No Clinically Significant Interaction Between Ibuprofen and Augmentin
There is no clinically significant drug interaction between ibuprofen and Augmentin (amoxicillin/clavulanate) that would contraindicate their concurrent use. These medications can be safely prescribed together when both are clinically indicated.
Evidence Base
The available guideline evidence does not identify any pharmacokinetic or pharmacodynamic interaction between NSAIDs like ibuprofen and amoxicillin/clavulanate combinations:
Multiple treatment guidelines recommend both agents without interaction warnings: Guidelines for acute otitis media 1, acute bacterial rhinosinusitis 1, and streptococcal pharyngitis 1 recommend amoxicillin/clavulanate as antibiotic therapy without any contraindication to concurrent NSAID use for symptom management.
Concurrent use studied without safety concerns: A randomized controlled trial directly compared ibuprofen 600 mg three times daily versus amoxicillin-clavulanate 500/125 mg three times daily versus placebo in 416 adults with acute bronchitis, with no reported drug interactions or safety concerns when these medications were used in the same patient population 1.
Important Caveats About Ibuprofen Use
While ibuprofen does not interact with Augmentin specifically, clinicians should be aware of important ibuprofen interactions with other commonly prescribed medications:
Aspirin Interaction (Critical)
- Ibuprofen blocks aspirin's cardioprotective effects through competitive inhibition at the COX-1 binding site 1.
- If a patient requires both medications, ibuprofen should be taken at least 30 minutes after immediate-release aspirin or at least 8 hours before aspirin ingestion 2.
- The American College of Rheumatology strongly recommends using a nonselective NSAID other than ibuprofen when patients are taking low-dose aspirin for cardioprotection 1.
Anticoagulant Interaction (Critical)
- NSAIDs including ibuprofen significantly increase bleeding risk when combined with warfarin or other anticoagulants 1, 3.
- The risk of gastrointestinal bleeding increases 3-6 fold with this combination 3.
- If concurrent use is unavoidable, add proton pump inhibitor prophylaxis and increase INR monitoring frequency 1, 3.
Gastrointestinal Risk
- Ibuprofen combined with aspirin increases the odds ratio for GI bleeding to 5.6 1.
- Consider proton pump inhibitor prophylaxis for patients over age 75 or those with history of peptic ulcer disease 1, 3.
Clinical Bottom Line
Prescribe ibuprofen and Augmentin together without concern for direct drug interaction. Focus your attention instead on screening for aspirin use (for cardioprotection) or anticoagulant therapy, as these represent the clinically significant interactions with ibuprofen that require management adjustments 1, 2, 3.