Taking Ibuprofen With Lexapro

In our latest question and answer, the pharmacist discusses the potential interaction between Lexapro (escitalopram) and ibuprofen.

Question

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

Asked by Fran On Jun 19, 2022

Answered by
Medical Content Reviewed By HelloPharmacist Staff

Published Jun 19, 2022
Last updated Jun 19, 2022

Key points

  • Taking Lexapro and ibuprofen together increases the risk of stomach bleeding.
  • In general, the combination of drugs should be avoided unless specifically recommended by your doctor.
  • Alternative pain medications that may be options for you include Tylenol (acetaminophen) and topical analgesics.

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 inhibitor) 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

  • 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

About the Pharmacist

Dr. Brian Staiger, PharmD

Dr. Brian has been practicing pharmacy for over 11 years and has wide-ranging experiences in many different areas of the profession. From retail, clinical and administrative responsibilities, he's your knowledgeable and go-to source for all your pharmacy and medication related questions!

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