Is it safe to take ibuprofen with antibiotics?

After starting antibiotics, you may still need relief from ongoing pain or discomfort. But with the risk of side effects and drug interactions, choosing the right painkiller can be tricky. Should you take ibuprofen or avoid it and wait it out?

It's always best to consult your doctor before combining medications with antibiotics, but generally, ibuprofen doesn't pose a significant issue. Most antibiotic classes, including macrolides, penicillins, cephalosporins, nitrofurans, sulfonamides, and tetracyclines, do not interact negatively with NSAIDs like ibuprofen.

There is one significant exception to the rule: fluoroquinolones. These antibiotics defy many standard guidelines. Fluoroquinolones are powerful medications, but this potency comes with some severe side effects. In 2008, the U.S. Food & Drug Administration (FDA) issued a boxed warning for all fluoroquinolones due to the risk of tendon damage and rupture. A boxed warning is the most severe warning available, meant to ensure doctors and patients take notice. The FDA issued another warning in 2013, highlighting the risk of peripheral neuropathy, which involves nerve damage between the spinal cord and brain, causing numbness, tingling, pain, and potentially long-term disability in the arms and legs.

Fluoroquinolones can have serious effects on the central nervous system, often being described as toxic to it. Ibuprofen also affects the central nervous system, and combining these two drugs can lead to problems. Fluoroquinolones are known to increase the risk of seizures, and this risk is heightened when they are used with NSAIDs [source: Hori]. A study found that each fluoroquinolone interacts differently with various NSAIDs, making the situation even more complex [source: Hori]. As a result, it’s generally advised to avoid taking ibuprofen with any fluoroquinolone.

In an ideal world, the issue with fluoroquinolones and ibuprofen wouldn’t even be a concern. Given their side effect risks, most fluoroquinolones are meant to be used only as a last resort. However, in 2011, doctors prescribed 23 million fluoroquinolone prescriptions – it's hard to imagine that every one of these patients was in a critical situation [source: Miller]. So, if your doctor prescribes Cipro, Avelox, Levaquin, Factive, Noroxin, or Floxin for a urinary tract infection or pneumonia, make sure to ask plenty of questions and consider getting a second opinion.