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Coumadin & Ibuprofen?

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  • Coumadin & Ibuprofen?

    This question is directed at Al Lodwick, but if any of you out there have an answer, I'm listening.

    Occasionally I have muscle aches or headaches that Tylenol just doesn't take care of in the way of pain releif. In the past (pre-AVR) I would have just taken an aspirin. Now, of course, I can't do that since I'm on warfarin. My question is, can I take Ibuprofen? I've seen somewhere that I shouldn't take it, but I've never seen it explained why. Can coumadin/warfarin patients take ibuprofen or, are we stuck with only Tylenol for pain relief?

    Kristy S.
    AVR 6-19-01 (S.J. Mechanical)
    Centura Porter Hospital
    Dr. Brad Hofer (Surgeon)

  • #2
    Hi Kristy,

    Ibuprofen is also a blood thinner, and it can cause internal bleeding in some cases. You certainly do not want this if you are already on blood thinners.

    For more information about this drug, click onto the link below.


    Once you get to the site, scroll down, there is alot of information there regarding this type of drug.

    Hope you get rid of those headaches,

    3/23/00 Ascending Aortic Dissection-St. Judes mech valve+graft, Vanderbilt, Nashville, TN
    9/16/10 ON-X Aortic Valve/Root Replacment, Cleveland Clinic,OH, Dr Pettersson
    9/16/10 Aortic Stent and Frozen Elephant Trunk Procedure, Cleveland Clinic,OH, Dr. Roselli


    • #3
      My husband has been on Coumadin for 24 years. He cannot take aspirin, ibuprofen or their derivitives.

      The only thing he can take OTC is Tylenol, I'm sorry to report.


      • #4

        Gina, Rob & Nancy,

        Thanks for your replies. It's interesting because my hygenist never complained when I took Ibuprofen before a dental procedure, but she sure did when I took aspirin!

        Gina -- Unfortunately, codeine and any of its derivitaves (including darvocet & vicodin) make me extremely sick to my stomach. In the hospital, after the surgery the docs couldn't seem to find any pain killer that I could take. Therefore I was only on Tylenol. Sometimes it works great, but there are certain kinds of pain that it just doesn't touch. Oh well, I'll live with it!

        Thanks again all!
        Kristy S.
        AVR 6-19-01 (S.J. Mechanical)
        Centura Porter Hospital
        Dr. Brad Hofer (Surgeon)


        • #5
          Hi Krist,

          I just read your post. I agree with the others. Don't mix the Coumadin with Ibuprofen. Have you tried Extra Strength Tylenol? I know after I got out of the hospital, I too couldn't take the codiene. My cardio told me to use the Extra Strength Tylenol. I don't use it very often. I did more so, after surgery. When I really do need a pain killer though, thats what I use. Regular Tylenol doesn't do a thing for me.
          AVR & MVR and Tricuspid Repair
          St. Judes Mechanical
          March 8, 2001
          Chicago University Hospital


          • #6
            Hi Kristy,

            Just thought I would share some info that my cardiologist told me.

            I too had many headaches in the past and the only thing that would get rid of them was Excedrin. Well, being aspirin based, I can no longer take it.

            My doctor told me to take a combination of Tylenol and caffine. He said that is basically the same as Excedrin. So, maybe you might want to try it.

            Also, I take a coated Aspirin everyday with my other medications. I am on a combination Coumadin and 325 mg coared aspirin program. The good news is... since my surgery 3/23/00 I have ony had 1 headache, and that may have been caused from alittle too much partying!

            Perhaps you could try a coated Aspirin and caffine.

            Well, I am sure we will here from some others as to what they use. Hopefully you will find something to help.

            3/23/00 Ascending Aortic Dissection-St. Judes mech valve+graft, Vanderbilt, Nashville, TN
            9/16/10 ON-X Aortic Valve/Root Replacment, Cleveland Clinic,OH, Dr Pettersson
            9/16/10 Aortic Stent and Frozen Elephant Trunk Procedure, Cleveland Clinic,OH, Dr. Roselli


            • #7
              Unlike many, my cardiologist said I could take one dose only of aleve when I have menstrual cramps, so I have to time it carefully so I get the maximum effect when I need it most.
              I rarely take ibuprofen or aleve anymore, but I know that I can take one dose if I really need it.
              Ask your MD about it.


              • #8
                The resoning around the no NSAIDs (like Ibuprofen) is that they do have some antiplatelet effect. This is similar to the aspirin effect. The other thing is that like aspirin, they tend to have an irritating effect on the lining of the GI tract. If they get a bleed started, the warfarin will keep it going real well.
                One thing about acetaminophen (Tylenol etc.) is that most people who say it does not work do not take enough of it. You need 2 extra strength (2 X 500 mg = 1000 mg) or 3 regular strength for each dose (3 X 325 = 975 mg). You should not take more than 4 doses of this much per day.
                The news made a big fuss a couple of years ago about acetaminophen not being suitable with warfarin. I talked with Dr. Elaine Hylek who authored the report. That was not what the report said - the news media sensationalized it. The report said that if you take more than 2 X 1000 mg doses per day every day for about a week, then you have a greater than normal chance of having an INR of 6 or greater. Obviously this does not rule out taking 1000 mg of acetaminophen occasionally for pain relief.
                One other possibility is taking one of the COX-2 inhibitors (Celebrex or Vioxx). One or the other now has approval to be prescribed for acute pain relief. (I can't remember which one since both sales reps have called on me lately.) There have been a few scattered reports of these having interactions with warfarin but rarely have the effects been significant. When you consider that Celebrex was the fastest drug to sell $1 billion after it came on ethe market, it is actually surprising that there have been so few reports. These were designed to be the pain relievers that spared the lining of the stomach and they appear to do just that.


                • #9
                  Hi Al

                  Can you tell us what you know about Vioxx and reported bleeding in patients that don't take Coumadin? My doctor absolutely does not want me taking this combination. I don't have any other conditions that would cause unnecessary bleeding say in the stomach lining....so can't understand why it was deemed as such a danger if only taken occasionally?

                  I also have a very low response when taking Tylenol. Therefore, required pain relief recently...took 4 EX Tylenol's and nothing! My MD called in Darvocet. One tablet did the trick. Darvocet is acetaminophen based so I have a hard time understanding this. Must be the narcotic response? Was big on Motrin and Advil for pain prior to my MVR. Would this raise the INR automatically or just increase the "potential" to bleed if the conditions where right?

                  All the best,
                  LuvMyBirman :)
                  MVR, 3/99


                  • #10
                    Vioxx was designed to be the remedy for bleeding for drugs called non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDS inhibit two enzymes cyclo-oxygenase-1 (COX-1) and (COX-2). COX-1 is responsible for platelet inhibition (increased bleeding) and irritation of the stomach. COX-2 is responsible for pain relief. Prior to Vioxx and Celebrex the fact that there were 2 COX enzymes was unknown. When they found out that there were two, they were able to separate the effects. Therefore, these two drugs are able to relieve pain with a minimum of GI bleeding. Vioxx says in its package insert that it can cause a 10% rise in the INR. If your INR was 3.0 and you took Vioxx it might go up to about 3.3!! Big deal. However, I'm sure that some of the Celebrex people were only too happy to point this out to doctors. Of course as the drugs were used by millions of people there were some reports of bleeding. But whether or not this was truly related to the drugs is unknown. I would rate myself as very knowledgable in this area because I have given talks to groups of doctors about the relatively few interactions between Celebrex and warfarin. Of course, someone could turn this around and say that I was paid by Celebrex so my judgement is cloudy. But those of you who have followed what I write, know that I was not invited back by the Coumadin people because I would not say that there product was superior when I did not believe it. I would have done the same thing if I did not truly believe that these drugs are safe with warfarin.
                    Darvocet is a very interesting drug. The people who study it say that it is no better than a placebo. However, the World Health Organization wanted it declared a dangerous narcotic and banned from world trade. The difficulty in rating pain relievers is that pain is such a subjective issue. In other words, if it works for you, use it. I have not found any reliable reports of harm being caused by Darvocet and warfarin. I looked really hard too, because I wanted to find some. I haven't been a big fan of Darvon or Darvocet because when I was dispensing prescriptions, I had more people (3) die from this drug than anything else that I dispensed. They were all addicted and taking in excess of 25 a day. The first one was shortly after Darvon came out and we were told that it was non-addicting. He was taking about 50m every other day. The other two people took an entire month's worth at once.
                    Advil etc. does not raise the INR. Therein lies the problem. It just causes you to bleed with no warning such as an elevated INR would give.