10-pill warning: ramipril, amlodipine, furosemide and ibuprofen
If you’re taking ramipril + furosemide, be particularly careful about adding ibuprofen or another NSAID. This combination can increase the risk of acute kidney injury, especially with dehydration, older age, or existing kidney problems.
Medicines and products to watch
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Ibuprofen
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Naproxen
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Diclofenac
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Ketoprofen
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Indomethacin
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High-dose aspirin/other NSAIDs
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Cold and flu products containing an NSAID
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Combination painkillers containing ibuprofen
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Potassium supplements — ask your clinician before using them with ramipril.
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Potassium-containing salt substitutes — these can raise potassium when combined with ramipril.
Why ibuprofen deserves special attention
Ramipril is an ACE inhibitor and furosemide is a diuretic. Adding an NSAID such as ibuprofen creates the well-known “triple whammy” combination, which can substantially increase the risk of acute kidney injury. NSAIDs can also interfere with the blood-pressure-lowering and diuretic effects of treatment.
Amlodipine doesn’t create this same classic triple-whammy interaction, but ibuprofen and other NSAIDs can still interact with blood-pressure medicines and may reduce their effectiveness
