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In two postmarketing clinical studies the incidence of a decreased hemoglobin level was greater than previously reported. Decrease in hemoglobin of 1 gram or more was observed in Positive stool occult blood tests and elevated serum creatinine levels were also observed in these studies. NSAIDs inhibit platelet aggregation and have been shown to prolong bleeding time in some patients.

Unlike aspirin, their effect on platelet function is quantitatively less, of shorter duration, and reversible. Patients receiving ibuprofen tablets who may be adversely affected by alterations in platelet function, such as those with coagulation disorders or patients receiving anticoagulants should be carefully monitored.

Preexisting asthma Patients with asthma may have aspirin-sensitive asthma. The use of aspirin in patients with aspirin-sensitive asthma has been associated with severe bronchospasm, which can be fatal. Since cross reactivity, including bronchospasm, between aspirin and NSAIDs has been reported in such aspirin-sensitive patients, ibuprofen tablets should not be administered to patients with this form of aspirin sensitivity and should be used with caution in patients with preexisting asthma.

If a patient develops such complaints while receiving ibuprofen tablets, the drug should be discontinued, and the patient should have an ophthalmologic examination which includes central visual fields and color vision testing. Aseptic Meningitis Aseptic meningitis with fever and coma has been observed on rare occasions in patients on ibuprofen therapy. Although it is probably more likely to occur in patients with systemic lupus erythematosus and related connective tissue diseases, it has been reported in patients who do not have an underlying chronic disease.

If signs or symptoms of meningitis develop in a patient on ibuprofen tablets, the possibility of its being related to ibuprofen tablets should be considered. Information for Patients Patients should be informed of the following information before initiating therapy with an NSAID and periodically during the course of ongoing therapy.

Cardiovascular Thrombotic Events Advise patients to be alert for the symptoms of cardiovascular thrombotic events, including chest pain, shortness of breath, weakness, or slurring of speech, and to report any of these symptoms to their health care provider immediately [see WARNINGS ].

Ibuprofen tablets, like other NSAIDs, can cause GI discomfort and, rarely, serious GI side effects, such as ulcers and bleeding, which may result in hospitalization and even death. Although serious GI tract ulcerations and bleeding can occur without warning symptoms, patients should be alert for the signs and symptoms of ulcerations and bleeding, and should ask for medical advice when observing any indicative signs or symptoms including epigastric pain, dyspepsia, melena, and hematemesis.

Although serious skin reactions may occur without warning, patients should be alert for the signs and symptoms of skin rash and blisters, fever, or other signs of hypersensitivity such as itching, and should ask for medical advice when observing any indicative signs or symptoms. Patients should be advised to stop the drug immediately if they develop any type of rash and contact their physicians as soon as possible. Heart Failure And Edema Advise patients to be alert for the symptoms of congestive heart failure including shortness of breath, unexplained weight gain, or edema and to contact their healthcare provider if such symptoms occur [see WARNINGS ].

Patients should be informed of the warning signs and symptoms of hepatotoxicity e. If these occur, patients should be instructed to stop therapy and seek immediate medical therapy. Patients should be informed of the signs of an anaphylactoid reaction e. In late pregnancy, as with other NSAIDs, ibuprofen tablets should be avoided because it may cause premature closure of the ductus arteriosus.

Laboratory Tests Because serious GI tract ulcerations and bleeding can occur without warning symptoms, physicians should monitor for signs or symptoms of GI bleeding. If clinical signs and symptoms consistent with liver or renal disease develop, systemic manifestations occur e. Aspirin When ibuprofen tablets are administered with aspirin, its protein binding is reduced, although the clearance of free ibuprofen tablets is not altered.

The clinical significance of this interaction is not known; however, as with other NSAIDs, concomitant administration of ibuprofen and aspirin is not generally recommended because of the potential for increased adverse effects.

Diuretics Clinical studies, as well as post marketing observations, have shown that ibuprofen tablets can reduce the natriuretic effect of furosemide and thiazides in some patients. This response has been attributed to inhibition of renal prostaglandin synthesis. Lithium Ibuprofen produced an elevation of plasma lithium levels and a reduction in renal lithium clearance in a study of eleven normal volunteers.

This effect has been attributed to inhibition of renal prostaglandin synthesis by ibuprofen. Thus, when ibuprofen and lithium are administered concurrently, subjects should be observed carefully for signs of lithium toxicity. Read circulars for lithium preparation before use of such concurrent therapy. Methotrexate NSAIDs have been reported to competitively inhibit methotrexate accumulation in rabbit kidney slices.

This may indicate that they could enhance the toxicity of methotrexate. Warfarin-type anticoagulants Several short-term controlled studies failed to show that ibuprofen tablets significantly affected prothrombin times or a variety of other clotting factors when administered to individuals on coumarin-type anticoagulants. However, because bleeding has been reported when ibuprofen tablets and other NSAIDs have been administered to patients on coumarin-type anticoagulants, the physician should be cautious when administering ibuprofen tablets to patients on anticoagulants.

The effects of warfarin and NSAIDs on GI bleeding are synergistic, such that the users of both drugs together have a risk of serious GI bleeding higher than users of either drug alone. H-2 Antagonists In studies with human volunteers, co-administration of cimetidine or ranitidine with ibuprofen had no substantive effect on ibuprofen serum concentrations.

Pregnancy Category C Reproductive studies conducted in rats and rabbits have not demonstrated evidence of developmental abnormalities. However, animal reproduction studies are not always predictive of human response. There are no adequate and well-controlled studies in pregnant women. Ibuprofen should be used in pregnancy only if the potential benefit justifies the potential risk to the fetus.

Nonteratogenic effects Because of the known effects of NSAIDs on the fetal cardiovascular system closure of ductus arteriosus , use during late pregnancy should be avoided. Considering there are no known drug interactions with Tramadol, an individual with moderate to moderately severe pain could be prescribed both drugs together.

Similar Components Again, there are differences found when comparing Tramadol and ibuprofen but in crystal form both share much the same processes and offer the same uses although ibuprofen has the added element of being an anti-inflammatory medication. Now, one thing that Tramadol offers that ibuprofen does not is the ability to also treat anxiety and depression. While the primary purpose is to relieve pain, Tramadol does have this extra benefit. Conclusion The bottom line is that both Tramadol and Ibuprofen have been proven effective and safe for treating pain.

Even so, it is important to understand the distinct differences. For instance, in comparing Tramadol and ibuprofen, Tramadol appears to work best for more intense levels of pain whereas ibuprofen seems to be somewhat better for mild to moderate pain. Then as mentioned, from what experts can tell there is no real risk associated with taking Tramadol and ibuprofen at the same time.

When it comes to pain medication, this is somewhat rare so having the ability to combine the two drugs is highly beneficial for certain situations. Remember that ibuprofen also offers anti-inflammatory properties, something Tramadol does not provide. Such drugs include dicyclomine Bentyl , some antihistamines for example, carbinoxamine [Rondec], clemastine [ Tavist ], diphenhydramine [ Benadryl ], promethazine [Phenergan] ; some phenothiazines for example, thioridazine [Mellaril], triflupromazine [Stelazine] ; some tricyclic antidepressants for example, amitriptyline [ Elavil , Endep ] amoxapine [Asendin], clomipramine [ Anafranil ], protriptyline [Vivactil] ; clozapine Clozaril , cyclobenzaprine Flexeril , and disopyramide Norpace.

The use of antidiarrheals for example, diphenoxylate [ Lomotil ], loperamide [ Imodium ] in persons taking opioid analgesics such as hydrocodone can lead to severe constipation and possibly greater sedation. Cimetidine Tagamet , when used with opiate analgesics such as hydrocodone, can cause confusion , disorientation, seizures or respiratory depression by increasing blood concentrations of the opiate. Ibuprofen, which has blood thinning anticoagulant properties, is used with caution in patients taking other blood thinning anticoagulants such as warfarin Coumadin , because of an increased risk of bleeding.

Concurrent use of ibuprofen and clopidogrel Plavix can also lead to increased risk of bleeding. Patients taking lithium Eskalith, Lithobid can develop toxic blood lithium levels if ibuprofen is taken at the same time.

Ibuprofen may increase methotrexate Rheumatrex , Trexall toxicity when used together.

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