloroquine, while there is no major direct interaction with ibuprofen, combining multiple medications always carries some risk of unexpected side effects.

If you need pain relief while on these medications, acetaminophen (Tylenol) is often a safer alternative for people taking blood pressure medications, as it is less likely to worsen blood pressure control compared to ibuprofen 1. The specific risk depends on which blood pressure medication you're taking, your overall health status, and other factors unique to your situation. It's essential to consult your doctor or pharmacist before combining these medications, as they can assess your individual situation and provide personalized advice. Recent guidelines for the management of elevated blood pressure and hypertension also emphasize the importance of careful medication management and monitoring 1.

Some key points to consider when taking blood pressure medications and other medications like ibuprofen and hydroxychloroquine include:

• The potential for interactions between medications that can increase blood pressure or reduce the effectiveness of blood pressure medications
• The importance of monitoring blood pressure closely when taking multiple medications
• The need to consult with a healthcare provider before combining medications
• The potential benefits and risks of different pain relief options, such as acetaminophen versus ibuprofen, in the context of blood pressure management.

It's also worth noting that recent guidelines recommend certain medications as first-line treatments for hypertension, including ACE inhibitors, ARBs, dihydropyridine CCBs, and diuretics 1, and that combining two RAS blockers (ACE inhibitor and an ARB) is not recommended 1. However, the primary concern with taking Motrin (ibuprofen) with blood pressure medication and hydroxychloroquine is the potential for adverse interactions and the importance of consulting with a healthcare provider to determine the best course of action.

From the FDA Drug Label

WARNINGS Cardiovascular Thrombotic Events Clinical trials of several COX-2 selective and nonselective NSAIDs of up to three years duration have shown an increased risk of serious cardiovascular (CV) thrombotic events, including myocardial infarction (MI) and stroke, which can be fatal ... Hypertension NSAIDs including ibuprofen tablets can lead to onset of new hypertension or worsening of preexisting hypertension, either of which may contribute to the increased incidence of CV events. Patients taking thiazides or loop diuretics may have impaired response to these therapies when taking NSAIDs NSAIDs, including ibuprofen tablets should be used with caution in patients with hypertension. Blood pressure (BP) should be monitored closely during the initiation of NSAID treatment and throughout the course of therapy ... Use of Ibuprofen may blunt the CV effects of several therapeutic agents used to treat these medical conditions [e.g., diuretics, ACE inhibitors, or angiotensin receptor blockers (ARBs)]

Motrin (ibuprofen) should be used with caution when taking blood pressure medication. The FDA drug label warns that NSAIDs, including ibuprofen, can lead to onset of new hypertension or worsening of preexisting hypertension, and may impair the response to certain blood pressure therapies. Blood pressure should be monitored closely when initiating NSAID treatment and throughout the course of therapy. There is no direct information about the interaction between Motrin and hydroxychloroquine in the provided drug label. 2

From the Research

Interaction between Motrin and Blood Pressure Medication

• The interaction between ibuprofen (Motrin) and antihypertensive drugs has been well documented, with studies showing that ibuprofen can reduce the antihypertensive activity of these drugs 3, 4, 5, 6, 7.
• The mechanism of action of ibuprofen involves inhibition of the enzyme cyclooxygenase, which can lead to increased blood pressure in some patients 3.
• Studies have shown that ibuprofen can increase systolic and diastolic blood pressure in patients taking antihypertensive drugs, with the magnitude of the increase varying depending on the specific antihypertensive drug and the dose of ibuprofen 4, 5, 7.

Interaction between Motrin and Hydroxychloroquine

• There is limited information available on the interaction between ibuprofen and hydroxychloroquine.
• However, it is known that hydroxychloroquine can increase the risk of cardiovascular side effects, and the concomitant use of ibuprofen may potentially increase this risk 6.

Clinical Relevance

• The interaction between ibuprofen and antihypertensive drugs can have significant clinical implications, particularly in patients with hypertension who are taking multiple medications 3, 6.
• Patients taking ibuprofen and antihypertensive drugs should be closely monitored for changes in blood pressure, and their antihypertensive regimen may need to be adjusted to minimize the risk of adverse effects 5, 7.
• The use of alternative pain relievers, such as acetaminophen, may be considered in patients who are taking antihypertensive drugs and require pain management 4, 7.