Ibuprofen with Ardeparin Interaction Details

Brand Names Associated with Ibuprofen

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Nov 12, 2023

Interaction Effect

An increased risk of bleeding

Interaction Summary

Concomitant use of low-molecular-weight heparins (LMWH) or heparinoids with NSAIDs may increase the risk of major bleeding events, including epidural or spinal hematomas in patients who are receiving neuraxial anesthesia or undergoing spinal puncture. Discontinuation of an NSAID prior to initiation of LMWH therapy is recommended when possible. If concomitant use of an LMWH and an NSAID is required, use extreme caution and closely monitor the patient for signs and symptoms of bleeding .

Severity

Major

Onset

Unspecified

Evidence

Probable

How To Manage Interaction

Concomitant use of low-molecular-weight heparins (LMWH) or heparinoids with NSAIDs may increase the risk of major bleeding events, including epidural or spinal hematomas in patients who are receiving neuraxial anesthesia or undergoing spinal puncture. Discontinuation of an NSAID prior to initiation of LMWH therapy is recommended when possible. If concomitant use of a LMWH and an NSAID is required, use extreme caution and closely monitor the patient for signs and symptoms of bleeding .

Mechanism Of Interaction

Decreased platelet function; decreased coagulation

Literature Reports

A) A 60-year-old female patient taking aspirin, naproxen, nifedipine, captopril, cimetidine, and potassium supplements was scheduled for ambulatory arthroscopic lateral meniscectomy. Ninety minutes prior to the initiation of epidural anesthesia, she received 30 mg of a low-molecular-weight heparin. The surgical procedure was uneventful, and she was discharged home with full motor and sensory function. Approximately 2 hours later, she began to experience excruciating lumbar back pain and returned to the hospital 90 minutes later. By this time, she had lost motor function of her lower extremities. Computerized tomography revealed an epidural hematoma, which was subsequently removed during emergency surgery. The patient regained full motor and sensory function by the second postoperative day. Although aspirin, NSAIDs, and low-molecular-weight heparin are all considered safe when administered alone prior to neuraxial block, it was felt that the combination of all 3 agents in this patient resulted in the development of the epidural hematoma .

B) Sixty patients undergoing total hip replacement surgery were randomized into 2 groups to determine whether enoxaparin and ketorolac used simultaneously can result in excessive postoperative bleeding. Prior NSAID therapy was discontinued 4 weeks before surgery. All patients received enoxaparin 40 mg subcutaneously 12 hours prior to surgery and then once daily for 10 days. Twenty-six patients also received ketorolac 30 mg intramuscularly on induction of anesthesia and then 30 mg once daily for 4 days. The other 34 patients received enoxaparin and opioid and acetaminophen analgesia. There were no significant differences between groups for intraoperative blood loss, postoperative drainage, transfusion requirements, wound oozing, bruising, and leg swelling. Also, no patients developed a clinically detectable gastrointestinal hemorrhage. The authors suggested that the risk of increased bleeding due to concomitant administration of a low-molecular-weight heparin and an NSAID is low, provided that the dose of the NSAID is modest .

C) A retrospective study of patients given enoxaparin in hip replacement surgery found significantly higher perioperative blood loss and increased use of blood transfusions in the group of patients who used preoperative NSAIDs compared with the group who did not use NSAIDs prior to surgery. No difference was found in the 2 groups comparing postoperative blood loss .

D) Twenty-four healthy male volunteers between the ages of 18 and 55 years were given all 4 combinations of ketorolac/placebo and dalteparin/placebo in a double-blind, placebo-controlled, randomized, crossover study designed to assess the hemostatic interaction between ketorolac and dalteparin. Ketorolac inhibited platelet aggregation in both whole blood and platelet-rich plasma and consequently prolonged the skin bleeding time. Although in range with normal population, there was a significant increase in levels of antifactor Xa and prolongation in the activated partial thromboplastin time after dalteparin administration. There was an interaction between ketorolac and dalteparin to prolong bleeding time, but dalteparin alone had no effect on bleeding time. There exists the possibility of hemorrhagic complications developing perioperatively when dalteparin and ketorolac are administered together .

Ibuprofen Overview

• Prescription ibuprofen is used to relieve pain, tenderness, swelling, and stiffness caused by osteoarthritis (arthritis caused by a breakdown of the lining of the joints) and rheumatoid arthritis (arthritis caused by swelling of the lining of the joints). It is also used to relieve mild to moderate pain, including menstrual pain (pain that happens before or during a menstrual period). Nonprescription ibuprofen is used to reduce fever and to relieve minor aches and pain from headaches, muscle aches, arthritis, menstrual periods, the common cold, toothaches, and backaches. Ibuprofen is in a class of medications called NSAIDs. It works by stopping the body's production of a substance that causes pain, fever, and inflammation.

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Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.

Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.

Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.

Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.