Is It Safe to Take Ibuprofen With Epilepsy Medications? Interactions and Precautions

Can I Take Ibuprofen With Epilepsy Medication?

Ibuprofen is a common over-the-counter non-steroidal anti-inflammatory drug (NSAID) used to treat pain, fever and inflammation. For people with epilepsy who take anti-seizure medications, ibuprofen may potentially interact with these drugs and alter their effectiveness.

This article covers whether it is safe to take ibuprofen alongside epilepsy medications, potential interactions and risks, safer alternatives to ibuprofen, and tips to use them together safely under medical guidance.

How Ibuprofen May Interact With Epilepsy Drugs

Ibuprofen belongs to the NSAID class of medications. It works by inhibiting the production of prostaglandins which are chemicals that cause inflammation and pain in the body.

Many older generation epilepsy medications are broken down in the liver by specialized CYP enzymes. Ibuprofen enhances the activity of one such enzyme called CYP2C9. This speeds up the metabolism of some anti-seizure drugs.

Faster breakdown means the concentration and efficacy of epilepsy medications in the blood can get lowered. This may potentially cause breakthrough seizures in controlled patients.

Epilepsy Drugs With Most Ibuprofen Interaction Risks

Some commonly used older epilepsy medications that interact with ibuprofen include:

• Phenytoin - Used for tonic-clonic, focal and status epilepticus seizures
• Phenobarbital - Prescribed for generalized and focal onset seizures
• Primidone - Treats generalized and focal epilepsies
• Carbamazepine - Used for focal, tonic-clonic and mixed seizures
• Valproic Acid - Broad spectrum anticonvulsant for most seizure types

These older anti-epileptics are more prone to interactions with ibuprofen due to CYP2C9 metabolism. However, some newer drugs may also be affected.

Other Epilepsy Medications That May Interact

In addition to older generation drugs, some newer epilepsy medications like levetiracetam, brivaracetam, zonisamide, lacosamide etc. may have possible interactions with ibuprofen, especially at higher doses.

Though the mechanisms are not fully clear, ibuprofen use has been linked with reduced levels or efficacy of these newer epilepsy drugs too in some people.

Similarly, specific drugs like clobazam and rufinamide that treat Lennox-Gaustaut syndrome may also get affected by concurrent ibuprofen intake.

Risks of Taking Ibuprofen With Epilepsy Medications

Possible risks of using ibuprofen alongside anti-seizure drugs include:

Lowered Epilepsy Drug Levels

As mentioned earlier, ibuprofen can speed up the metabolism of some epilepsy medications and reduce their blood concentrations. This decline in active drug levels can potentially lead to clusters of breakthrough seizures.

Loss of Seizure Control

With sub-therapeutic concentrations of epilepsy drugs, previously well-controlled seizures may start recurring more frequently.

Seizures that were infrequent may suddenly increase in number affecting day-to-day activities and quality of life.

Worsening Seizure Severity

Inadequate epilepsy medication levels may also lead to worsening of seizure intensity and duration.

Seizures that were milder earlier could evolve into more severe manifestations like generalized tonic-clonic seizures.

Status Epilepticus

Status epilepticus refers to prolonged, recurring seizures without recovery in between. It is a medical emergency that can lead to brain damage and respiratory arrest if not treated immediately.

Ibuprofen lowering anti-seizure drug concentrations significantly raises the risk for status epilepticus.

Adverse Drug Interactions

Besides reduced efficacy, combining ibuprofen and epilepsy medications may also cause additional side effects due to their synergistic actions.

For example, it can increase the risk of internal bleeding or kidney problems especially in older adults or those with comorbidities.

Safer NSAID Alternatives to Ibuprofen

Instead of ibuprofen, people with epilepsy may use the following safer NSAID alternatives under medical guidance:

Acetaminophen

Acetaminophen provides comparable pain relief to ibuprofen without substantially affecting epilepsy medication levels or interactions.

However, it should not be taken by people with liver disorders or in high doses for long term.

Celecoxib

Celecoxib is a selective COX-2 inhibitor that has minimal interactions with epilepsy drugs. It can be used for pain and arthritis.

But it carries some cardiovascular risks like heart attacks or strokes with long term use.

Aspirin

Low-dose aspirin does not significantly interact with most epilepsy medications. It can provide analgesic, anti-inflammatory and cardiovascular benefits.

However, aspirin is not suitable for children due to Reyes syndrome risks.

Topical NSAIDs

Diclofenac gel, ibuprofen cream and other topical NSAIDs have minimal systemic absorption. These can provide localized pain relief with minimal epilepsy drug interactions.

Acetaminophen-NSAID combinations

Combined formulations like acetaminophen with ketorolac provide an optimal balance of efficacy with minimal interactions.

But may have more GI side effects than single-agent NSAIDs.

When Is It Safe To Take Ibuprofen With Epilepsy Medications?

In certain situations, ibuprofen may be considered relatively safe to use along with epilepsy drugs but always under medical supervision:

• For very short-term use like a few days when acetaminophen proves inadequate
• In low 200-400mg doses and not on a regular basis
• By closely monitoring drug levels and seizure frequency
• When prescribed anti-epileptics are not significantly affected by CYP2C9 metabolism
• With newer generation epilepsy drugs that have lower interaction potential
• In patients who are seizure-free on stable medication regimens

However, ibuprofen is best avoided in high-risk groups like the elderly, people with uncontrolled seizures, liver disease or those on multiple medications.

Precautions When Taking Ibuprofen With Epilepsy Drugs

If ibuprofen has to be used along with anti-epileptics, some precautions include:

• Start with lowest effective ibuprofen dose for shortest duration required
• Maintain >2 hours gap between taking ibuprofen and epilepsy medications
• Never take ibuprofen on an empty stomach
• Stay well hydrated and monitor kidney function
• Watch for increased breakthrough seizures or side effects
• Carry rescue benzodiazepines like clonazepam for emergencies
• Avoid combining with other NSAIDs, blood thinners, steroids
• Consider taking epilepsy drugs 3-4 times a day to maintain stable levels

Key Takeaways

• Ibuprofen may potentially lower levels and efficacy of some epilepsy medications by interacting with liver enzymes
• Older generation anti-seiz

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.