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AF Association
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Ibuprofen

I think I’ve read a few times here that ibuprofen is a no no if you have AFib, can anyone tell me if this is correct and why, thank you 😊

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I was told because of high blood pressure I can only have paracetamol. X

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Thank you, that might have been what I read. I don’t have high blood pressure so I should be ok 😊x

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Me too.

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Yes a definite no no - some reports say that prolonged use can cause AF. When I was diagnosed with AF my GP changed me to Solpadol (similar to Co-codamol) Codeine 30mg/Paracetamol 500mg) for my arthritis, I had been on a anti-inflamitory medication before . You can get Co-codamol over the counter but it is a weaker strength. That is also why a lot of over the counter cold/flu medicines are a no no as well because they contain Ibuprofen plus a few other things that are not good for AF.

Cassie

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Oh no really, I don’t tolerate codeine at all even a tiny amount. I have endometriosis and I rely on ibuprofen and paracetamol taken in combination a few days every month. I’ve tried to manage with just paracetamol but the pain is still bad.

Thank you for your really helpful reply.

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You should speak to your GP there other pain killers but your GP would have to prescribe them, I do not find the Solpadol as effective but thats all I can take. There is Tramadol but that knocks me out completely. See what your GP has to say.

Cassie

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Thanks Cassie, I have been using ibuprofen every month,maximum dose for three days for the last 6 years. My GP has known about it and never mentioned anything about my AFib. I had no idea, why don’t doctors tell you stuff like this?

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I'm new to Afib but the hospital pharmacist came and spent time talking to me last week to explain about the different medications. I asked about Ibuprofen because its the only thing that works for migraine for me. The reason we are not supposed to take it isn't that it might make the Afib worse, it's because it can cause the stomach to bleed and we are on anticoagulant medication. That's the reason.

You are always supposed to take Ibuprofen with food, not on an empty stomach. It's probably on the information leaflet in the packet.

She said to me that if I needed it for a short amount of time and not regularly, then I could still take it provided I made sure to eat something first. It should not be taken every day as it is often prescribed when inflammatory conditions are involved.

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Thank you so much for your interesting reply 😊 I am really struggling without it, it’s the only thing that helps with the endometriosis pain. I’m not anticoagulated so would imagine that’s why it’s never been picked up.

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You've been through all that for many years and not been on anticoagulants! Gosh, how did you manage to avoid them. I've been bullied onto them.

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My chad score was always 1 so my doctor said I didn’t need them, cardiologist too and more recently the EP. I had them for 7 days after my ablation but that’s it.

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Pseudoephedrine is the worst, don't touch anything with that in. It is very difficult to know what to take for pain, I can't take NSAIDs because of AF and asthma and have be careful with codeine because of bowel probs. I think there is a pain reliever specifically for period pains so your GP might help.

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Thanks Buffafly, I’ve been given mefanemic acid which is specifically for periods but it’s an NSAID, why would my doctor prescribe that when he knows about my AFib. I picked them up from the pharmacy on the same prescription as my flecainide and the pharmacist never mentioned anything.

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I absolutely agree about Pseudoephedrine. It’s in Sudafed which I have used twice and gone into AF. (I have PAF and now avoid anything with Pseudoephedrine).

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Thanks for that, really good to know 😊

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Hi Kelly.

I think your right. Personally I won`t chance it. Stick with paracetamol IMO.

It`s crazy with a-fib to be honest. Somethings seem to suit some people, and others don`t. It`s the same with med`s - some tolerate and some don`t.

Kelly - keep off the ibuprofen unless a doctor or pharmacist gives you the go ahead.

I`m not medically trained so that`s only IMHO. Have a chat to your health care provider and see what they say ;-)

Best,

Paul

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Thanks Paul, I will stick with paracetamol 😊

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Research in Holland and Denmark showed that Ibuprofen and Diclofenac caused AF. The recommendation was that the use of NSAID’s should be carefully monitored and that they should be avoided if possible by over 55’s.

In addition, NSAID’s can increase the effect of anticoagulants and should be not be taken with them.

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Thanks for that Finvola, I’m so shocked that my doctor knows I’ve been using ibuprofen for years to manage my endometriosis pain and doesn’t seem to know anything about the impact that could have on AFib. The same with A&E doctors, my cardiologist etc, how can that be??? Surely it should be on the list of questions they ask you.

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I agree kelly - the focus of warnings about NSAID’s seems to be interaction with anticoagulants and not its role in triggering AF. The research itself seems not to have become widespread knowledge. I think one of the centres involved was the University of Aarhus.

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Here's a link to the Danish report:

bmj.com/content/343/bmj.d3450

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I think Ibuprofen and Mobic (another NSAID) could have contributed to my AF. I was on them for 11 months after injuring my ankle. I was treated with painkillers, physio and rehab exercises then the tendon ruptured and surgery was my only option. It was the day after the surgery that I was diagnosed with tachycardia and a few months later (when I was out of the wheelchair and able to walk again) I was diagnosed with SVT, then a few months later again with Multifocal Atrial Tachycardia. The following year (last year) I was diagnosed with atrial flutter and then with AF.

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Thanks Kaz, it’s awful to think that something as supposedly innocuous as an over the counter painkiller could have potentially contributed to what happened to you. This thread has got me thinking, I developed endometriosis 6 years ago and started taking the maximum dose of ibuprofen alongside paracetamol for 3 days every single month. Five years ago my flecainide became less effective and the really bad problems started with my tummy, the burping and bloating with rapid heartbeat etc all started then too. My husband has always thought that there is a connection between my endometriosis and the worsening of my AFib because they happened quite close together but maybe it was the ibuprofen.

I am shocked that not one single doctor or pharmacist I have seen has ever mentioned anything when I’ve told them I take ibuprofen regularly for endometriosis.

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It’s hard to know what’s related to what 🙃

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It’s good to know to avoid something that has a potential link though. 😊

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Unfortunately doctors often know very little about the adverse effects of the medicines they prescribe and even less about the interactions between different drugs. That is why iatrogenic disease is on the rise. They rely for the most part on info put out by the manufacturer which is often less than honest ( think Seroxat, Avandia ,Vioxx ) and the reporting system for adverse effects is in most countries notoriously inefficient. It is estimated that in the US only one adverse event in ten is reported. Patient's complaints are often brushed aside with remarks such as "drug x does not do that " even when the side effect is listed in the leaflet. Or "oh that is very rare" as if the person in front of them could not possibly be the rare sufferer. I now am very wary of taking anything unless I have thoroughly researched it myself and deem that there is no alternative. In short having been poisoned and misdiagnosed more than once I do not trust the medical profession that much. Sad but there it is.

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Ibuprofen is known to promote arrhythmias and should definitely be avoided. My husband is not one to take painkillers but was given Naproxen..a similar NSAID for bad back pain and went into AF for several hours for the first time after 7 days on this drug. He stopped this and has not had a repeat. ( All this captured on my Kardia.

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Thanks Yatsura, I had no idea and I’m in shock to think of all the healthcare professionals and pharmacists I have come into contact with that have known I have AFib and take regular max doses of ibuprofen and never warned me about it. Surely that should be standard advice right across the board?!

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Hi. In my experience GP’s know hardly anything about AF. The only way I got any decent information was on here and seeing a EP privately.

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mefenamic acid is fabulous, but as you say - another NSAID. I have problems finding 'safe' painkillers due to various issues. Nefopam is a drug I hadn't previously heard of, but was suggested for me to propose to my doctor. Maybe one to look into for you too?

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Thank you, I didn’t have much luck with mefanemic acid but ibuprofen in combination with paracetamol really worked for me. The paracetamol alone just doesn’t control the pain in the same way. I will ask about Nefopam 😊

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Re GP doctors - I have found that they don't always check on the interactions of drugs unless prompted. Not just for AF but also for other prescribed medicines and disorders. Several times my doctor has been going to prescribe a medicine and I've had to remind him of my AF before he picks up the relevant book to check.

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Doctors and pharmacists have asked me if I have any bowel problems before giving my NSAIDs, I just think that if there is a known link with AFib they should ask that question as standard just like they do with bowel disorders.

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I agree.

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When I was first taken into hospital and diagnosed with afib, ten years ago this week the first thing my consultant told me was never ever again take ibuprofen or similar. I had been taking it for a neck injury post a car accident and have not touched it since. The consultant was so adamant about it that I had no doubt he was correct. That was in the same hospital you had your ablation.

I think it's become fairly common knowledge amongst medics and afibbers now.

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Thanks meadfoot, that’s really interesting. I have never been told by anyone, no one has ever asked me if I take ibuprofen regularly and my doctor prescribed me NSAID for my pain, i picked it up with my flecainide from my pharmacist and he never mentioned it. It might be common knowledge to some but it wasn’t to me and I’ve been taking it for 6 years. In that time I have seen countless doctors.

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I wasn't on anticoagulants or put on them at the time of af diagnosis as I was low risk so it wasn't advice because of anticoagulation. I was not put on anticoagulants for a further five years post diagnosis when I hit a magic age and gained a further point on the chads vasc score. Interesting how we get different advice in different hospitals and medics.

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It looks like if you are anticoagulated the advice is standard but if not it depends on the doctor. 😊

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Forgot to say it was a cardiologist who told me not to take ibuprofen not an EP. However I moved to London before I needed anticoagulation and have been under the care of one of the top ten EPs in the uk as rated by their peers. He gave me exactly the same advice re not taking ibuprofen and I truly trust him with my life. Hope this helps.

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I was told right at the beginning when I was diagnosed with AF and put on Warfarin not to take Ibuprofen. Not because of AF but because of Warfarin. It works against the effectiveness of Warfarin in stroke prevention.

So his has never been an issue for me. I use other stuff for pain relief.

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Ah ok, I’ve never been on anticoagulants so that’s why it might never have been mentioned.

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Most of us with AF will be on an anti clotting agent like wafrin or rivaroxaban, so we should not take ibuprophen or aspirin as they also thin the blood.

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Thank you, just thinking that might be why I’ve slipped through the net because I’ve never been on an anticoagulant.

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Good

Morning, you can’t take ibuprofen if you are on blood thinners. And if you have AF it is most likely you are. Also you can’t have any creams that contain ibuprofen. I am prescribed voltarol cream for neck pain but you can only use it twice a day and very sparingly. As we are on blood thinners it can thin your blood even more. Have a good day.

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Thank you 😊

I’m not on any anticoagulants so I think that’s why the doctor has never mentioned it.

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I remember you from the other week. How are you. Don’t do to much too soon. If you ever have any queries about anything just badger the doctors,and nurses at your surgery. And if you have a query at night just ring 111 they are amazingly helpful. All the very best.Gill Dale.

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Thanks Gill 😊 will do

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Ps, I’m doing ok. I had my ablation on 25th March and I’ve found recovery a bit of a journey but I’m getting there. 😊

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I was told it was ok to use topical ibuprofen !!?? I use it occasionally and it hasn't set off my AF (yet...)

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Hi, it's never affected me, as far as I'm aware anyway. I take it fairly regularly too, sometimes with flecainide before I go to bed. I'm not on any anticoagulants.

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I don’t think it affected me in terms of making my palpitations worse but I’m not sure if taking it long term might have affected my AFib overall. I guess I will never know.

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I would say probably the majority of people aren't told, I only learned after coming on the forum and since reading articles in the newspapers. Not one of the professionals I have seen has ever checked to see if I take it. Of course I don't now, and I am very careful in what sort of cold and flu preparations I am tempted to take, as many contain ibuprofen.

My daughter had endometriosis diagnosed about six years ago too and everything fell into place, her IBS, bloating and extreme pain every month. She had keyhole surgery and a lot of endometrial tissue removed from her womb and back passage. It helped a lot with her symptoms, and if you really suffer it may well be worth pushing for a referral. However, it isn't a cure and new endometrial tissue could be developing again right now. You may already know this, but being on the contraceptive pill (without a seven day break) greatly suppresses symptoms of endometrosis, it isn't ideal, but what is the alternative? I really feel for you, having this on top of everything else as it is a very difficult condition to manage.

My best wishes, Kelly x

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Thank you so much Irene,

I’m sorry your daughter suffers with this awful condition. I have been referred and decided for now not to have surgery but it’s fear that stopped me. I’ve been thinking since my ablation that I might go back and have it done, it’s really impacting my life. The pill makes my arrhythmias worse so I’ve just been managing the symptoms with paracetamol and ibuprofen for years. My ablation has given me a new found courage to tackle it head on.

Thanks for you kind wishes, have a lovely day x

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I can't stress enough how much better she felt after the keyhole surgery, the only sign and side effect were the four or five very small entry points in her abdomen that literally healed in days. Go for it!

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I don't know if Ibuprofen makes AF worse. I can't take it because like many others on this site I take an anticoagulant.

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Thank you, the advice if you’re anticoagulated is very clear isn’t it. Seems to be a bit hit and miss if you’re not

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True and since my stroke I don't have the brain power to advise you. Personally I hate taking any meds and in my experience even the "specialists" sometimes get it wrong so you just have to find a good site like this one that has lots of experienced people on it read the information available in your meds box and try to make an informed decision. Good luck.

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Thank you 😊

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I've checked the leaflet info in Naproxen pack (my husband's on it short term) and the info in the OTC ibuprofen we have and there is no mention of AF per se. In cautions Naprox refers to heart problems but the e.gs it mentions are high BP, stroke, heart attack. Further on, after the very rare side effects, it lists some other side effects including heart palpitations.

Brufen lists more cautions but not AF. And nothing in side effects re palpitations/AF.

I'll ask my arrythmia nurse about it. If NSAIDs do cause AF it needs to be listed on patient info leaflet and should be common knowledge. It would be contraindicated for people with AF.

I work in elderly care and many older people are on NSAIDs for pain control and a good few have AF too.

I wonder if NSAIDs are a trigger for some people rather than a definitive cause. Since the medical staff I have seen for my AF don't appear to 'believe' in triggers they will need definitive control research.

I'm going to see what I can find out when I go back to work.

Amanda

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Thank you so much Amanda, funnily enough I’ve looked too this morning and there is nothing on the info leaflet for nurofen.

I really appreciate your helpful reply 😊 and look forward to hearing what you find on it.

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Hi, about a month ago KKKats posted ‘Pain Relief on anticoagulants (Edoxaban)’ and there were some very helpful replies. I accept that you are not on an anticoagulant, however, my understanding is that Ibuprofen (and similar) should only be taken with extreme caution if you have AFib – irrespective of whether or not you also take an anticoagulant. Maybe have a look at that post and the responses to it in conjunction with the responses to your post today and, hopefully, you may find a suitable alternative.

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Thank you so much for your helpful reply, I will take a look. 😊

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I was told not to take it with apixaban..think increases chance of bleeding

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Thank you 😊

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I took ibuprofen for a back pain in December last year. About a couple of hours later went in to afib. Read on here that it may cause af so I’ve never taken any since. I’m convinced ibuprofen caused the episode.

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Thank you for your reply that’s really interesting, Amanda just suggested that ibuprofen could be a trigger for some people rather than a cause.

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Nothing is a silver bullet - just read the notes accompanying any medication!

The simple answer seems to be that pain management v AF has to be a compromise and will depend on how your body copes (we are all different). NSAIDS are discouraged but

I have used diclofenac (sanctioned by my cardiologist) for chronic muscle and joint pain for years, popped 50mg night and morning and felt no discomfort at all. Because recently Diclofenac has been linked to an increase in the risk of stroke we have experimented with paracetamol. cocodamol, meloxicam and currently celecoxib but none of these are as effective as diclofenac (for me) and both the hospital medical specialist and my GP have said that if nothing else works I should go back on the diclofenac. What it comes down to is risk versus quality of life - I recall that using aspirin rather than warfarin increases the likelihood of stroke by something like 45% - but that is from 1.6% to 2.3% so it is still very tiny.

I agree with many replies - make sure your medical specialists are aware of your condition(s) and and THEN follow their advice.

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Thank you for your helpful answer. 😊

My healthcare specialists are all aware of my conditions and so far I’ve been given no advice.

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I’ve never seen anything about ibuprofen and AFib. I know you can’t take it on warfarin. But long before that when I was just on betablockers it was a definite no alongside them. I think possibly that it doesn’t go with the other medications rather than causing AFib in isolation. If people feel it does cause it, then the yellow card system can be used to raise an alert. An interesting question this which needs more research for sure.

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Thank you, I had never heard anything about it either and It doesn’t say anything on the info leaflet. The first I heard was here. I think that the guidelines are very clear on interactions with other meds but really unclear when it comes to the affect it may have, if any on arrhythmias.

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You should not take ibuprofen tablets, nor aspirin if you are on blood thinners for AF. You can however use Ibuprofen gel to rub into aching/arthritic muscles or limbs. I use 10% ibuprofen gel for rheumatic aches.It does not affect my INR levels.

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Thank you 😊 you are right, the guidelines surrounding anticoagulants and ibuprofen are very clear. The effect it can have on AFib seems more confusing.

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I was told to take Ibuprofen occasionally due to me being on Xarelto and mixing blood thinners isn’t good. Personally I do fine taking it every few days though.

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Thank you, that’s interesting. I think you have to be more careful with ibuprofen and anticoagulants like your doctor has said 😊

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I quit taking the stuff altogether and I know of another who's quit also!

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I suppose NSAID's are forbidden if you are on an anticoagulant unless the dose is adjusted but simply contraindicated otherwise, similar to the difference between 'Use by' and 'Best by' dates. Someone in extreme chronic pain or regular severe pain for a few days might well decide to take the risk if their AF is infrequent or permanent.

I think that explains why you didn't get a warning. Medications that can cause constipation are not advisable for me but my cardiologist didn't mention that when Diltiazem was prescribed. His only concern was that too high a dose might cause my heart to slow too much or stop which is obviously a dangerous outcome. As has frequently been said 'AF won't kill you' so it's now your unwelcome choice whether to take ibuprofen or not.

Best wishes if you go for the operation. You may have an episode of AF during or afterwards but it will be worth it in the long run.

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Thank for your helpful reply, I agree that the guidelines are very clear and well established when it comes to anticoagulants and ibuprofen. The confusion comes from the studies someone mentioned linking AFib to NSAIDs and the recommendations from some cardiologists regarding the use of ibuprofen etc even when patients aren’t anticoagulated.

I just can’t believe that if there was causative a link between ibuprofen and Afib that it wouldn’t be listed as a side effect.

My mum has Crohn’s disease and that doesn’t kill you either but there isn’t a doctor in the land that would prescribe her NSAIDs. And if they did you could check the information sheet and see that it’s not suitable to take. That’s what makes me think it is more linked to anticoagulants than AFib itself.

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Possibly not take it with A-Fib, but only for indirect reason. If you are on a blood thinner for A-Fib to prevent clots, they might not want you to have the additional blood thinner of an NSAID such as Ibuprofen, Aleve or aspirin to prevent internal bleeding or external bruising.

I myself have taken Naproxen Sodium (Aleve) AND a full size aspirin a day along with Xarelto for many months w/o any issues.

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Thank you for your help 😊

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Do be careful Aufgeblassen. Are these all prescribed? Don’t want to cause unnecessary concern but A gastro intestinal bleed can be nasty and occur with little warning.

Take care

Pat x

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No prescribed, OTC. Never had a problem. I have been taking a full size, regular aspirin daily for probably 35 years on an empty stomach w/o any issues.

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Increased bleeding risk, especially if taking anticoagulants

Pat x

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Thank you 😊

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I have a golden rule - whenever my meds are changed I ask the prescribing doctor how the new med fits in with the rest of my meds and if there are any side effects to look out for. My GP always checks to see if there are any contra indications with other meds. As a belt and braces exercise, when I collect new meds from the pharmacist I ask the same question; useful since I was once given a med that the pharmacist identified as a no no to take with my IBD. I have also found the opportunity to discuss my medication with a pharmacist whilst a hospital in-patient invaluable, they seem to have time, doctors are always in a rush to get to the next patient and you can feel a bit guilty about questioning their choice of pill and what it is doing to your body at any length. Medication reviews carried out by local pharmacies are also useful if you have the time to participate. Unfortunately, as we are all so different, we are never going to get round the age old problem of one man's medicine...…etc But, fortunately this amazing forum and the contributors gives us so many insights into the differences we have in our common affliction we gain helpful knowledge each time we visit.

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Thank you for your helpful post, I definitely will do that in future if I ever get a prescription, I was really talking about nurofen which is an over the counter medicine, it would never occur to me to do anything other than read the info leaflet. I just wonder why it’s not mentioned on the leaflet or by GPs or any doctor I’ve ever seen if it is well known that it can have a causative effect when it comes to AFib? My doctor told me not to take any cold and flu preparations because they contain phenylephrine but never any mention of nurofen.

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Long term use of ibuprofen and all NSAIDS (non steroidal anti inflammatories, which include naproxen) is associated with increased risk of heart attack and stroke- and even short term use concurrently with blood thinners like Eliquis is dangerous, because it increases risk of hemorrhagic stroke.

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Thank you, yes I think that the advice if taking anticoagulants is very clear. If you don’t take anticoagulants or beta blockers the advice is somewhat more confusing.

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I have been on a baby aspirin 75mg on and off for 9 years but had to take ibuprofen for a bad back no problems but left out the aspirin even went a whole 3 weeks without an AF attack which is very rare.

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Thanks for that Maril1, the plot thickens 😊

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With AFIB, I can only take Tylenol, no Advil, Aleve or IBPRO....I think it has to do more with the blood thinners...probably can get a list from doctor, as some cold medicines are a No-No, also.

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Thank you, yes I think the link with anticoagulants is very clear but with AFib not so much. 😊

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After going over and over the sudden change in my health from excellent to AF, the only tie-clue is my heavy use of ibuprofen for dental pain over several months. It damaged my heart and began the fibrillations. You watch: the news about the dangers of ibuprofen to the heart is coming out, and it will be quietly, if they can, removed from the marketplace before that becomes widely known and the lawsuits begin pouring in.

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Thank you for your interesting reply, 😊

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I'm on Pradaxa (dabigatran) anticoagulant and it specifies that I must not take Ibuprofen.

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