ibuprofen and ramipril

Pharmacodynamic interaction: NSAIDs such as ibuprofen inhibit renal prostaglandin synthesis, leading to afferent arteriolar vasoconstriction and reduced renal blood flow. This counteracts the vasodilatory effect of ramipril on the efferent arteriole, impairing renal hemodynamics and reducing the antihypertensive efficacy of ramipril.

Co-administration may result in acute kidney injury, particularly in patients with hypovolaemia, heart failure, or pre-existing renal impairment. The antihypertensive effect of ramipril is blunted, potentially leading to loss of blood pressure control.

Avoid co-prescription in patients at high risk of renal impairment or hypovolaemia. If necessary, use the lowest effective dose of ibuprofen for the shortest duration, monitor renal function and blood pressure at initiation and regularly thereafter, and ensure adequate hydration. Consider alternative analgesics such as paracetamol.

Well established: supported by clinical guidelines, multiple studies, and case reports. The interaction is recognised in standard references including the British National Formulary and is a commonly cited cause of drug-induced renal impairment.