Is ibuprofen contraindicated in patients with asthma or those taking Eliquis (apixaban)?

From the Guidelines

Ibuprofen should be used with caution in asthma patients and avoided in patients taking Eliquis (apixaban). For asthma patients, ibuprofen can trigger bronchospasm in approximately 0.07% to 21% of adults with asthma, particularly those with aspirin-exacerbated respiratory disease (AERD) 1. If you have asthma and have never had a reaction to NSAIDs before, you may be able to take ibuprofen, but should discuss this with your healthcare provider first. Key considerations include:

• The prevalence of aspirin-exacerbated respiratory disease is 0.07% in the general population and up to 21% in adults with asthma 1
• Asthma patients with nasal polyps or recurrent sinusitis are at higher risk of adverse reactions to NSAIDs
• Aspirin desensitization may be an option for some patients, but data is limited 1

For patients on Eliquis, ibuprofen should generally be avoided as the combination increases bleeding risk significantly. Ibuprofen inhibits platelet aggregation while Eliquis is an anticoagulant that prevents blood clot formation, creating a dangerous additive effect. The risk of GI bleeding increases three to six times when NSAIDs are used with anticoagulants 1. If pain relief is needed, acetaminophen (Tylenol) is typically a safer alternative for both asthma patients and those taking Eliquis. Always consult your healthcare provider before combining medications or if you need pain relief while managing these conditions.

From the FDA Drug Label

Ibuprofen tablets should not be administered to patients with this form of aspirin sensitivity and should be used with caution in patients with preexisting asthma Patients receiving ibuprofen tablets who may be adversely affected by alterations in platelet function, such as those with coagulation disorders or patients receiving anticoagulants should be carefully monitored.

Ibuprofen Contraindications and Precautions:

• Ibuprofen is contraindicated in patients with a history of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
• Ibuprofen should be used with caution in patients with preexisting asthma.
• Patients taking anticoagulants, such as Eliquis (apixaban), should be carefully monitored due to the potential for increased risk of bleeding.

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From the Research

Ibuprofen and Asthma

• Ibuprofen is not absolutely contraindicated in patients with asthma, but caution is advised due to the potential for cross-reactivity with aspirin in patients with aspirin-induced asthma 3, 4.
• The risk of acute bronchospasm induced by ibuprofen in children with asthma is considered low, and ibuprofen may even have therapeutic benefits for some children with asthma 3.
• However, patients with a history of aspirin-induced asthma or those with severe asthma, nasal polyps, or chronic rhinosinusitis should use ibuprofen only under close medical supervision 5, 6.

Ibuprofen and Eliquis (Apixaban)

• There is no direct evidence in the provided studies regarding the interaction between ibuprofen and Eliquis (apixaban).
• However, it is known that ibuprofen can increase the risk of bleeding when used with anticoagulants, and Eliquis is an anticoagulant medication.
• Patients taking Eliquis should consult their doctor before using ibuprofen or any other NSAID, as the combination may increase the risk of bleeding 6.

NSAID Use in Asthma

• NSAIDs, including ibuprofen, can cause deterioration in respiratory function in approximately 10% of adults with asthma and a smaller proportion of children with asthma 6.
• Patients with asthma who are known to be intolerant of NSAIDs or who exhibit high-risk clinical features for intolerance to these drugs should use NSAIDs only under close medical supervision 6.
• Formal aspirin provocation testing may be recommended prior to the therapeutic use of NSAIDs in patients with high-risk features 6.