Clopidogrel × Ibuprofen

Ibuprofen, like other non-steroidal anti-inflammatory drugs (NSAIDs), can inhibit platelet aggregation and prolong bleeding time (ibuprofen SmPC); clopidogrel also prolongs bleeding time (clopidogrel SmPC). Ibuprofen itself can cause ulcers and gastrointestinal bleeding, and antiplatelet drugs raise the risk of such bleeding (ibuprofen SmPC). The US Food and Drug Administration (FDA) states that clopidogrel with NSAIDs increases the risk of gastrointestinal bleeding (clopidogrel FDA label). In patients who also take low-dose aspirin, ibuprofen may competitively reduce its effect on platelets; with occasional ibuprofen use a clinically relevant effect is unlikely (ibuprofen SmPC).

Bleeding gums, nosebleeds, bruising without injury, black tarry stools, blood in the urine, vomiting blood or coffee-ground material, abdominal pain. The risk of gastrointestinal bleeding is higher in older people, after a previous ulcer, especially one complicated by bleeding or perforation, and with higher ibuprofen doses (ibuprofen SmPC).

Clopidogrel is used with caution with non-steroidal anti-inflammatory drugs (NSAIDs) (clopidogrel SmPC), and ibuprofen with special caution with antiplatelet drugs (ibuprofen SmPC). Use ibuprofen at the lowest effective dose for the shortest time needed to relieve symptoms (ibuprofen SmPC). For patients who need drugs that raise gastrointestinal risk, the ibuprofen SmPC advises considering gastroprotection with misoprostol or a proton pump inhibitor; for older patients and those with a history of ulcer it recommends such protection and a start at the lowest dose (ibuprofen SmPC). Warn the patient that bleeding may last longer on clopidogrel and ask them to report any unusual bleeding or abdominal symptoms at once (clopidogrel and ibuprofen SmPCs). Stop ibuprofen at once if gastrointestinal bleeding or an ulcer occurs (ibuprofen SmPC).