Paracetamol and ibuprofen are two of the most commonly used and widely available painkillers in the UK, but there are certain medications that should not be taken alongside them
09:18, 30 May 2025Updated 13:19, 30 May 2025
Paracetamol can increase the risk of bleeding if you take warfarin regularly(Image: Getty)
The NHS has issued a warning to those on certain medications about the potential hazards of combining them with commonly-used painkillers. The health service advises consulting with your doctor or pharmacist before taking paracetamol or ibuprofen if you’re affected.
Many rely on over-the-counter remedies like paracetamol for common complaints including headaches, backaches, and the symptoms of colds. Ibuprofen is another accessible pain reliever in the UK, used against various discomforts such as back and period pains, toothaches, and symptoms related to colds, flu, or COVID-19.
While these medications are typically safe when used according to instructions, the NHS lists medicines on its website that should not be mixed with either paracetamol and ibuprofen.
With regard to paracetamol, the NHS suggests speaking with your GP prior to use if you are on certain drugs. Specifically, they warn against the use of the painkiller along with warfarin, a medicine used to prevent blood clots, reports the Express.
They said: “Paracetamol can increase the risk of bleeding if you take it [warfarin] regularly.”
However, a lower dose of paracetamol can be safe alongside warfarin, with the health service clarifying: “It’s safe to take paracetamol while you’re on warfarin. But take the lowest dose that controls your pain.
“Taking more than four 500mg tablets over 24 hours for longer than a few days may make your blood clot more slowly. This puts you at risk of bleeding.”
It can also be potentially hazardous to take the painkiller alongside other medications that contain paracetamol such as co-codamol or certain cold and flu tablets, due to the risk of overdose. However, ibuprofen, aspirin and codeine are other painkillers that do not contain paracetamol and are safe to take with paracetamol.
The NHS advises that you should consult your doctor before taking paracetamol if you are on medicine to treat epilepsy or tuberculosis (TB) as this can also pose an added risk.
Ibuprofen
The NHS has warned that people on certain medications might not be able to take these painkillers(Image: Getty)
These include aspirin, diclofenac, celecoxib and naproxen, and when taken together could heighten the risk of side effects such as stomach bleeding or kidney problems.
“NSAIDs are also used in medicines you can purchase from pharmacies, such as cough and cold remedies,” states the NHS. “Before taking any other medicines, check the label to see if they contain aspirin, ibuprofen or other NSAIDs.”
For your safety, you should also inform your doctor if you’re taking any of the following medicines before you start taking any type of ibuprofen:
- Medicines that help to prevent blood clots, such as warfarin
- Medicines for high blood pressure
- Steroid medicines such as betamethasone, dexamethasone, hydrocortisone or prednisolone
- Antibiotics such as ciprofloxacin, levofloxacin, moxifloxacin, norfloxacin or ofloxacin
- Antidepressants such as citalopram, fluoxetine, fluvoxamine, venlafaxine, paroxetine or sertraline
- Diabetes medicines such as gliclazide, glimepiride, glipizide or tolbutamide.
You should also avoid taking ibuprofen with ginkgo biloba supplements as it can “increase the chance of bleeding”. The NHS added that you should see a doctor as soon as possible or call 111 if you have been taking ibuprofen and you experience:
- Black poo or blood in your vomit – these can be signs of bleeding in your stomach.
- Swollen ankles, blood in your pee or not peeing at all – these can be signs of a kidney problem.