NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

Ibuprofen Safety Update

The MHRA has published updated advice on cardiovascular risks of high dose ibuprofen and interaction of ibuprofen with aspirin. This confirms previous information on both of these issues.


A recently published meta-analysis showed that people taking ≥2400 mg of ibuprofen per day are at higher risk of arteriothrombotic events (heart attack, stroke) than people taking placebo. This higher risk is similar to that seen with COX-2 inhibitors and diclofenac. No increased risk of arterial thrombotic events is seen with ibuprofen at doses up to 1200 mg per day compared with not taking ibuprofen. It is uncertain whether doses between 1200 mg and 2400 mg per day are associated with an increased cardiovascular risk compared with not taking ibuprofen.


The latest experimental data confirm previous findings that ibuprofen competitively inhibits the effect of low-dose aspirin on platelet aggregation. Clinical data does not support a clinically meaningful interaction. However, the possibility that long-term, daily use of ibuprofen might reduce the cardioprotective effects of low-dose aspirin cannot be excluded. Occasional ibuprofen use is unlikely to have a clinically meaningful effect on the benefits of low-dose aspirin.


For more details on safe prescribing of oral NSAIDs, see Medicines Update Extra 24.