What Pain Medication Can I Take While on Warfarin?

Ask the experts

A friend has recently been diagnosed with ankylosing spondylitis. She chronically requires blood thinning medication, warfarin (Coumadin), to prevent recurring deep vein thrombosis (DVT). The HLA-B27 gene is present.

What antiinflammatory drugs are treatment options while taking warfarin?

Doctor's response:

The bad news: not many. The good news: there are some and a very popular antiinflammatory is now available that might be a possibility.

Most anti-inflammatory drugs present to great a bleeding risk for patients taking warfarin. Non-acetylated salicylate drugs, like choline magnesium salicylate (Trilisate) and salsalate (Disalcid) do not present the same risks and might be of consideration.

A newer class of nonsteroid anti-inflammatory drug has been developed and is represented by the drugs now on the market called "Cox-2 inhibitors." An example is, celecoxib, sold under the brand name of Celebrex.

This class of medications has been shown to not affect the function of an essential element in the blood that is necessary for normal clotting called platelets. Celebrex does not typically affect warfarin's blood-thinning (anticoagulant) action and does not carry the bleeding risk of traditional nonsteroid anti-inflammatory drugs. The manufacturers do recommend that anticoagulant activity be monitored, particularly in the first few days, after initiating or changing Cox-2 inhibitor therapy in patients receiving warfarin or similar agents, since these patients are at an increased risk of bleeding complications.

They further state that "The effect of 'Celebrex' on the anticoagulant effect of warfarin was studied in a group of healthy subjects receiving daily doses of 2-5 mg of warfarin. In these subjects, celecoxib did not alter the anticoagulant effect of warfarin as determined by prothrombin time. However, in post-marketing experience, bleeding events have been reported, predominantly in the elderly, in association with increases in prothrombin time in patients receiving Celebrex concurrently with warfarin."

(By the way, there is some increased risk of allergic reactions to Celebrex in persons who have a history of sulfa allergy and your friend should be aware of this.)

Your friend should review these possible options with her doctor.

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Reviewed on 1/11/2018
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