Interactions between ibuprofen and antihypertensive drugs: incidence and clinical relevance in dental practice.

It has been well documented in the literature that ibuprofen interacts with different groups of antihypertensive drugs (beta-adrenergic blockers, alpha-adrenergic blockers, diuretics and angiotensin-converting enzyme inhibitors), reducing their antihypertensive activity. The mechanism of action of ibuprofen involves inhibition of the enzyme cyclooxygenase, thereby inhibiting the synthesis of inflammatory prostaglandins and vasodilatory prostaglandins that increase renal blood flow and thus favor the excretion of water and sodium. More than five days of treatment with both drugs are normally required for the interaction to manifest. Although the changes in blood pressure resulting from this interaction are typically small, some patients can experience substantial elevations in both systolic and diastolic blood pressure. It has been estimated that the avoidance of minor changes in systolic pressure in patients with osteoarthritis subjected to treatment with nonsteroidal antiinflammatory drugs would avoid over 30,000 deaths due to myocardial infarction, and over 2000 deaths due to coronary disease, in the United States alone.