Combining certain medications with paracetamol or ibuprofen could be risky.
The NHS has warned that people taking specific medicines should take care when using painkillers as combining them could prove risky. You should speak with your GP before taking paracetamol or ibuprofen if this applies to you, the health service has advised.
Many people rely on over-the-counter painkillers for everyday ailments. Paracetamol is one such medication commonly used for headaches, back pain and colds, among other problems.
Ibuprofen is similarly widely available throughout the UK, used for different aches and pains, including back pain, period pain, toothache and treating symptoms of colds, flu or even COVID-19. Although these tablets are generally safe to take provided you follow the instructions on the packet, they do come with certain warnings.
On its website, the NHS explains that certain other medications should not be taken alongside paracetamol and ibuprofen.
Paracetamol
The NHS says that paracetamol is “not suitable” for everyone. This includes people who regularly take warfarin, a medication to prevent blood clots.
If this applies to you, you should consult with your doctor before taking paracetamol, the health authority says. The NHS adds: “Paracetamol can increase the risk of bleeding if you take it [warfarin] regularly.”
However, it remains safe to take low-dose paracetamol with warfarin. The NHS continues: “It’s safe to take paracetamol while you’re on warfarin. But take the lowest dose that controls your pain.
“Taking more than four 500mg tablets over 24 hours for longer than a few days may make your blood clot more slowly. This puts you at risk of bleeding.”
It’s also potentially dangerous to consume the painkiller alongside other medications containing paracetamol, such as co-codamol or certain cold and flu remedies, because of the overdose risk.
Nevertheless, ibuprofen, aspirin and codeine are alternative painkillers that don’t contain paracetamol and can be safely taken with it. The NHS recommends consulting your GP before using paracetamol if you’re taking medication for epilepsy or tuberculosis (TB) as this may also present risks.
Ibuprofen
The NHS website warns: “Ibuprofen does not mix well with some medicines.” The health service has advised people against taking ibuprofen simultaneously with other nonsteroidal anti-inflammatory drugs (NSAIDs).
These include aspirin, diclofenac, celecoxib and naproxen, and combining them could increase the risk of adverse effects such as stomach bleeding or kidney complications. “NSAIDs are also used in medicines you can buy from pharmacies, such as cough and cold remedies,” explains the NHS.
“Before taking any other medicines, check the label to see if they contain aspirin, ibuprofen or other NSAIDs.” For safety purposes, you should also tell your doctor if you’re using any of the following medicines before starting any form of ibuprofen:
- Medications that help prevent blood clots, such as warfarin
- Medications for high blood pressure
- Steroid medications like betamethasone, dexamethasone, hydrocortisone or prednisolone
- Antibiotics such as ciprofloxacin, levofloxacin, moxifloxacin, norfloxacin or ofloxacin
- Antidepressants such as citalopram, fluoxetine, fluvoxamine, venlafaxine, paroxetine or sertraline
- Diabetes medications such as gliclazide, glimepiride, glipizide or tolbutamide
You should also avoid combining ibuprofen with gingko biloba supplements as it can “increase the chance of bleeding”. The NHS has further warned that you should seek urgent medical help or ring 111 if you have been taking ibuprofen and experience:
- Dark stools or blood in your vomit – these can indicate bleeding in your stomach
- Swollen ankles, blood in your urine or complete inability to urinate – these can signal kidney problems
