Can You Take Advil (Ibuprofen) With Prednisone?

Among the most common medications taking on pain and inflammation are prednisone (sold as Rayos, Prednisone Intensol, Orapred ODT) and Advil (ibuprofen). Both of these drugs modulate immune system responses to reduce symptoms of rheumatoid arthritis, osteoarthritis, lupus, and other painful, inflammatory conditions.

Though they have similar activity on the body—and treat some of the same conditions—there are key differences, and there are reasons why they should not be taken together.

Prednisone is a corticosteroid drug that works by regulating immune and metabolic function. It also helps treat severe allergic reactions, multiple sclerosis (MS), certain cancers, and other conditions. It is available by prescription in tablets and liquids.

Advil is widely available and well-known as a pain-reliever and fever-reducer. Coming in both prescription as well as over-the-counter forms, it’s a non-steroidal anti-inflammatory drug (NSAID) like Aleve (naproxen), aspirin, and Celebrex (celecoxib), among others.

Though they’re largely safe, as with all pharmaceutical drugs, there’s always a chance of unintended side effects when you take these drugs. However, when Advil and prednisone are taken together, this risk increases a great deal, with some patients developing bleeding or other symptoms in the gastrointestinal, or digestive, tract.

Given this risk, it’s important to get a sense of how these drugs align, what makes them different, and why they shouldn’t be taken together.  

How Prednisone and Ibuprofen Are Similar

As noted, both of these drugs both reduce and pain and swelling by moderating inflammatory responses in the body. But what does inflammation actually mean? Here’s a quick breakdown:

• Tissue damage: In response to bacterial or viral infection, toxins, or other causes, the immune system is stimulated, releasing several chemicals into the bloodstream.
• Swelling: The released chemicals—histamine, bradykinin, and prostaglandins—affect blood flow and cause fluid to leak into affected areas. This isolates them from healthy tissues and causes swelling.
• Repair: Phagocytes, a type of white blood cell, are also released, which attack bacteria, viruses, or damaged cells.

Though the exact mechanism of how they work varies, both prednisone and Advil reduce these inflammatory responses, which eases associated pain, itching, redness, warmth, and swelling. This immunosuppressive effect makes prescribed Advil and prednisone among the more common options for rheumatoid arthritis and osteoarthritis, in particular.

How Prednisone and Ibuprofen Are Different

Though both of these drugs have an anti-inflammatory effect, there are a number of significant differences. These have to do with how they work in the body as well as what conditions they treat.

Advil (ibuprofen), as a NSAID, is a drug defined by its being anti-inflammatory without involving corticosteroid hormones. This drug reduces the activity of cyclooxygenase enzymes (COX-1 and COX-2), which in turn prevent prostaglandins from stimulating inflammation and pain.

Commonly available over the counter, doctors may also prescribe stronger doses of Advil to help with acute or chronic pain. In addition to arthritis pain, it helps with symptoms of:

• Menstrual cramps
• Headaches
• Back pain
• Toothaches
• Fever
• The common cold

Prednisone is a corticosteroid drug that works by mimicking cortisol, a hormone that helps regulate metabolic and immune function. Not as widely available as Advil, it comes as a prescription tablet or liquid. It helps with a wide range of conditions, some of which aren’t usually treated with Advil. These include:

• Severe allergic reactions
• Skin problems
• Multiple sclerosis
• Leukemia and other cancers
• Gastrointestinal diseases (Crohn’s and ulcerative colitis)
• Pulmonary diseases 
• Lupus

Drugs of the corticosteroid class are often called “steroids,” but they’re actually only related to, and not the same thing as drugs that athletes take to boost athletic performance. 

Is It Safe to Take Advil With Prednisone?

Since prednisone and Advil both reduce the body’s inflammatory response—and since they both take on arthritis—it’s important to consider what happens when you take them at the same time. Though not outright contraindicated, it's recommended that people avoid Advil if they’ve been prescribed prednisone.

The combined or “entourage” effect of these two can be damaging and increases the likelihood of adverse effects. As a standard or practice, doctors carefully weigh the benefits and risks before prescribing drugs that interact like this, avoiding doing so if possible.

Increased Side Effects

One of the side-effects of Advil and other NSAIDs is an erosion of the lining of the digestive tract, which can lead to stomach ulcers as well as bleeding in the intestines and colon. Unfortunately, prednisone in combination with these drugs dramatically increases the chance of this occurring.

The most common signs of gastrointestinal (GI) bleeding are:

• Black, tarry stool
• Bright red, bloody stool
• Red blood in the vomit
• Coffee-ground-shaped vomit
• Abdominal Cramping
• Weakness, fatigue

NSAID Warnings

Even though Advil and other NSAIDs are widely available and highly effective in managing symptoms, you have to be careful when taking them. Risk of GI bleeding and other side-effects is increased in several types of patients:

• Heart problems: Use of NSAIDs should be avoided two weeks before and for at least a month after coronary artery bypass graft (CABG) heart surgery. High blood pressure can also be problematic, as well as heart disease.
• Age over 60: Especially for long-term users, the risk of negative side-effects increases with older people.
• Pregnancy and breastfeeding: The safety of NSAIDs has not been established for the fetus or for nursing infants. Unless otherwise directed, avoid Advil and others for the last three months of pregnancy.
• Medications: In addition to corticosteroids like prednisone, those taking blood-thinning medications (such as Coumadin), other NSAIDs, and diuretics should also avoid these.
• Stomach and kidney problems: People with a history of kidney disease, chronic ulcers, and other issues may find issues worsen with NSAID intake.
• Alcohol consumption: While light consumption of alcohol isn’t as risky, these drugs should be avoided if you have more than three drinks a night.

A Word From Verywell

There’s a balance needed when treating pain and inflammation; doctors need to ensure that your symptoms are being managed, while also avoiding overprescribing the medication. The idea, especially with drugs like NSAIDs and corticosteroids, is to find the smallest possible dose.

In turn, you have a responsibility to yourself as a patient to be careful. Learn about what you’re taking, be very careful about mixing medications, and only use your medications as prescribed.