Ibuprofen (Advil, Motrin) and Plavix (clopidogrel): Can You Take Them Together?

  • Medical Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Ibuprofen (Advil, Motrin) and Plavix (clopidogrel) quick overview

What is ibuprofen? What is Plavix?

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). Other NSAIDs include aspirin, naproxen (Aleve), indomethacin (Indocin), and nabumetone (Relafen). NSAIDs are used to manage mild to moderate pain, fever, and inflammation. Pain, fever, and inflammation are promoted by the release in the body of chemicals called prostaglandins. Ibuprofen blocks the enzyme that makes prostaglandins (cyclooxygenase), resulting in lower levels of prostaglandins and reduced levels of inflammation, pain and fever.

Plavix (clopidogrel bisulfate) is an anti-platelet drug used to prevent blood clots. Plavix is used to reduce the risk of heart attacks and strokes, particularly in people with a recent history of stroke or heart attack, angina, and peripheral vascular disease. Plavix works by irreversibly binding to the P2Y12 receptor on platelets, preventing adenosine diphosphate (ADP) from activating platelets. It belongs to a class of drugs called P2Y12 inhibitors. Other P2Y12 inhibitors include ticagrelor (Brilinta) and prasugrel (Effient). Clopidogrel is similar to ticlopidine (Ticlid) in chemical structure and in the way it works.

What are the uses for ibuprofen vs. Plavix?

Ibuprofen uses

Ibuprofen is used for the treatment of mild to moderate pain, inflammation and fever caused by many and diverse diseases. It is used for treating dysmenorrhea (menstrual cramps), osteoarthritis, rheumatoid arthritis, and juvenile idiopathic arthritis.

Plavix uses

Plavix is used for preventing strokes, heart attacks, and death in individuals who have had a previous stroke, unstable angina, heart attack or have peripheral arterial disease (PAD). The combination of Plavix and aspirin is better than aspirin or Plavix alone in preventing another heart attack but the risk of bleeding is higher.

What are the side effects of ibuprofen vs. Plavix?

Ibuprofen side effects

The most common side effects from ibuprofen are:

NSAIDs reduce the ability of blood to clot and therefore increase bleeding after an injury.

Ibuprofen may cause ulceration of the stomach or intestine, and the ulcers may bleed. Sometimes, ulceration can occur without abdominal pain; and due to bleeding, the only signs or symptoms of an ulcer may be black, tarry stools, weakness, and dizziness upon standing (orthostatic hypotension).

Sometimes, ulceration can occur without abdominal pain, due to the bleeding, and the only signs or symptoms of an ulcer are:

NSAIDs reduce the flow of blood to the kidneys and impair function of the kidneys. The impairment is most likely to occur in patients who already have impaired function of the kidney or congestive heart failure, and use of NSAIDs in these patients should be cautious.

People who are allergic to other NSAIDs, including aspirin, should not use ibuprofen. Individuals with asthma are more likely to experience allergic reactions to ibuprofen and other NSAIDs.

Other serious side effects associated with NSAIDs are:

NSAIDs (except low- dose aspirin) may increase the risk of potentially fatal heart attacks, stroke, and related conditions in people with or without heart disease or risk factors for heart disease. The increased risk of heart attack or stroke may occur as early as the first week of use and the risk may increase with longer use and is higher in patients who have underlying risk factors for heart and blood vessel disease. Therefore, NSAIDs should not be used for the treatment of pain resulting from coronary artery bypass graft (CABG) surgery.

Plavix side effects

People tolerate clopidogrel in the same way as aspirin.

The more common side effects of clopidogrel are:

Severe side effects and adverse reactions to Plavix include:

  • severe bleeding,
  • allergic reactions,
  • stroke,
  • pancreatitis, and
  • liver failure.

Ticlopidine (Ticlid) is an antiplatelet medication quite similar to clopidogrel. It has been associated with a severe reduction in white blood cell count in between 0.8% and 1% of persons. The risk of this dangerous side effect with clopidogrel is about 0.04%, much less than with ticlopidine but twice that of aspirin.

Clopidogrel rarely causes a condition called thrombotic thrombocytopenic purpura (TTP) in one out of every 250,000 people. TTP is a serious condition in which blood clots form throughout the body. Blood platelets, which participate in clotting, are consumed, and the result can be bleeding because enough platelets are no longer left to allow blood to clot normally. For comparison, the related drug, ticlodipine (Ticlid), causes TTP 17-50 times more frequently than clopidogrel.

What are the drug interactions of ibuprofen vs. Plavix?

Ibuprofen drug interactions

Ibuprofen is associated with several suspected or probable interactions that can affect the action of other drugs.

  • Ibuprofen may increase the blood levels of lithium (Eskalith, Lithobid) by reducing the excretion of lithium by the kidneys. Increased levels of lithium may lead to lithium toxicity.
  • Ibuprofen may reduce the blood pressure-lowering effects of drugs that are given to reduce blood pressure. This may occur because prostaglandins play a role in the regulation of blood pressure.
  • When ibuprofen is used in combination with methotrexate (Rheumatrex, Trexall) or aminoglycosides (for example, gentamicin) the blood levels of the methotrexate or aminoglycoside may increase, presumably because their elimination from the body is reduced. This may lead to more methotrexate or aminoglycoside-related side effects.
  • Ibuprofen increases the negative effect of cyclosporine on kidney function.
  • Individuals taking oral blood thinners or anticoagulants, for example, warfarin (Coumadin), should avoid ibuprofen because ibuprofen also thins the blood, and excessive blood thinning may lead to bleeding.
  • If aspirin is taken with ibuprofen there may be an increased risk for developing an ulcer.
  • Persons who have more than three alcoholic beverages per day may be at increased risk of developing stomach ulcers when taking ibuprofen or other NSAIDs.
  • Combining SSRIs or selective serotonin reuptake inhibitors (for example, fluoxetine [Prozac], citalopram [Celexa], paroxetine [Paxil, Paxil CR, Pexeva) with NSAIDs may increase the likelihood of upper gastrointestinal bleeding.

Plavix drug interactions

  • The combination of clopidogrel with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil, Nuprin), naproxen (Naprosyn, Aleve), diclofenac (Voltaren), etodolac (Lodine), nabumetone (Relafen), fenoprofen (Nalfon), flurbiprofen (Ansaid), indomethacin (Indocin), ketoprofen (Orudis; Oruvail), oxaprozin (Daypro), piroxicam (Feldene), sulindac (Clinoril), tolmetin (Tolectin), and mefenamic acid (Ponstel) may increase the risk of stomach and intestinal bleeding.
  • Combining clopidogrel with warfarin (Coumadin) or other drugs that cause bleeding increases the risk of bleeding.
  • Clopidogrel is converted to its active form by enzymes in the liver. Drugs that reduce the activity of these enzymes, for example, omeprazole (Prilosec, Zegerid) or esomeprazole (Nexium) may reduce the activity of clopidogrel and should not be used with clopidogrel. Other drugs that also may react with clopidogrel in a similar fashion include fluoxetine (Prozac, Sarafem), cimetidine (Tagamet), fluconazole (Diflucan), ketoconazole (Nizoral, Extina, Xolegel, Kuric), voriconazole (Vfend), ethaverine (Ethatab, Ethavex), felbamate (Felbatol), and fluvoxamine (Luvox).

Are ibuprofen or Plavix safe to take if I am pregnant or breastfeeding?

Ibuprofen and pregnancy safety

  • There are no adequate studies of ibuprofen in pregnant women. Therefore, ibuprofen is not recommended during pregnancy. Ibuprofen should be avoided in late pregnancy due to the risk of premature closure of the ductus arteriosus in the fetal heart.
  • Ibuprofen is excreted in breast milk but the American Academy of Pediatrics states that ibuprofen is compatible with breastfeeding.

Plavix and pregnancy safety

  • There are no adequate studies of clopidogrel in pregnant women.
  • Studies in rats have shown that clopidogrel appears in breast milk; however, it is not known whether it also appears in human breast milk. Because of a potential for side effects in the nursing infant, the physician must weigh the potential benefits and possible risks before prescribing clopidogrel to nursing mothers.

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Summary

Ibuprofen is an anti-inflammatory medication (NSAID) used for the treatment of mild to moderate pain and fever. Plavix (clopidogrel) is a blood thinner (anti-platelet) drug used for the prevention of strokes, heart attacks, and peripheral artery disease. Ibuprofen also thins the blood. If ibuprofen and Plavix are taken together it creates an interaction that thins the blood even more, which may cause gastrointestinal bleeding from ulcers in the digestive tract.

Common side effects of ibuprofen and Plavix include headaches, dizziness, rash, abdominal pain, and diarrhea. Side effects of ibuprofen that do not occur with Plavix include ringing in the ears, heartburn, drowsiness, nausea, and constipation. Serious side effects of Plavix that do not occur with ibuprofen include pancreatitis, severe bleeding, allergic reactions, and liver failure. Plavix also interacts with many other drugs so check with your doctor or pharmacist before taking over the counter medication or other prescription before taking Plavix.

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Medically Reviewed on 2/2/2018
References
REFERENCE: FDA Prescribing Information.
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