What are the contraindications for ibuprofen?

October 12, 2025 •

3 min read

An estimated 10–20% of patients taking Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) like ibuprofen experience dyspepsia. Knowing what are the contraindications for ibuprofen is crucial for safe use, as it can pose serious risks for individuals with specific health conditions.

Quick Summary

Ibuprofen is contraindicated in individuals with a history of NSAID hypersensitivity, heart bypass surgery, active peptic ulcers, severe heart failure, and during the third trimester of pregnancy.

Key Points

Absolute Contraindications: Avoid ibuprofen if you have a history of NSAID allergy, are just before or after heart bypass surgery, have an active stomach ulcer, severe heart failure, or are in your third trimester of pregnancy.
Cardiovascular Risks: Ibuprofen increases the risk of heart attack and stroke, especially with long-term use or in those with pre-existing heart disease.
Gastrointestinal Damage: A major risk is stomach irritation and bleeding; individuals with a history of ulcers or those over 65 are at higher risk.
Kidney and Liver Health: Regular or high-dose use can impair kidney function, and caution is needed for those with liver disease.
Asthma: People with aspirin-exacerbated respiratory disease (AERD) can experience worsening asthma symptoms after taking ibuprofen.
Drug Interactions: Ibuprofen can negatively interact with common medications, including blood thinners, aspirin, other NSAIDs, and blood pressure drugs.
Pregnancy vs. Breastfeeding: Ibuprofen is contraindicated late in pregnancy but is generally considered safe to use while breastfeeding.

Understanding Ibuprofen and Its Mechanism

Ibuprofen is a widely used nonsteroidal anti-inflammatory drug (NSAID) that works by inhibiting cyclooxygenase (COX) enzymes. These enzymes are involved in the production of prostaglandins, which promote inflammation, pain, and fever. By blocking COX enzymes, ibuprofen reduces these symptoms. However, prostaglandins also protect the stomach lining and help maintain blood flow to the kidneys. This dual action is why ibuprofen, while beneficial, carries risks for certain individuals.

Absolute Contraindications: Who Should Not Take Ibuprofen

Absolute contraindications are situations where ibuprofen should not be used due to a high risk of serious adverse effects. Individuals with the following conditions should avoid ibuprofen completely:

History of Hypersensitivity: A known allergy to ibuprofen, aspirin, or any other NSAID.
Coronary Artery Bypass Graft (CABG) Surgery: Avoid right before or after heart bypass surgery due to increased risk of heart attack and stroke.
Active Peptic Ulcer: Can worsen the condition and lead to severe gastrointestinal bleeding.
Severe Heart Failure: Can cause sodium and water retention, exacerbating the condition.
Third Trimester of Pregnancy: Not recommended due to potential harm to the fetus.

Relative Contraindications and High-Risk Groups

Relative contraindications mean caution is required and a healthcare professional should be consulted. Risks and benefits must be carefully weighed.

Cardiovascular Conditions

Ibuprofen and other NSAIDs increase the risk of serious cardiovascular events, including heart attack and stroke, according to a black box warning from the FDA. This risk may increase with duration of use and is higher for those with existing cardiovascular disease. Caution is advised for people with:

High blood pressure
History of heart attack or stroke
Angina or peripheral arterial disease

Gastrointestinal (GI) Issues

Long-term ibuprofen use can irritate the stomach lining and cause peptic ulcers. Caution is advised for individuals with a history of GI problems. Risk factors include:

Age over 65
Previous history of peptic ulcers or GI bleeding
Concurrent use of certain medications (corticosteroids, anticoagulants, SSRIs)
Heavy alcohol consumption

Kidney and Liver Disease

NSAIDs can reduce blood flow to the kidneys, potentially impairing function, especially with regular use. Those with pre-existing kidney disease are at higher risk of acute kidney injury. Individuals with severe liver disease should also use caution.

Asthma

Some individuals with asthma, particularly those with aspirin-exacerbated respiratory disease (AERD), may experience worsened asthma symptoms after taking NSAIDs like ibuprofen.

Special Populations

Pregnancy: Ibuprofen is generally avoided during pregnancy, especially after 20 weeks, and is contraindicated in the third trimester.
Breastfeeding: Ibuprofen is generally considered safe during breastfeeding due to low levels in breast milk.
Elderly (Over 65): Older adults are more susceptible to GI and kidney-related side effects.

Ibuprofen Drug Interactions

Ibuprofen can interact with several medications, increasing the risk of adverse effects:

Anticoagulants: Increased bleeding risk.
Aspirin: Can interfere with aspirin's heart-protective effect and increase GI bleeding risk.
Other NSAIDs: Significantly increases the risk of side effects.
Antihypertensives: Can reduce the effectiveness of blood pressure medications and increase kidney damage risk.
Lithium and Methotrexate: May increase the risk of toxicity.

Comparison Table: Contraindications vs. Common Side Effects


Feature	Contraindications	Common Side Effects
Nature	Conditions that make taking the drug unsafe.	Unwanted effects that can occur when the drug is taken as directed.
GI System	Active peptic ulcer disease, history of GI bleeding.	Nausea, indigestion, diarrhea, constipation, abdominal pain.
Cardiovascular	History of CABG surgery, severe heart failure.	Raised blood pressure, fluid retention (edema).
Renal System	Advanced or severe kidney disease.	Can potentially lead to kidney failure with long-term use or in susceptible individuals.
Allergy	Known hypersensitivity to aspirin or other NSAIDs.	Skin rashes.
Pregnancy	Contraindicated in the third trimester.	N/A

Conclusion

Ibuprofen is an effective over-the-counter pain reliever, but it is not suitable for everyone. The contraindications for ibuprofen are significant and emphasize the importance of knowing your health history. Absolute contraindications include NSAID allergy, recent heart bypass surgery, active ulcers, severe heart failure, and late-stage pregnancy. Individuals with a history of heart, kidney, or gastrointestinal problems, asthma, or those who are elderly, should consult a healthcare professional. Understanding these risks and potential drug interactions is crucial for safe and effective ibuprofen use.

For more detailed information, consult a qualified health care professional or visit an authoritative source such as the NHS page on Ibuprofen.

Frequently Asked Questions

You should use ibuprofen with caution if you have high blood pressure (hypertension). NSAIDs like ibuprofen can increase blood pressure and may reduce the effectiveness of blood pressure medications. It is best to consult your doctor first.

If you have an active stomach ulcer, you should not take ibuprofen. If you have a history of ulcers, you are at a higher risk of developing another one and should use ibuprofen with caution, preferably after consulting a healthcare provider.

Ibuprofen is contraindicated right before or after coronary artery bypass graft (CABG) surgery because it increases the risk of serious cardiovascular events like heart attack and stroke.

Some people with asthma, particularly those with aspirin-exacerbated respiratory disease (AERD), may experience worsening symptoms like wheezing and shortness of breath after taking ibuprofen. If you have asthma, you should talk to a doctor before using it.

No, ibuprofen is generally not recommended during pregnancy, especially after week 20. It is contraindicated during the third trimester because it can cause serious harm to the unborn baby, including heart and kidney problems.

It is best to avoid or limit alcohol when taking ibuprofen. The combination can increase your risk of stomach upset and serious gastrointestinal bleeding.

If you have kidney disease, you should avoid ibuprofen. NSAIDs can reduce blood flow to the kidneys, leading to fluid retention, elevated blood pressure, and potential worsening of kidney function or even acute kidney injury.