Warfarin & arthritis: pain relievers?

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svAdagioME

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I am going to be on warfarin after surgery this week. I have had a knee replacement on one side, need one on the other, and have degenerative arthritis in my neck and back. Oh yeah and the hips. I keep going though, and take ibuprofen and aleve, and have had meloxicam. All of these are no-no’s on warfarin. I am using Tylenol now instead. It doesn’t cut it though.

I am not looking for medical advice but wondering what other people have been allowed to use. I am thinking of asking my dr about celebrex once I am up and running.
 

tom in MO

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I am going to be on warfarin after surgery this week. I have had a knee replacement on one side, need one on the other, and have degenerative arthritis in my neck and back. Oh yeah and the hips. I keep going though, and take ibuprofen and aleve, and have had meloxicam. All of these are no-no’s on warfarin. I am using Tylenol now instead. It doesn’t cut it though.

I am not looking for medical advice but wondering what other people have been allowed to use. I am thinking of asking my dr about celebrex once I am up and running.
If you are going to be on warfarin due to a mechanical valve, you might want to opt for a tissue valve. You will be able to take some if not all of the drugs you are currently taking.. If you need to be on warfarin short term, Percocet is the one I take for severe back and neck pain. It is a narcotic. You will be probably on something similar if you have a valve replacement this week. My cardio allows me to take Ibuprofen but no more than the over-the-counter dose and no more than 2 months.
 

svAdagioME

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If you are going to be on warfarin due to a mechanical valve, you might want to opt for a tissue valve. You will be able to take some if not all of the drugs you are currently taking.. If you need to be on warfarin short term, Percocet is the one I take for severe back and neck pain. It is a narcotic. You will be probably on something similar if you have a valve replacement this week. My cardio allows me to take Ibuprofen but no more than the over-the-counter dose and no more than 2 months.
Thanks, but no. I am going in in the morning and it will be mechanical. I am 58. I want to avoid another heart surgery. A 2nd surgery could be TAVR but that is far from a guarantee. If the valve lasts 8-10 years, and the replacement lasts the same, then I am in my mid 70s and looking at #3 via open heart. And tissue is no guarantee I won’t end up on warfarin anyway. With mechanical I have a shot at living to be 90, with the others probably not, so I can suck it up and do the warfarin. If there aren’t options other than Tylenol I will suck it up and deal with it on Tylenol. But I am interested in what other people use while on warfarin.
 

carolinemc

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If you are going to be on warfarin due to a mechanical valve, you might want to opt for a tissue valve. You will be able to take some if not all of the drugs you are currently taking.. If you need to be on warfarin short term, Percocet is the one I take for severe back and neck pain. It is a narcotic. You will be probably on something similar if you have a valve replacement this week. My cardio allows me to take Ibuprofen but no more than the over-the-counter dose and no more than 2 months.
Most of us have had the choice on Mechanical Valve for various reasons. I am glad I went this route due to young age (38) and warfarin was no problem. All of the Cardios I have seen only recommends Tylenol, which I only use the extra strength, since I get no relief from just Tylenol.
 

carolinemc

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Thanks, but no. I am going in in the morning and it will be mechanical. I am 58. I want to avoid another heart surgery. A 2nd surgery could be TAVR but that is far from a guarantee. If the valve lasts 8-10 years, and the replacement lasts the same, then I am in my mid 70s and looking at #3 via open heart. And tissue is no guarantee I won’t end up on warfarin anyway. With mechanical I have a shot at living to be 90, with the others probably not, so I can suck it up and do the warfarin. If there aren’t options other than Tylenol I will suck it up and deal with it on Tylenol. But I am interested in what other people use while on warfarin.
Use the Extra Strength tylenol. Good luck on your surgery.
 

JaneF

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I am going to be on warfarin after surgery this week. I have had a knee replacement on one side, need one on the other, and have degenerative arthritis in my neck and back. Oh yeah and the hips. I keep going though, and take ibuprofen and aleve, and have had meloxicam. All of these are no-no’s on warfarin. I am using Tylenol now instead. It doesn’t cut it though.

I am not looking for medical advice but wondering what other people have been allowed to use. I am thinking of asking my dr about celebrex once I am up and running.
You might could try Tramadol, it’s a relatively mild non-narcotic pain reliever. Since my MVR in 2017 I have had a cervical fusion with plates & screws, a lumbar fusion with rods, and a rotator cuff repair. I am unable to tolerate hydrocodone or oxycodone due to severe nausea & vomiting. I had no notable issues with my INR while taking it, so It might be worth checking with your doctor. Good luck!
 

pellicle

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I keep going though, and take ibuprofen and aleve, and have had meloxicam. All of these are no-no’s on warfarin.
not entirely.

For some reason people seem to exchange the word "may" for the word "certainly" in their reading of sentences like "and may interact with warfarin"

 

Superman

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If you take it daily for pain and inflammation, and you’re consistent with your dose, then “dosing the diet” should apply here too.

If you take it randomly as needed for pain, it could present challenges in regulating your INR. That said, I’ve taken steroids and anti-inflammatory meds (prescription) for back pain while on warfarin. During treatment, I increased my testing and adjusted my warfarin dosing as needed. I did go out of range to the high side, and was glad when I was done.
 

oo0My_Valve0oo

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OTC Tylenol is really just for inflammation and not a pain reliever despite what is said on the bottle. My big surgery discovery was that there is an intravenous Tylenol and it actually relieves pain but it doesn't last very long and they don't allow you to receive more soon enough so there are gaps in relief. It doesn't present the constipation issue a narcotic does as well. I have tried many prescription and OTC pain relievers but the only OTC option that has any effect on me is Excedrine. The combination of the three active ingredients must be the key. One of the three is Tylenol which by itself does nothing for me. You won't be able to use Excedrine though. One of the three is caffeine. My friend has severe arthritis and gets prescription strength Advil which works for her. Any dosage of OTC Advil has not helped my relatively lesser pain and there are so many additives you would get sick if you equaled the same active ingredients of prescription strength using the OTC form. Being on blood thinners for the rest of my life was a factor when I chose a biological valve. Maybe it was the foolish choice of my life but I desired a day to day existence with less restrictions and did not place as much significance on having another surgery experience. I have arthritis and my work is a source of many aches and pains.
 

tom in MO

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The risk with Ibuprofen and other NSAIDs with warfarin is stomach bleeding, not a change in INR. NSAIDs can cause ulcers which are very difficult to treat if you are on any anti-coagulant.
 

Protimenow

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The risk of using NSAIDS (Aspirin, Naproxen, Ibuprofen) isn't stomach bleeds - it's bleeding. These NSAIDs make the platelets 'slippier' - they don't clump together when you take NSAIDs than they normally do. The result may be more bleeding, slower clotting - but these results can't be tested using an prothrombin time tester (like CoaguChek XS and CoagSense meters are designed for). Continued use of NSAIDs can result in bleeding problems.

Tylenol presents a different problem - continuous use can cause liver damage. You don't want to be taking this for more than a few days at a time. I've also seen some materials that said something about acetaminophen being contraindicated for people on warfarin.

A Rheumatologist I used to go to once prescribed Ketoprophen - which he said did less damage to the platelets. This is fairly expensive, but may be an alternative to the other NSAIDs.

I usually avoid NSAIDs and Acetaminophen - but I probably didn't have to deal with the severe pain associated with surgeries or chronic arthritic or other issues. I may also take NSAIDs for their anti-inflammatory effects, as much as for pain relief. There may be few ways to avoid it.

Good luck dealing with your pain - I hope it's easily managed.
 

tom in MO

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The risk of using NSAIDS (Aspirin, Naproxen, Ibuprofen) isn't stomach bleeds - it's bleeding. These NSAIDs make the platelets 'slippier' - they don't clump together when you take NSAIDs than they normally do. The result may be more bleeding, slower clotting - but these results can't be tested using an prothrombin time tester (like CoaguChek XS and CoagSense meters are designed for). Continued use of NSAIDs can result in bleeding problems.

Tylenol presents a different problem - continuous use can cause liver damage. You don't want to be taking this for more than a few days at a time. I've also seen some materials that said something about acetaminophen being contraindicated for people on warfarin.

A Rheumatologist I used to go to once prescribed Ketoprophen - which he said did less damage to the platelets. This is fairly expensive, but may be an alternative to the other NSAIDs.

I usually avoid NSAIDs and Acetaminophen - but I probably didn't have to deal with the severe pain associated with surgeries or chronic arthritic or other issues. I may also take NSAIDs for their anti-inflammatory effects, as much as for pain relief. There may be few ways to avoid it.

Good luck dealing with your pain - I hope it's easily managed.
Well I have had several doctors and two cardios tell me that NSAIDs such as warfarin can cause stomach bleeding if used for a long period of time or in higher doses. Stomach bleeding is bad news if you are on warfarin for a heart valve. They have also told me to use Acetaminophen aka Tylenol.
 

Dodgy Ticker

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Well - hello fellow sufferer!!
I have the same problem, due to Ankylosing Spondlitis, and my back and neck are genuinely ruined. But due to Warfarin, I am also stuck for pain relief.
What I take is a capsule that is combines Paracetamol and Codeine. I have no idea whether you can get these in the US, but if you can - it is safe and very effective..
Let me know if you can't find it
 

oo0My_Valve0oo

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AKA Tylenol (Paracetamol aka Acetaminophen) and Codeine have been one of the few prescription med combos that work well in my experience. It was common back in the 80's and 90's. Frequently prescribed by a dentist rather than a doctor in the USA but I am not currently on meds for my arthritis so I wouldn't know how common it is prescribed for it in the USA these days. I have not had a dentist who offered more than OTC suggestions in at least 20 years. My experience of this combo has been for an injury, dental work and a pinched nerve. As for stomach problems, that risk can be reduced taking such meds with food. Tylenol, don't know about Codeine, does its thing with or without food in the stomach.
 
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dwhist

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Elmhurst, IL
I am going to be on warfarin after surgery this week. I have had a knee replacement on one side, need one on the other, and have degenerative arthritis in my neck and back. Oh yeah and the hips. I keep going though, and take ibuprofen and aleve, and have had meloxicam. All of these are no-no’s on warfarin. I am using Tylenol now instead. It doesn’t cut it though.

I am not looking for medical advice but wondering what other people have been allowed to use. I am thinking of asking my dr about celebrex once I am up and running.
I had a mechanical valve 11 years ago. On Warfarin. Left Knee replacement 2 years ago. Right knee may be next in a few years.
I had a long discussion with my primary doc about taking Tylenol or Celebrex and decided it was a toss up. Have been taking Celebrex for a year with no issues. My dad also had mechanical valve and took Celebrex with no issues.
 

Justmadi

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Wisconsin
OTC Tylenol is really just for inflammation and not a pain reliever despite what is said on the bottle. My big surgery discovery was that there is an intravenous Tylenol and it actually relieves pain but it doesn't last very long and they don't allow you to receive more soon enough so there are gaps in relief. It doesn't present the constipation issue a narcotic does as well. I have tried many prescription and OTC pain relievers but the only OTC option that has any effect on me is Excedrine. The combination of the three active ingredients must be the key. One of the three is Tylenol which by itself does nothing for me. You won't be able to use Excedrine though. One of the three is caffeine. My friend has severe arthritis and gets prescription strength Advil which works for her. Any dosage of OTC Advil has not helped my relatively lesser pain and there are so many additives you would get sick if you equaled the same active ingredients of prescription strength using the OTC form. Being on blood thinners for the rest of my life was a factor when I chose a biological valve. Maybe it was the foolish choice of my life but I desired a day to day existence with less restrictions and did not place as much significance on having another surgery experience. I have arthritis and my work is a source of many aches and pains.
Actually, tylenol /acetaminophen, is NOT an anti-inflammatory. It is strictly a pain reducer. I have found that it does work for me.
Advil is ibuprofen, an NSAID
NSAIDs should not be taken on a regular basis with a mechanical valve…not sure how it works with a tissue valve.
 

thomas999

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sterling heights, michigan, usa
I had a St Jude valve put in when I was 32 years old. I am now 67. I have used ibuprofen and other pain relievers that many say I shouldn't use. I now use Celebrex and it helps me out. I haven't had any problems because of these pain relief options so far. They may thin the blood a little bit, but that doesn't bother me too much because it's just a little, maybe. Maybe I am a bit Cavalier with these types of medicines, but arthritis really hurts and Tylenol doesn't seem to do the trick for me. At age 32, a mechanical valve was pretty much the only option because of their longevity. Although, at age 58, if you had a biological valve put in, you may only need one more in the future. Surgery is really becoming a successful science these days that those surgeries are becoming quite routine. If I had the choice right now, I would gladly swap out my mechanical valve for a biological valve for the blood thinning reason, and among other issues.
 

Nick Drew

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UK
Well - hello fellow sufferer!!
I have the same problem, due to Ankylosing Spondlitis, and my back and neck are genuinely ruined. But due to Warfarin, I am also stuck for pain relief.
What I take is a capsule that is combines Paracetamol and Codeine. I have no idea whether you can get these in the US, but if you can - it is safe and very effective..
Let me know if you can't find it
Hi i only joined this forum yesterday can i ask if your back and neck pain were due to surgery?
 

carolinemc

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Actually, tylenol /acetaminophen, is NOT an anti-inflammatory. It is strictly a pain reducer. I have found that it does work for me.
Advil is ibuprofen, an NSAID
NSAIDs should not be taken on a regular basis with a mechanical valve…not sure how it works with a tissue valve.
Actually, acetaminophen is an anti-inflammatory. And is a pain reliever and fever reducer. I use the extra-strength. And you cannot take Advil or ibuprofen as they have many side effects.
 

carolinemc

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Well I have had several doctors and two cardios tell me that NSAIDs such as warfarin can cause stomach bleeding if used for a long period of time or in higher doses. Stomach bleeding is bad news if you are on warfarin for a heart valve. They have also told me to use Acetaminophen aka Tylenol.
Warfarin is not a nsaid, or a pain reliever. LMAO! Loved your joke. LMAO!
 

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