Taking Ibuprofen With Lexapro
In our latest question and answer, the pharmacist discusses the potential interaction between Lexapro (escitalopram) and ibuprofen.
I'm on 0.5mg Klonopin twice daily and 20mg Lexapro once daily. I also have 50mg tramadol twice a day or as needed for pain. Can I take 600mg ibuprofen too for inflammation? I have advanced arthritis. Thank you
Jun 19, 2022- Taking ibuprofen with Lexapro increases your risk of gastrointestinal bleeding because both medications can thin your blood and reduce your stomach's protective lining.
- Acetaminophen (Tylenol) is a safer pain relief option to try first, or your doctor may recommend adding a stomach-protective medication if you need to use ibuprofen.
- Talk to your doctor before taking ibuprofen with Lexapro to discuss the best pain relief option for your situation.
There is a moderate interaction between ibuprofen and Lexapro (escitalopram).
The use of NSAIDs (non-steroidal anti-inflammatory drugs), like ibuprofen, and SSRIs (selective serotonin reuptake inhibitors) medications, like Lexapro, increases the risk of gastrointestinal bleeding.
In general, the use of alternative analgesic options (like Tylenol) should be explored first or it would be prudent to consider the addition of a gastroprotective drug, like Prilosec or Nexium to mitigate the risk.
There are no specific guidelines on exactly how to approach this interaction, but the recommendation above (to take a drug like Nexium) comes from a large review study, published in Pharmacotherapy, that reviewed the matter.
Details About Ibuprofen - Lexapro Interaction
A variety of studies have reported a significant increase in the risk of gastrointestinal bleeding with the concurrent use of SSRIs (e.g. Lexapro) and NSAIDs (e.g. ibuprofen).
Just how much the risk is increased varies by study, but it is nearly universally reported that there is a definitive risk. One study, published in the British Journal of Clinical Pharmacology, reported a nearly 10-fold increase in the risk of GI bleeding:
In conclusion, our results confirm that particularly the use of SSRIs in combination with NSAIDs increases the risk of gastrointestinal adverse effects, a 10 times higher risk than for SSRIs alone."
Both NSAIDs and SSRIs have anti-platelet effects, meaning they decrease blood platelet aggregation and inhibit the formation of blood clots.
The additive antiplatelet effect of both ibuprofen and Lexapro increases the risk of bleeding.
Adding on to this, NSAIDs, like ibuprofen, cause a reduction of gastroprotective prostaglandins (which is why long-term use can cause stomach ulceration).
Lastly, there have been small studies that suggest that NSAID use can decrease the effectiveness of SSRIs.
One study found individuals taking SSRI medication had decreased rates of depression remission if they were also taking NSAIDs (45% remission), compared to those not taking NSAIDs (55% remission).
More studies are needed to determine the validity of this however as the study mentioned above was not a large clinical trial and was based on self-reported NSAID use.
Other Options
Due to the increased risk of bleeding, it would be prudent to try other pain-relieving options, like acetaminophen (Tylenol) or prescription analgesics before ibuprofen use.
Topical analgesics, like Voltaren, Salon-Pas or IcyHot may be an option too.
You should speak to your doctor before adding ibuprofen to your current medication.
Final Words
Thanks again for reaching out to us!
I know how challenging it can be to find the right pain medication to take that is safe with all your other medications.
I highly recommend reaching out to your doctor so they can provide you with guidance for your specific medical situation.
References & sources
- Antidepressant effects of selective serotonin reuptake inhibitors (SSRIs) are attenuated by antiinflammatory drugs in mice and humans — PubMed
- Combined use of SSRIs and NSAIDs increases the risk of gastrointestinal adverse effects — PubMed
- Interaction between selective serotonin reuptake inhibitors and nonsteroidal antiinflammatory drugs: review of the literature — PubMed
Glossary — Terms in This Answer
- NSAIDs
- Non-steroidal anti-inflammatory drugs are pain relievers and anti-inflammatory medications like ibuprofen.
- SSRIs
- Selective serotonin reuptake inhibitors are a class of antidepressant medications like Lexapro that work by increasing serotonin levels in the brain.
- Gastrointestinal bleeding
- Bleeding that occurs in the stomach or digestive tract, which can be a serious side effect.
- Gastroprotective
- A medication or substance that protects the stomach lining from damage or ulcers.
- Anti-platelet effects
- The ability of a drug to reduce blood clotting by decreasing how well platelets stick together.
- Prostaglandins
- Natural substances in the body that help protect the stomach lining and regulate inflammation.
- Acetaminophen
- A pain reliever and fever reducer, also known as Tylenol, that works differently than NSAIDs.
- Topical analgesics
- Pain-relieving medications applied directly to the skin over the affected area rather than taken by mouth.
Dr. Brian Staiger, PharmD
Doctor of Pharmacy, board certified clinical pharmacist (BCPS), American Herbalist Guild, Medication Therapy Management certified
Brian Staiger, PharmD, BCPS, is a licensed pharmacist with more than 13 years of experience across retail pharmacy, clinical pharmacy, medication safety, pharmacy program development, and healthcare administration. He is the founder of HelloPharmacist.com, where he helps patients...
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