Can you take ibuprofen (Nonsteroidal Anti-Inflammatory Drug) with lithium (medication for bipolar disorder)?

Ibuprofen and Lithium Interaction: Significant Risk of Lithium Toxicity

Ibuprofen should not be taken with lithium due to the significant risk of lithium toxicity caused by reduced lithium clearance and increased serum lithium levels. 1, 2

Mechanism of Interaction

The interaction between ibuprofen and lithium occurs through:

• Inhibition of renal prostaglandin synthesis by ibuprofen 1
• Decreased renal lithium clearance, leading to increased serum lithium levels 2
• Potential for lithium toxicity even in patients with normal renal function 3

Evidence of Interaction

Research demonstrates that:

• Ibuprofen can increase mean minimum lithium concentration by 15% 4
• Lithium renal clearance decreases significantly when ibuprofen is added 4
• The FDA drug label for lithium explicitly warns about this interaction, stating: "Lithium levels should be closely monitored when patients initiate or discontinue NSAID use" 2
• The FDA drug label for ibuprofen specifically mentions lithium as a drug interaction concern 1

Clinical Implications

When ibuprofen is added to lithium therapy:

• Serum lithium levels can increase unpredictably, with marked interindividual variation 5
• Lithium toxicity symptoms may develop within days to a week 6
• The interaction can lead to potentially life-threatening lithium intoxication 6

Signs of Lithium Toxicity to Monitor

If a patient has taken both medications, watch for:

• Diarrhea, vomiting
• Tremor, mild ataxia
• Drowsiness
• Muscular weakness
• Confusion
• Neurological toxicity 2

Alternative Pain Management Options

For patients on lithium requiring pain management:

1. Acetaminophen (paracetamol) - Does not affect lithium levels and is safer for short-term pain relief
2. Non-pharmacological approaches - Physical therapy, heat/cold therapy, etc.
3. If NSAID is absolutely necessary:
   • Consider sulindac or aspirin which have less effect on lithium levels 3
   • Implement very close monitoring of lithium levels (every 4-5 days) 3
   • Be prepared to reduce lithium dosage as needed 3, 5

Important Precautions

• Any patient receiving both lithium and ibuprofen requires careful monitoring of lithium levels
• Patients with decreased renal function or decreased intravascular volume are at even higher risk 6
• Patients should be educated about the signs of lithium toxicity and instructed to seek immediate medical attention if they occur 2

This interaction represents a significant clinical concern that can lead to serious adverse outcomes, including lithium toxicity with potential neurological complications. The safest approach is to avoid the combination whenever possible.