ibuprofen and prednisolone

Pharmacodynamic interaction: ibuprofen and prednisolone act additively on the gastric mucosa. Ibuprofen inhibits cyclooxygenase, reducing gastroprotective prostaglandins; prednisolone impairs mucosal defence and repair. This combined effect increases susceptibility to ulceration and bleeding. There is no significant pharmacokinetic interaction.

Concurrent use markedly raises the risk of gastrointestinal ulceration, haemorrhage, and perforation, particularly in patients with prior ulcer disease, the elderly, or those taking high doses or long-term therapy. Renal impairment may also be aggravated in volume-depleted states.

Avoid co-prescription where alternative analgesic or anti-inflammatory options exist. If unavoidable, prescribe a proton pump inhibitor or misoprostol, use the lowest effective doses for the shortest duration, and monitor for dyspepsia, melaena, or anaemia. Exercise extreme caution in high-risk groups.

Well-established in clinical practice; risk is documented in large observational studies and meta-analyses. Widely recognised in national guidelines and summary of product characteristics.