Written by Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP | Reviewed by Christina Aungst, PharmD Updated on January 20, 2023
Key takeaways:
- Blood thinners are medications used to prevent or treat clots that form in the blood. They can interact with over-the-counter (OTC) medications that contain nonsteroidal anti-inflammatory drugs (NSAIDs).
- Aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve) are all NSAIDs. They’re included in many OTC products and treat symptoms like pain, swelling, and headaches.
- NSAIDs like ibuprofen aren’t technically blood thinners. But they can increase your risk of bleeding, especially if they’re taken with prescription blood thinners.
- It’s important to read the ingredients list on OTC medications, so you can identify NSAIDs and avoid them if you also take blood thinners.
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Blood thinners include medications like warfarin (Coumadin, Jantoven) and clopidogrel (Plavix). They’re used to prevent or treat clots that form in the blood, and help protect against strokes and heart attacks. One of the biggest risks of taking these medications is bleeding that’s difficult to stop or happens more often than usual.
Because of this side effect, people taking blood thinners have to be careful with other medications they take. One group of medications to be aware of is nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include over-the-counter (OTC) medications like aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve). NSAIDs cause, among other side effects, a higher risk of bleeding.
In this article, we’ll discuss the dangers of taking NSAIDs and blood thinners together. , We’ll also review what OTC products often contain NSAIDs, and what alternatives you can use to avoid this interaction.
1. Are ibuprofen and other NSAIDs blood thinners?
Not exactly. The reason most people think of NSAIDs as blood thinners is because they can make it harder for your blood to clot. This can raise your risk of bleeding while you’re taking them.
But this bleeding risk is generally considered a side effect. NSAIDs treat pain and swelling; they’re not used to prevent blood clots. The exception to this is low-dose aspirin, which we’ll talk more about later.
2. What are the risks of taking NSAIDs while on blood thinners?
If you’re taking a prescription blood thinner, one of the biggest concerns is bleeding. As mentioned, NSAIDs can also raise your risk of bleeding. So taking these medications together makes the risk of bleeding even greater.
Just because some NSAIDs are available without a prescription doesn’t mean they’re risk-free. Even common OTC NSAIDs like ibuprofen and naproxen pose a danger if you take them with prescription blood thinners.
In 2009, the FDA required that a warning about bleeding risks be added to the labels of all OTC products containing NSAIDs. Since you can buy these medications OTC, your healthcare provider may not know you’re taking them. So they won’t be able to warn you of their risks. This warning helps make sure you’re aware that the product may not be safe for you.
But bleeding isn’t the only problem with taking NSAIDs and blood thinners together. You also have a higher risk of heart attacks if you take both blood thinners and NSAIDs. This risk goes up even if you take NSAIDs for just a few days.
This combination of possible problems makes taking NSAIDs riskier for people who also take blood thinners than for those who don’t.
3. Which blood thinners interact with NSAIDs?
There are many different types of blood thinners, but they all interact with NSAIDs. Most blood thinners used at home come as oral tablets or capsules, but some people may need to useinjectable products.
Examples of blood thinners include:
- Aspirin
- Warfarin
- Apixaban (Eliquis)
- Dabigatran (Pradaxa)
- Rivaroxaban (Xarelto)
- Edoxaban (Savaysa)
- Clopidogrel (Plavix)
- Prasugrel (Effient)
- Ticagrelor (Brilinta)
- Enoxaparin (Lovenox)
- Fondaparinux (Arixtra)
Aspirin is a unique member of this group because it is actually an NSAID. At low doses, it’s often used for its blood-thinning abilities.
Many people with chronic heart conditions or complicated Type 2 diabetes take a blood thinning medication. If you are unsure if you’re taking a blood thinner, ask your pharmacist or healthcare provider before taking an NSAID.
4. What OTC medications contain NSAIDs?
One of the dangers of using OTC medications without consulting your provider or pharmacist first is that many contain NSAIDs. While you might know to be cautious with pain relievers, you might not know that NSAIDs are also included in several other types of OTC medications.
Here, we’ll discuss common OTC remedies that have these “hidden” NSAIDs and warrant extra awareness if you take blood thinners.
Cough and cold products
Cough and cold products often contain many different ingredients to help relieve multiple symptoms at once. They often include a pain reliever to help lower a fever or ease muscle aches. The pain reliever may be an NSAID, such as ibuprofen, naproxen, or aspirin.
Common examples of cold remedies that have NSAIDs include:
- Advil Cold & Sinus (ibuprofen/pseudoephedrine)
- Sudafed PE Head Congestion + Pain (ibuprofen/phenylephrine)
- Alka-Seltzer Plus Severe Cold (aspirin/chlorpheniramine/dextromethorphan/phenylephrine)
- Aleve-D Sinus and Cold (naproxen/pseudoephedrine)
It’s best to read the label carefully and ask your pharmacist if the cough and cold product you’ve selected is safe to take with your other medications.
Sleep aids
There are many OTC products available to help with occasional difficulty sleeping. Some sleep aids also contain NSAIDs like ibuprofen and naproxen. They’re marketed for people with sleep troubles caused by aches and pains.
Examples of these products include:
- Advil PM(ibuprofen/diphenhydramine)
- Motrin PM(ibuprofen/diphenhydramine)
- Aleve PM (naproxen/diphenhydramine)
- Excedrin PM (aspirin/acetaminophen/diphenhydramine)
Most retailers also sell generic or store-brand versions of these products, so be sure to ask a pharmacist if your sleep aid contains any NSAIDs before taking it.
Headache and migraine relief
Products for treating headaches and migraines often contain a combination of aspirin, acetaminophen, and caffeine. But ibuprofen and naproxen are also found in these types of OTC medications.
Some well-known brands that contain NSAIDs include:
- Excedrin Migraine (acetaminophen/aspirin/caffeine)
- Advil Migraine (ibuprofen)
- Aleve Headache Pain (naproxen)
- Motrin IB Migraine (ibuprofen)
- Goody’s Extra Strength Headache Powder (acetaminophen/aspirin/caffeine)
These may also have generic and store-brand equivalents. So it’s a good idea to double check with a pharmacist or your healthcare provider before taking an OTC headache medication if you’re trying to avoid NSAIDs.
Products for upset stomach
Some OTC products for upset stomach contain salicylates (a product like aspirin) or aspirin itself. These ingredients are both NSAIDs.
Some examples of these products include:
- Pepto-Bismol (bismuth subsalicylate)
- Alka-Seltzer (citric acid/aspirin/sodium bicarbonate)
- Kaopectate (bismuth subsalicylate)
Again, pharmacies will often carry generic versions of these products. So it’s best to have a pharmacist double check the product you’re interested in taking before purchasing it.
Menstrual cramp relief
Some OTC products that can help relieve menstrual period pain and cramps contain NSAIDs. These products might include aspirin, ibuprofen, or naproxen, but they often also offer NSAID-free versions.
For example, Pamprin Max Pain + Energy contains aspirin (an NSAID), acetaminophen, and caffeine. But Pamprin Multi-Symptom contains no NSAID and instead uses acetaminophen, pamabrom (to reduce bloating), and pyrilamine (an antihistamine). Midol also reformulated all their products to be NSAID-free.
Just be cautious if you select a store-brand “menstrual relief” product. They may have a different combination of ingredients and could include an NSAID. Ask your pharmacist if you’re unsure.
5. Why do so many OTC medications include NSAIDs?
NSAIDs can help relieve multiple symptoms, such as fevers, pain, and swelling. They do this by blocking prostaglandins. Prostaglandins are substances that tell our bodies to raise our temperature and create swelling as a way to protect us when we’re injured or sick. Many of the OTC medications listed above treat conditions that can cause pain, fever, or other similar discomforts.
Many of these products, especially those that treat cold and flu symptoms, treat several symptoms at once. These combination products contain several active ingredients. So they’re generally more convenient and cost less than taking each medication individually. But that means you should be more careful when purchasing combination products if you need to avoid certain ingredients. Luckily, there are a wide variety of these products, and many manufacturers offer NSAID-free options.
6. How do I know if an OTC medication contains an NSAID?
One of the first steps in choosing OTC medications safely while taking blood thinners is learning if an OTC product contains an NSAID. The best way to do this is by carefully reading the “drug facts label” on the package.
How to read a drug facts label
A drug facts label tells you important information about the OTC medication you’re considering. All NSAID-containing medications must have this label. The drug facts label tells you:
- Active ingredients and how much of each ingredient is present
- The purpose and use of the medication
- How to take the medication (when, how, and how often)
- Warnings about who should not use it
- Inactive ingredients (fillers, dyes, and other substances that don’t affect how the medication works)
First, look in the active ingredients list for the words “aspirin,” “naproxen,” “ibuprofen,” or “salicylate” to know if they are present in the product. The words “NSAID” or “nonsteroidal anti-inflammatory drug” should also be next to the ingredient name.
Another section to check is the warning section. Any NSAID-containing products must list a specific warning about the risk of bleeding. This section should also state that people taking blood thinners have a higher risk of this happening. To see an example of an NSAID drug facts label, click here.
OTC medications that include salicylates are not required to have the FDA warning of bleeding risks on their drug facts label. But there should still be a section that indicates people taking blood thinners should avoid using the product. This is why it’s a good idea to read all sections of the label very carefully.
If you’re ever unsure, ask your pharmacist for help. They can tell you if the product you’re looking at contains an NSAID.
7. Are there alternatives to OTC medications with NSAIDs?
Yes, most OTC medications will also have options that are NSAID-free, depending on the symptom you’re experiencing.
Pain relief
If you’re looking for an alternative pain reliever to an NSAID, acetaminophen (Tylenol) may be a safer option. Many of the products listed earlier have versions that contain acetaminophen instead of an NSAID.. This includes cold remedies, sleep aids, and menstrual cramp medications. Keep in mind that acetaminophen has risks of its own, so it’s a good idea to talk to your healthcare provider before taking it.
Upset stomach
If you’re looking for an alternative medication for an upset stomach, there are a few NSAID-free options. Tums (calcium carbonate), Mylanta (aluminum hydroxide/magnesium hydroxide/simethicone), or Rolaids (calcium carbonate/magnesium hydroxide) can help with heartburn or acid reflux symptoms. Emetrol (phosphorylated carbohydrate) and Dramamine (dimenhydrinate) can ease nausea or motion sickness. And Imodium A-D (loperamide) is available to manage occasional diarrhea.
The bottom line
NSAIDs work great for pain and fever, but they aren’t for everyone. If you’re already taking blood thinners, adding an NSAID could raise your risk of serious bleeding and heart attacks. Many OTC medications contain NSAIDs, so it’s important to look for NSAIDs on the drug facts labels before choosing a product. When in doubt, ask your pharmacist or healthcare provider if an OTC medication is safe for you before starting anything new.
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