The short answer
- Usually fine for occasional, short-term ibuprofen at normal doses, taken with food.
- Be more careful if you are over 65, also take an SSRI or a blood thinner, have had a stomach ulcer, or have kidney or heart problems.
- Paracetamol combines with amitriptyline without these concerns.
Why people ask about this combination
Amitriptyline is a tricyclic antidepressant. At antidepressant doses (75–150 mg a day) it’s now used less often, but at low doses (10–50 mg at night) it’s widely prescribed for nerve pain, fibromyalgia, migraine and tension-headache prevention, IBS and poor sleep with pain. Many people on it still get headaches, period pain or injuries and reach for ibuprofen. Pharmacy interaction checkers often flag the pair, which is why the question comes up.
What the interaction actually is
Amitriptyline and ibuprofen don’t change each other’s blood levels. The flagged risk is bleeding, mainly in the stomach. Ibuprofen reduces the stomach’s protective prostaglandins and affects platelets. Antidepressants that block serotonin reuptake reduce the serotonin stored in platelets, which makes them a little less effective at forming clots. The effect is strong with SSRIs (sertraline, citalopram, fluoxetine) and SNRIs, and weaker with amitriptyline. The extra risk from amitriptyline plus a short course of ibuprofen is small for most people, but it adds up with age, ulcer history, alcohol, steroids and blood thinners.
| Your situation |
Ibuprofen with amitriptyline? |
| Under 65, healthy, occasional use |
Usually fine, with food, lowest dose |
| Also take an SSRI/SNRI, steroid or aspirin |
Ask your pharmacist; paracetamol preferred |
| Take warfarin, apixaban, rivaroxaban or clopidogrel |
Avoid unless your doctor approves |
| History of ulcer or stomach bleeding |
Avoid |
| Kidney disease, heart failure, high blood pressure |
Avoid or ask first |
| Over 65 |
Prefer paracetamol or a gel; short courses only |
Other things to know with amitriptyline
- Drowsiness adds up with alcohol, sedating antihistamines, codeine, tramadol, gabapentin and sleeping tablets. See tramadol and gabapentin.
- Serotonin: tramadol, triptans and St John’s wort with amitriptyline can, rarely, cause serotonin toxicity.
- Anticholinergic load: constipation, dry mouth and urinary retention worsen with Buscopan-type medicines, older antihistamines and bladder tablets.
- Heart rhythm: high doses of amitriptyline can affect the heart rhythm; some antibiotics and other medicines add to this. Tell every prescriber you take it.
- Don’t stop suddenly after long use; reduce gradually with your doctor.
Pain relief options while on amitriptyline
| Option |
Suitability |
| Paracetamol |
First choice; no relevant interaction |
| Ibuprofen tablets |
Short courses for most people (see table above) |
| Ibuprofen or diclofenac gel |
Good for joint and muscle pain; low absorption |
| Codeine, tramadol |
Only if prescribed; extra drowsiness and serotonin risk |
| Triptans for migraine |
Often used together safely; ask your prescriber |
The broader rules for combining are in our guide to combining medicines safely.
Frequently asked questions
Can I take ibuprofen and amitriptyline at the same time of day?
Yes, timing doesn’t change the interaction. Amitriptyline is usually taken at night because of drowsiness; ibuprofen is best taken with a meal.
Can I take Panadol with amitriptyline?
Yes. Paracetamol at normal doses is the safest everyday painkiller to combine with amitriptyline.
Does amitriptyline make Nurofen less effective?
No. The two don’t reduce each other’s effects.
I take amitriptyline for migraine. What should I take during an attack?
Ibuprofen, aspirin or paracetamol, or a triptan if prescribed, are commonly used during attacks. If you need acute treatment on more than about 10 days a month, see your doctor: overuse can cause more headaches.
Sources and further reading
CanforaMedicine Guide
