From the Guidelines
Ibuprofen is contraindicated in patients with a history of hypersensitivity to ibuprofen or other NSAIDs, active peptic ulcer disease, gastrointestinal bleeding, severe heart failure, severe kidney disease, and during the third trimester of pregnancy, as well as in patients taking aspirin for its antiplatelet effects, due to the risk of blocking aspirin's antiplatelet effects 1. The contraindications for ibuprofen are based on its potential to cause significant harm in certain patient populations.
- Hypersensitivity to ibuprofen or other NSAIDs is a clear contraindication, as it can lead to severe allergic reactions.
- Active peptic ulcer disease and gastrointestinal bleeding are also contraindications, as ibuprofen can exacerbate these conditions and increase the risk of further bleeding.
- Severe heart failure and severe kidney disease are contraindications, as ibuprofen can worsen these conditions by increasing fluid retention and reducing renal function.
- Use of ibuprofen during the third trimester of pregnancy is contraindicated, as it can cause premature closure of the ductus arteriosus and increase the risk of pregnancy complications.
- Additionally, ibuprofen should not be used in patients taking aspirin for its antiplatelet effects, as it can block the antiplatelet effects of aspirin and increase the risk of cardiovascular events 1. Other patient populations should use ibuprofen with caution, including those with:
- Hypertension, as ibuprofen can increase blood pressure and worsen cardiovascular disease
- Mild to moderate heart failure, as ibuprofen can worsen fluid retention and reduce renal function
- History of peptic ulcer disease, as ibuprofen can increase the risk of further bleeding
- Inflammatory bowel disease, as ibuprofen can worsen gastrointestinal symptoms
- Those on anticoagulants or corticosteroids, as ibuprofen can increase the risk of bleeding and interact with these medications. It is essential to weigh the potential benefits and risks of ibuprofen use in each patient and consider alternative treatments when necessary, as the risk of cardiovascular events is proportional to COX-2 selectivity and the underlying risk in the patient 1.
From the FDA Drug Label
Ibuprofen tablets are contraindicated in patients with known hypersensitivity to ibuprofen. Ibuprofen tablets should not be given to patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs. Ibuprofen tablets are contraindicated in patients with previous serious skin reactions to NSAIDs Ibuprofen tablets are contraindicated in patients with the aspirin triad
The contraindications for ibuprofen include:
- Hypersensitivity to ibuprofen
- Asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs
- Previous serious skin reactions to NSAIDs
- Aspirin triad
- In the setting of coronary artery bypass graft (CABG) surgery 2
From the Research
Contraindications for Ibuprofen
The following are contraindications for ibuprofen, a Nonsteroidal Anti-Inflammatory Drug (NSAID):
- Advanced age, as the risk of bleeding is increased with advancing age 3, 4, 5
- Presence of Helicobacter pylori (HP) infection, as it increases the risk of gastrointestinal ulcers and bleeding 3, 4, 5
- Previous history of bleeding, as it increases the risk of further bleeding 3, 4, 5
- Anticoagulant use, as it increases the risk of bleeding 3, 4, 5
- History of peptic ulcer disease, as NSAIDs can exacerbate the condition 4, 6, 5
- Severe chronic kidney disease (CKD), as NSAIDs can worsen renal function 5
- Treatment-resistant hypertension, as NSAIDs can increase blood pressure 5
- High risk of cardiovascular disease, as NSAIDs can increase the risk of cardiovascular events 5
- Gastrointestinal comorbidities, such as gastrointestinal ulcers or bleeding 3, 4, 6, 5
Special Considerations
- Patients with pre-existing hypertension receiving renin-angiotensin system blockers should have their blood pressure monitored and may require additional antihypertensive therapy 5
- Patients with a high risk of peptic ulcer disease should receive prophylactic therapy with a proton pump inhibitor (PPI) or a selective cyclo-oxygenase-2 (COX-2) inhibitor 4, 5
- Patients with a moderate risk of peptic ulcer disease should receive monotherapy with a non-selective NSAID plus a PPI, or a selective COX-2 inhibitor 5