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naproxen oral

Anticoagulants/NSAIDs

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Serious. These medicines may interact and cause very harmful effects. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

The cause of the interaction is not known. NSAIDs may increase the effects of your blood thinner. NSAIDs may also have blood thinning effects.

What might happen:

The effect of your blood thinner may increase.You may experience an increased chance for bleeding including bleeding from your gums, nosebleeds, unusual bruising, or dark stools.

What you should do about this interaction:

This interaction is most likely to occur when starting, stopping or changing the dose of your NSAID. If your doctor prescribes these two medicines together, you may need to have your bleeding times checked more often. It may be necessary to adjust the dose of your blood thinner. This dose adjustment will be more complicated if you use your NSAID only when needed and not every day.If you experience bruising or bleeding, contact your doctor. Your healthcare professionals (e.g. doctor or pharmacist) may already be aware of this drug interaction and may be monitoring you for it. Do not stop, start, or change the dosage of any medicine before checking with them first.

References:

1.Thilo D, Nyman D. A study of the effects of the anti-rheumatic drug ibuprofen (Brufen) on patients being treated with the oral anti-coagulant phenprocoumon (Marcoumar). J Int Med Res 1974;2:276-8.
2.Boekhout-Mussert MJ, Loeliger EA. Influence of ibuprofen on oral anti-coagulant with phenprocoumon. J Int Med Res 1974;2:279-83.
3.Penner JA, Abbrecht PH. Lack of interaction between ibuprofen and warfarin. Curr Ther Res Clin Exp 1975 Dec;18(6):862-71.
4.Michot F, Ajdacic K, Glaus L. A double-blind clinical trial to determine if an interaction exists between diclofenac sodium and the oral anticoagulant acenocoumarol (nicoumalone). J Int Med Res 1975;3(3):153-7.
5.Marbet GA, Duckert F, Walter M, Six P, Airenne H. Interaction study between phenprocoumon and flurbiprofen. Curr Med Res Opin 1977;5(1):26-31.
6.Slattery JT, Levy G, Jain A, McMahon FG. Effect of naproxen on the kinetics of elimination and anticoagulant activity of a single dose or warfarin. Clin Pharmacol Ther 1979 Jan;25(1):51-60.
7.Jain A, McMahon FG, Slattery JT, Levy G. Effect of naproxen on the steady-state serum concentration and anticoagulant activity of warfarin. Clin Pharmacol Ther 1979 Jan;25(1):61-6.
8.Loftin JP, Vesell ES. Interaction between sulindac and warfarin: different results in normal subjects and in an unusual patient with a potassium-losing renal tubular defect. J Clin Pharmacol 1979 Nov-Dec; 19(11-12):733-42.
9.Carter SA. Potential effect of sulindac on response of prothrombin-time to oral anticoagulants. Lancet 1979 Sep 29;2(8144):698-9.
10.Ross JR, Beeley L. Sulindac, prothrombin time, and anticoagulants. Lancet 1979 Nov 17;2(8151):1075.
11.Stricker BH, Delhez JL. Interactions between flurbiprofen and coumarins. Br Med J (Clin Res Ed) 1982 Sep 18;285(6344):812-3.
12.Dahl SL, Ward JR. Pharmacology, clinical efficacy, and adverse effects of piroxicam, a new nonsteroidal anti-inflammatory agent. Pharmacotherapy 1982 Mar-Apr;2(2):80-90.
13.Rhodes RS, Rhodes PJ, Klein C, Sintek CD. A warfarin-piroxicam drug interaction. Drug Intell Clin Pharm 1985 Jul-Aug;19(7-8):556-8.
14.Flessner MF, Knight H. Prolongation of prothrombin time and severe gastrointestinal bleeding associated with combined use of warfarin and ketoprofen. JAMA 1988 Jan 15;259(3):353.
15.Griffin MR, Piper JM, Daugherty JR, Snowden M, Ray WA. Nonsteroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons. Ann Intern Med 1991 Feb 15;114(4):257-63.
16.Gabriel SE, Jaakkimainen L, Bombardier C. Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs. A meta-analysis. Ann Intern Med 1991 Nov 15; 115(10):787-96.
17.Shorr RI, Ray WA, Daugherty JR, Griffin MR. Concurrent use of nonsteroidal anti-inflammatory drugs and oral anticoagulants places elderly persons at high risk for hemorrhagic peptic ulcer disease. Arch Intern Med 1993 Jul 26;153(14):1665-70.
18.Hilleman DE, Mohiuddin SM, Lucas BD Jr. Nonsteroidal antiinflammatory drug use in patients receiving warfarin: emphasis on nabumetone. Am J Med 1993 Aug 9;95(2A):30S-34S.
19.Mieszczak C, Winther K. Lack of interaction of ketoprofen with warfarin. Eur J Clin Pharmacol 1993;44(2):205-6.
20.Celebrex (celecoxib) US prescribing information. Pfizer Inc. February 4, 2011.
21.Vioxx (rofecoxib) US prescribing information. Merck & Co., Inc. March, 2004.

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