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Pain Killers with Coumadin

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  • Pain Killers with Coumadin

    First cardiologist tells me not to take aspirin, take Motrin, writes me a prescription for it in industrial strength. I take it a few times, it works. Next cardiologist tells me that I'm very lucky - Coumadin patients should never take Motrin. I should take Tylenol instead. Take it (2 X 500mg) a couple of times, helps with pain but my INR spikes to 11 and there's blood in my urine so I stop. I know that's only supposed to happen with long-term use, but I guess I'm just lucky.

    So far only pain med with no problems is Vicodin, but docs treat you like a junkie if you ask for it and especially if you ask for a refill, hate to go snivelling to the doc for a 'script every time I've got an owie, anyway, and that stuff's so constipating I can't take it for more than a few days, anyway.

    Waah! Before I went under the knife (St. Jude's replacement for mitral valve) I never had to fuss with doctors and meds and all that nonsense and had never caught myself whining with health complaints.

    What pain killers have folks found work with Coumadin? I suspect that the only one without Coumadin interactions and without having to deal with suspicious physicians would be scoring some heroin on the street, and that doesn't sound like a real bright idea.

  • #2
    Hi Sutro,

    I believe your 2nd doctor was correct. Only Tylenol with Coumadin. Actually, any non-aspirin based pain killer will be OK.

    My cardiologist also mentioned Tylenol when taken with some caffine, (Coffee), will act much like Excedrin.

    There are also some prescription meds that have Tylenol as a base. You may ask for some of those. Who cares if they think you are a druggie. Just think of youself as an Over-the Counter Drug Challanged Patient. hehehehe..

    I am on an enteric (coated Aspirin) and Coumadin daily routine. I think that helps me with my headaches and other pains.

    Wishing you good health.

    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
      Hi Sutro-

      My husband Joe has been on Coumadin for 24 years and the only painkiller OTC that he can take is Tylenol. Everything else interferes with the INR, as you have already found out.

      By the way, welcome to the site. It's wonderful, with so many understanding and knowledgeable people who really can relate to what you're saying.


      • #4
        Hi and welcome

        My doctor believes in pain management. If you are taking the medication just when needed for the pain.... that doesn't make you a drug addict.

        I take my pain meds when needed and life is much better. Darvocet and Vicodin "do not" have an effect on the INR.

        Straight Tylenol never worked for me. I could take 3-4 tabs at once and nothing. Motrin and other NAIDS are a no no.
        All the best,
        LuvMyBirman :)
        MVR, 3/99


        • #5
          Thanks to all for the responses above!

          Alas, sounds like I'm pretty much stuck where I thought I was: NSAIDS are out, Tylenol is OK except for long-term use but my body doesn't seem to know that (scared myself half to death when I started peeing blood). That pretty much just leaves narcotics like Darvocet, Vicodin, and Percocet.

          Thankfully I don't care for narcotics all that much, so they're pretty safe for me to take.

          Somewhat in defense of the docs, as much as they annoy the heck out of me, they really are in a bad position when it comes to narcotics. Thanks to the so-called War on Drugs, they've got the DEA looking over their shoulders, ready to pursue criminal charges and license revocation if they don't abide by the under-prescribing standards of care established by law-enforcement officers with no medical training. Between the Feds and the constraints of managed care systems, it seems that the docs have to spend more time abiding by guidelines than practicing medicine.

          Thankfully I don't have chronic pain, although if I did it sounds like I could consistently take an aspirin/Coumadin combo that produced the proper INR.

          This board is wonderful, and copious thanks to those who established it!


          • #6
            The -cet in Darvocet and Percocet stands for acetaminophen which is the only ingredient in Tylenol. So if Tylenol affected you to cause an INR of greater than 11, then you might have problems with these. Acetaminophen is in Vicodin also.
            Most people on warfarin can take either Celebrex or Vioxx without much problem. There have been a few reports of problems, but RARELY have they been serious enough to cause hospitalization. I have been paid by the Celebrex people to give talks to groups of doctors. You could say that the money clouded my judgement or you could say that I had to know what I was talking about to stand up there and take questions from them. Take your pick.
            On the Tylenol issue, the real definitive study on this was done by Dr. Elaine Hylek. Her finding was that if you took more than about 19 Extra-Strength Tylenol in one week, then you had a higher chance than usual of having an INR of greater than 6. She was widely misquoted in the press and on CNN. I talked to her about this and she said that she would never again give an interview on tape, because they so distorted what she said. She also confirmed that what I have on my website at is accurate.
            What I would be interested in knowing is how well regulated were you when the Tylenol caused the INR of 11? Were you on the same warfarin dose for many months? There is a long check list that I go over with my patients if the have a high INR. If you wish to provide details, I would be willing to go into this farther with you.
            You might also be interested in
            It might be a few days before I reply. I'm leaving town until New Years Day. Then it may take a few days to catch up with all of the e-mail. I'm going to close the year with about 75,000 visitors to my website during 2001, so I get quite a volume of e-mail.
            Last edited by allodwick; December 28th, 2001, 10:16 PM.


            • #7
              So is you, Allodwick? That's a pretty good site - I had stumpled across it in the course of surfing the 'Net looking for info. Congrats!

              My INR's have been consistently unstable, driving me nuts. I've been a very good boy, watching my diet, avoiding booze, complying with med regimen, switched to brand-name Coumadin when I read that it was somewhat less likely to produce unstable INR's. But by "unstable" I mean range from 2.0 to 5.0 or so, so I was astonished when it shot up to 11. Since this has happened only once, and then immediately after taking Tylenol, I'd have to do repeated trials with the Tylenol to determine for a fact that that's what caused the spike. But I'm too afraid of going through disgusting high-INR unpleasantness again to do a repeat trial to figure out whetherattributing it to Tylenol is a "post hoc ergo proper hoc" fallacy or not.

              Thanks for the leads on Celebrex and Vioxx.


              • #8


                I recently had to take Vioxx for inflamation of trapezoids. My Doc said ok IF I had PT/INR checked in one week. I did ...and two weeks in a row my level went LOW...down to 2.1 and 2.3. As I am told to keep it between 2.5 and 3.5, I stopped the Vioxx and it returned to normal. I found taking a Tylenol #3 and an extra strength tylenol eased the discomfort without affecting my level.

                Is this a usual reaction, or is it just me ??? Appreciate any responses.


                Zipper *~*


                • #9
                  My husband Joe took Vioxx and it interfered with Coumadin and also with Lasix. It was a bad deal for him. Caused serious CHF symptoms. He gained 10 pounds in 3 days. He went off it almost immediately.

                  It had been prescribed by his pcp. When discussing this with his cardiologist, the cardiologist said that if he really needed Vioxx for pain, he would have adjusted the Coumadin level and Lasix to accommodate the interactions.

                  Well, anyway, I don't think he'll be using it in the near future.

                  I must say though, that millions of people use it with no problems.


                  • #10
                    I think it was just you, Zipper.

                    Nancy, got it right when she said that millions of people take it without any problems. But when millions take it there are bound to be some problems.

                    It is only 6:13 AMand this is the second time I've dealth with this question this morning, so you get an idea that a lot of people are interested.


                    • #11

                      Hi Nancy and allod??? (sorry..too long to remember :>)

                      Thank you so much for your responses...I had aproblem due to the ER/ED Doc wanting me to take an anti-inflamatory and my Cardio says NOOOO...then PCP says take Vioxx..will not upset INR...called Cardio..he said..."well--ok..but..we will monitor it closely".. As usual ..I go against "the usual" and my INR it does with antibiotics...So I stopped it in fear of clotting...ended up just doing excercises and taking pain pills (in moderation as much as possible) and eventually worked it out.

                      It's a problem for me, tho, as I have a UN-ergomomical workplace (albeit I work in a hospital!lol!) and the trapezoids constantly flare. I prefer pain pills to increased coumadin (aka..rat poison) dosage. Any thoughts welcome...

             guys are Gr8...

                      Zipper/Joan *~*


                      • #12
                        Pain pills do not "cure" anything. If you can make it without them, then you have less chances of interactions etc.


                        • #13
                          Well, I certainly agree...that's a no brainer for sure. I hope I did not offend anyone by stating my reaction to Vioxx. Very sorry if I did.



                          • #14
                            Zipper, if folks take offense at reports of drug interactions we'll just have to start a new thread on what antipsychotic meds are best to take with Coumadin.


                            • #15
                              I have used darvocet with good results after surgery.
                              If I need to take something for pain due to cramps I am allowed to take one dose of aleve or motrin, so said my cardio. I have actually taken two doses but a day apart with no increase in inr to the out of range.