Is ibuprofen a blood thinner?

Ibuprofen, often referred to by the brand names Motrin and Advil, is a nonsteroidal anti-inflammatory drug (NSAID). Ibuprofen can be used to relieve pain, reduce inflammation (swelling), and lower a fever. Ibuprofen is available over-the-counter (OTC) and by prescription in higher doses. Ibuprofen can also be found as an ingredient in many OTC combination products, such as Advil PM. NSAIDs like ibuprofen are associated with an increased risk of bleeding. However, they are not blood thinners. Continue reading to learn more about this topic.

Does ibuprofen thin your blood?

Ibuprofen is classified as a nonsteroidal anti-inflammatory drug, or NSAID for short. Besides ibuprofen, some examples of other NSAIDs include Aleve (naproxen), Mobic (meloxicam), Celebrex (celecoxib), and Voltaren (diclofenac). Let’s talk about how NSAIDs like ibuprofen work.

• Enzymes are proteins that speed up chemical reactions.
• Cyclooxygenase is an enzyme needed to make certain substances in the body, such as prostaglandins and thromboxanes. Prostaglandins can cause pain, inflammation (swelling), and fever. Thromboxanes are associated with blood clotting, which helps heal wounds and prevent excess bleeding.
• NSAIDs work by interfering with the enzyme cyclooxygenase. By doing so, fewer prostaglandins and thromboxanes are produced. 
• Because fewer prostaglandins are produced, NSAIDs help with symptoms like pain, inflammation, and fever.
• However, because NSAIDs affect thromboxanes, which affect blood clotting, there is also a risk of bleeding. Ibuprofen does not directly thin the blood, however.

Ibuprofen vs. blood thinners

Now that we know how ibuprofen works, let’s discuss blood thinners. Blood thinners are medicines that prevent blood clots from forming. They do not break up blood clots that are already there. Blood clots can lead to serious or fatal problems like heart attacks and strokes. Examples of individuals who may need to take a blood thinner include:

• People with certain blood vessel or heart conditions
• People with atrial fibrillation (a type of abnormal heart rhythm)
• People who have had a heart valve replacement
• People who are at risk for blood clots after a surgical procedure
• People with certain congenital (inherited) heart defects

There are two types of blood thinners:

Anticoagulants work by slowing blood clot production. Examples of anticoagulants include Coumadin (warfarin), Eliquis (apixaban), and Xarelto (rivaroxaban).

Antiplatelets prevent platelets (blood cells that stop or prevent bleeding and make clots) from clotting. Examples of antiplatelets include Plavix (clopidogrel), Effient (prasugrel), and Brilinta (ticagrelor). Aspirin is also an antiplatelet drug. 

Note that aspirin is an NSAID as well as an antiplatelet drug. Because it is an antiplatelet drug, some people will be advised to take daily low-dose aspirin to either prevent or treat cardiovascular events like heart attacks and strokes. However, this is not recommended for everyone—you should not take daily aspirin without consulting a healthcare provider. Aspirin can be used as an NSAID in adults for pain, inflammation, and fever at higher doses. 

Although NSAIDs like ibuprofen may increase the risk of bleeding, they are not used as blood thinners. A healthcare professional will never recommend or prescribe ibuprofen to thin the blood. However, if you take an NSAID, you can have an increased risk of bleeding as a side effect.

Risks of ibuprofen 

Common side effects of ibuprofen may include:

• Constipation 
• Gas
• Bloating
• Dizziness
• Nervousness
• Tinnitus (ringing in the ears)

As a prescription, ibuprofen has a black box warning, the most serious warning required by the U.S. Food & Drug Administration (FDA). Some of the warnings include:

• NSAIDs like ibuprofen can increase the risk of heart attack and stroke, which can cause death.
• NSAIDs like ibuprofen can increase the risk of serious gastrointestinal events, including stomach bleeding, perforation (holes), and stomach ulcers (sores). 

In addition to the black box warning, other serious side effects may include but are not limited to:

• Allergic reactions (symptoms such as hives, shortness of breath, or swelling require emergency medical attention)
• Skin reactions (symptoms such as fever, sore throat, burning eyes, skin pain, red or purple rash, or blistering or peeling skin require emergency medical attention)
• Liver problems
• Kidney problems
• Heart failure
• High blood pressure
• Anemia (low red blood cells)
• Vision problems

Ibuprofen is not safe for everyone. Before taking ibuprofen, you should tell your healthcare provider about all of your medical conditions. You should not take ibuprofen if you are allergic to ibuprofen or any NSAID, including aspirin. Other contraindications (situations where you should not take this medication) include:

• Before or after coronary artery bypass graft (CABG) surgery
• Third trimester of pregnancy (always consult a healthcare provider if you are pregnant, planning to become pregnant, or breastfeeding)
• Severe kidney problems
• Recent heart attack

NSAIDs like ibuprofen are generally recommended to be taken at the lowest effective dose for the shortest period of time. The risk of bleeding from NSAIDs is higher if:

• You take certain medications, such as steroids, blood thinners, or SSRI or SNRI antidepressants
• You take an NSAID for a longer time or a higher dose
• You smoke
• You drink alcohol
• You are older
• You have other health conditions, such as liver problems
• You have bleeding problems

Ibuprofen drug interactions

Before taking ibuprofen, tell your healthcare provider about all your medications, including prescription drugs, OTC medicines, vitamins, and supplements. 

When certain medications are taken with ibuprofen, there is an increased risk of bleeding. Some examples include:

• Other NSAIDs
• Corticosteroids such as prednisone 
• Blood thinners such as warfarin or heparin
• SSRI antidepressants such as Lexapro (escitalopram)
• SNRI antidepressants such as Effexor (venlafaxine)

According to the prescribing information, studies have shown that ibuprofen can specifically interact with aspirin. Taking ibuprofen with aspirin can increase the risk of bleeding, which can be life-threatening. However, ibuprofen may also interfere with aspirin’s protective effects on the heart. So, if you take low-dose aspirin as a blood thinner, check with your healthcare professional before taking pain relievers. You may need to take a medication that is not an NSAID, such as Tylenol (acetaminophen).  

Ibuprofen dosage

Ibuprofen should generally be taken at the lowest dose, providing relief and for the shortest time. This reduces the risk of serious side effects. If you take OTC ibuprofen, read the label carefully and consult a healthcare provider for medical advice before using it. If you take prescription ibuprofen, take it exactly as directed by your healthcare provider. Doses will vary based on individual factors, such as other medical conditions you have. Ibuprofen should be taken with food, and you should avoid alcohol while taking ibuprofen.

Adult dosing

The OTC adult dose is 200 to 400 milligrams (mg) orally every 4 to 6 hours as needed. The maximum daily dose is 1,200 mg.

Prescription dosing is as follows:

• For pain or fever, the dose is 400 to 800 mg by mouth every 6 hours as needed. The maximum daily dose is 3,200 mg.
• For inflammatory conditions, the dose is 400 to 800 mg orally every 6 to 8 hours as needed. The maximum daily dose is 3,200 mg.
• For osteoarthritis or rheumatoid arthritis, the dose is 300 to 800 mg by mouth every 6 to 8 hours as needed. The maximum daily dose is 3,200 mg.

Pediatric dosing

• Check with a pediatrician before using OTC ibuprofen. 
• Dosage depends on age, weight, and symptoms or condition.
• Always use the enclosed measuring device when measuring liquid ibuprofen for a child. Household measuring devices, such as kitchen utensils, are inaccurate for measuring medications.

RELATED: Ibuprofen dosage, forms, strengths

The bottom line 

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain, inflammation, and fever. Although ibuprofen can increase the risk of bleeding, especially when combined with certain medications, it is not a blood thinner and should never be used as such. If you take a blood thinner, check with your healthcare provider about the best options for pain relief. 

If you have any questions about ibuprofen, consult your healthcare provider or pharmacist for more information.