The short answer
The long-term use of ibuprofen before surgery can increase your risk of bleeding. It is recommended to stop taking ibuprofen at least one week before surgery. However, the administration of ibuprofen just before or after the surgery can help with pain with no risk of bleeding.
- It is not allowed to take ibuprofen before surgery.
- Taking ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) before surgery can increase your risk of bleeding.
- It is advised to stop taking ibuprofen at least 1 week before surgery to avoid the risk of blood loss during surgery.
- Ibuprofen increases the risk of bleeding by inhibiting COX-1 enzymes which is important to produce prostaglandins that are converted into thromboxane A2 which is a necessary platelet adhesion factor.
- Other medications that you should stop before surgery include analgesics (Celebrex, aspirin, mefenamic acid, meloxicam, and diclofenac), blood thinners (Plavix, coumarin, and warfarin), herbal medicine (Garlic, green tea, and St. John’s Wort).
- Paracetamol and acetaminophen can be used safely before surgery with no risk of bleeding during or after surgery.
- Selective COX-2 inhibitors can be used before surgery with no risk of bleeding compared with nonselective COX inhibitors.
- Ibuprofen and a combination of ibuprofen with paracetamol can be safely used to reduce pain after surgery.
Is ibuprofen allowed before surgery?
The simple answer is NO. Ibuprofen isn’t allowed before surgery.
Ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) aren’t allowed to be used before surgery. It can increase your risk of bleeding in case of administration before surgery.
A study published in 2006 investigated the effect of ibuprofen administration on preoperative perioperative blood loss during hip arthroplasty. Fifty patients scheduled for total hip replacement were divided into two groups (double-blind, randomized manner). Before surgery, all patients were pretreated for 2 weeks as follows: Group-1: received placebo treatments (drug-free formulation). Group 2: treated with ibuprofen. Results showed a significant increase in perioperative blood loss in the group pretreated with ibuprofen compared with the placebo group. The authors recommend early discontinuation of non-steroidal anti-inflammatory drugs before surgery.
A Meta-analysis study published in 2019 reported that hemorrhage after tonsillectomy was increased with the use of ibuprofen long term before the surgery.
A previous controlled, single-blind study was designed to measure the effect of ibuprofen on intraoperative bleeding. Fifteen healthy subjects each having two sites that require periodontal surgery having similar complexity, type, and duration, were selected for the study. They were asked to take ibuprofen before the surgeries. The authors reported that taking ibuprofen prior to periodontal surgery was found to significantly increase intraoperative blood loss in patients up to almost two times that of those who did not take ibuprofen.
Why does ibuprofen increase your risk of bleeding during and after surgery?
Ibuprofen acts by reversible inhibiting the cyclooxygenase enzymes COX-1 and COX-2. The COX-1 enzyme is found within platelets. It helps to produce prostaglandin H2 from arachidonic acid. Prostaglandin H2 is then converted into thromboxane A2 which is a necessary platelet adhesion factor.
When COX-1 is inhibited by ibuprofen, the formation of thromboxane A2 and thus platelet aggregation is inhibited, Therefore, the risk of bleeding is increased.
Accordingly, it is better to avoid ibuprofen administration at least one week before surgery to allow sufficient time for platelet recovery and avoid the risk of bleeding..
How long before surgery should I stop ibuprofen?
Taking Ibuprofen for a long time before surgery is found to increase the risk of bleeding.
Therefore, it is recommended to stop taking ibuprofen at least 1 week before surgery to avoid the risk of bleeding during and after surgery.
What drugs should you not take before the surgery?
Certain medications can increase your risk of bleeding during and/or after surgery. You have to check the list of medications you use with your doctor before surgery. Therefore, it is important to look at the Preoperative Medicine Guidelines for your safety.
Here is a list of some of some medications that you should stop at least one week before surgery.
- Warfarin sodium
- Naprosyn (Aleve)
- Ibuprofen (Advil)
- Meclofenamate sodium (Meclomen)
- Mefenamic acid (Ponstel)
- Meloxicam (Mobic)
- Piroxicam (Feldene)
- Rofecoxib (Vioxx)
- Diclofenac potassium (Cataflam)
- Diclofenac sodium (Voltaren, Voltaren XR)
- Garlic tablets
- Ginger tablets
- Fish oil
- Green Tea
- Kava Kava
- St. John’s Wort
Which pain reliever is OK before surgery?
Ibuprofen, aspirin, and many other analgesic drugs should be avoided early before surgery. However, in case you have a headache, mild to moderate pain, or if you need cold and flu medicine during the 1-2 weeks before surgery you can take products that contain only acetaminophen and paracetamol and avoid NSAIDs
Paracetamol is considered the most safe painkiller to be taken before surgery. No risk of bleeding is associated with paracetamol administration.
Also, selective COX-2 inhibitors can be used safely before surgery. Studies showed that the preoperative use of selective COX-2 inhibitors does not increase the incidence of bleeding complications (Ref).
Is it safe to take ibuprofen after surgery?
Ibuprofen should be stopped one week before the operation to avoid the risk of bleeding. However, it can be used after surgery in a short term to reduce pain.
Ibuprofen is allowed after surgery to reduce pain.
After surgery, ibuprofen is commonly used in combination with paracetamol to give long-lasting pain relief.
You can take ibuprofen (Advil, Motrin) 600 mg every 6-8 hours for the first 2-3 days.
A study investigated the effect of a combination of paracetamol and ibuprofen for pain relief after oral surgery. Results showed that Ibuprofen can be used safely after surgery. Moreover, the combination of ibuprofen and paracetamol provides safe superior pain relief to placebo in adult patients following third molar removal surgery.
A multicenter, randomized, double-blind, placebo-controlled trial was conducted to evaluate the safety and efficacy of intravenous ibuprofen (IV-ibuprofen) as a postoperative analgesic. A total of 319 patients were randomly assigned to receive 800 mg IV-ibuprofen or placebo every 6 hours. Results showed that the intravenous administration of ibuprofen is considered as an effective analgesic medication that is safe and well tolerated when administered at 800 mg every 6 hours in patients undergoing total abdominal hysterectomy surgery (Ref).