Can I take Tamiflu with ibuprofen?

Why can ibuprofen go with Tamiflu?

Tamiflu and ibuprofen do different jobs. Tamiflu is a prescription antiviral that works against the flu virus itself. Its only active ingredient is oseltamivir. Ibuprofen and acetaminophen do not treat the virus. They ease symptoms. The CDC says flu symptoms such as pain and fever can be controlled with medicines like ibuprofen or acetaminophen.

The Tamiflu label says no clinically relevant interactions were seen when oseltamivir was given with acetaminophen or aspirin, among other drugs. Ibuprofen is not named in that list, and the label does not list it as an interaction either. In the Tamiflu flu treatment studies, people were allowed to take fever-reducing medicine. One catch: the Advil label says to ask a doctor or pharmacist before use if you take any other drug, and Tamiflu counts, so a quick check with your pharmacist is a good idea.

• Advil and Motrin are brand names for ibuprofen, an NSAID. Each Advil tablet has 200 mg of ibuprofen.
• Tylenol is acetaminophen. Each Tylenol Extra Strength caplet has 500 mg.
• Tamiflu is oseltamivir. Adults and teens 13 and older usually take 75 mg twice a day for 5 days, started within 48 hours of symptoms, per the label. Children's doses go by weight.

Can I take Tamiflu, ibuprofen, and Tylenol together?

Tamiflu can go with either one. Whether you should add both ibuprofen and Tylenol on top is a separate question. The NHS says adults can take paracetamol (the UK name for acetaminophen) at the same time as ibuprofen if needed, and says it is a good idea to try each one on its own first to see if it helps. MedlinePlus is stricter: do not take nonprescription ibuprofen with any other medicine for pain unless your doctor tells you to. The Advil label also says to ask a doctor or pharmacist before use if you take any other drug.

So the pairing is not right for everyone. If one medicine controls your fever and aches, stick with one. If you are unsure, ask a pharmacist, who can check your full medicine list.

How do I take each one safely?

Follow each product's own label. Neither the Tamiflu label nor the Advil or Tylenol labels give a rule for spacing them apart from each other.

• Tamiflu: take it with or without food. The label says it may be easier on your stomach with food. Nausea, vomiting, and headache are the most common side effects.
• Advil (adults and children 12+): 1 tablet every 4 to 6 hours. If 1 does not help, 2 may be used. No more than 6 tablets in 24 hours unless a doctor says so. Take it with food or milk if it upsets your stomach.
• Tylenol Extra Strength (adults and children 12+): 2 caplets every 6 hours. No more than 6 caplets in 24 hours unless a doctor says so.
• Only one NSAID. Do not take ibuprofen with naproxen (Aleve) or aspirin for pain. The Advil label says the chance of severe stomach bleeding is higher if you take other drugs that contain NSAIDs, such as aspirin or naproxen.
• Only one acetaminophen product. The Tylenol label says do not use it with any other drug containing acetaminophen. Many cold and flu remedies already contain it, so check the Drug Facts box on anything else you take.

Who should ask before taking ibuprofen with Tamiflu?

The issue is usually the ibuprofen, not the Tamiflu. The Advil label says to ask a doctor before use if you have high blood pressure, heart disease, kidney disease, liver cirrhosis, asthma, stomach problems such as heartburn, or have had a stroke, or if you take a diuretic. Ask a doctor or pharmacist first if you take aspirin for your heart, because ibuprofen may reduce its benefit.

The Advil label also warns that NSAIDs, except aspirin, increase the risk of heart attack, heart failure, and stroke. Stomach bleeding risk is higher if you are 60 or older, have had ulcers or bleeding problems, take a blood thinner or steroid, take another NSAID, or have 3 or more drinks a day.

If you are pregnant, ask first. The Advil label says it is especially important not to use ibuprofen in the last 3 months of pregnancy unless a doctor tells you to, and MedlinePlus says ibuprofen may cause problems if taken around 20 weeks of pregnancy or later.

For Tylenol, the label says to ask a doctor first if you have liver disease, and to ask a doctor or pharmacist if you take the blood thinner warfarin. Severe liver damage may occur with more than 4,000 mg in 24 hours, with other acetaminophen products, or with 3 or more drinks a day.

What can I give my child with flu who is on Tamiflu?

Tamiflu is approved to treat flu in children as young as 2 weeks old, dosed by weight. For fever and aches, use a children's acetaminophen or ibuprofen product, not an adult one. MedlinePlus says do not give ibuprofen products made for adults to children, and the Tylenol Extra Strength label says to ask a doctor for children under 12.

Never give aspirin to a child or teen with flu. The CDC says aspirin and salicylate-containing products should not be used for children or adolescents with flu, because they may raise the risk of Reye syndrome. Reye syndrome happens almost only in children taking aspirin, mainly with flu B or chickenpox. It causes severe vomiting and confusion and can lead to coma from brain swelling. Check the label of any combination product for aspirin or salicylate.

• Dose by the age chart on the children's product label, and use the measuring cup or dosing device that comes with it. Ask the child's doctor if you do not know how much to give.
• MedlinePlus says children's ibuprofen is usually given every 6 to 8 hours, with no more than 4 doses in 24 hours.
• Tell your child's doctor before giving ibuprofen if your child has not been drinking fluids or has lost a lot of fluid from vomiting or diarrhea.
• MedlinePlus says do not give nonprescription cough and cold combination products to children under 4.
• Watch for unusual behavior. The Tamiflu label reports delirium (sudden confusion) and abnormal behavior in people with flu taking Tamiflu, mostly children, and notes flu itself can cause these. Tell the doctor right away if you see it.