coumadin and advil

[Sherry]

My shoulder blade pain has really intensified over the past year, and I've just recently started popping an occasional advil (maybe three in the last month) which at least takes the edge off. I know we're not supposed to take Advil, but it really is the only thing that works. My doc had me on Celebrex for awhile, but that didn't really help. Anyone have any advice? (My numbers aren't totally out of range when I had it checked the last few times, but since I don't have a home testing unit, I can't really be for sure.)

 

[Ross]

As long as your not bleeding, I think I'd try aleve instead of advil. How out of range are your numbers?

 

[Sherry]

Good morning, Ross. The two times I've had it checked after taking advil, I was 4. something and the other was within range. The first check I had taken some penicyllin (sp?) for dental work, and she chalked the higher number up to that. So you think Aleve would be better? This is another of those situations I wish I were a home tester.

 

[Ross]

Aleve is a NSAID. No reported bleeding episodes that I know of and seems safer then Ibuprofen, but if Celebrex didn't do anything for you, Aleve may not either.

 

[tobagotwo]

Technically, Aspirin (acetosalysilic acid), Aleve (naproxen sodium), Advil/Motrin (ibuprofen), Orudis (ketoprofen), Celebrex, and Vioxx are all NSAIDS. They are COX-1/COX-2 inhibitors, and are classified as Non-Steroidal Anti-Inflammatory Drugs. There are many others as well, including most prescription arthritis drugs.

However, they don't all have the same effect on anticoagulation. Aspirin obviously works as an anticoagulant, with its prostaglandin-blocking effect, and is used for AC therapy. Paradoxically, most of the -profens actually block aspirin's effect, at least to some extent.

Pain relievers (other than narcotics) I know not to be NSAIDs are Tylenol (acetominephen - OTC) and Ultram (tramadol - prescription). However, I do not know their interactions with Coumadin.

I'm sure there is a thread here somewhere on pain relievers and Coumadin.

 

[Ross]

Bob your starting to scare me and kitty with your knowledge.

 

[KathyH]

Ross,
I think that is your kitty right after you discovered him biting your O2 line.
Kathy H

 

[bvdr]

Sherry,

Aleve is very effective as are some of the others.... but do watch out for fluid retention. If you are on something daily it can become a problem.

Let me know what works for you. I've been taking a couple of extra strength tylenol at night which helps me get to sleep. Is your shoulder making it hard for you to get comfortable enough to sleep? What does your doctor say about your shoulder pain? I hope you can get this cleared up.

 

[Guest]

Advil does not affect the INR. It erodes the lining of the stomach. If bleeding gets started, then the warfarin will keep it going. I think that bleeding caused by these drugs is the 15th leading cause of death in the US. While they are all int he same big family, their effects of the GI tract lining vary greatly. I cannot find any reports, ever, in any medical jorunal of Alleve causing harm with warfarin.

 

[tobagotwo]

You're so right about the stomach lining issue. That's profound. I didn't even think of that at all.

I believe the level of COX-1 inhibition is what causes that irritation and potential bleeding from NSAIDs. Unfortunately, I have no idea what the relative levels of that effect are in the various drugs. Even my beloved Toradol (ketoralac), which delivered me from thoracic agony the second night after surgery is an NSAID.

There's nothing like experience. Sounds like Aleve is a good bet.

 

[Sherry]

Al, thanks for the advice. I now understand the advil warning a little better. I think I may go out and buy some Aleve today. (I've never used it, so it's certainly worth a try. Hey, Betty, we seem to be corresponding on two different forums It all started about five years ago (after surgery) with a gnawing pain in my left shoulder blade that would come and go. Not a major deal. About a year and a half ago, the pain seemed to encompass my whole left side in the general area of my shoulder blade and was becoming a bit more consistent. I can actually feel a stabbing pain in the chest under my left breast at times which I felt could be nerve involvement. Anyway, my general doc has done injections, prescribed celebrex, MRIs of my spine (did have some moderate disk damage), Kidney scans, you name it. He called it costochondritis, inflammation of the rib lining, but I never understood why it was only on the left side. Just lately, I've noticed some numbness near my elbow and occasionally in my fingers. Also, when I raise my shoulders as though I'm shrugging or when I twist my body around, I feel very sharp pains all over my back. I'm kind of at a loss and like you, are just sick of being in pain. I'm going to try the aleve and see what it does. Let me know how you are doing and if you find out anything. You know, I can't help but think that having our ribcages open during surgery for as long as we all did doesn't factor into this somehow. Do you agree?

 

[Harpoon]

Yeah... My PCP told me to stay away from Advil not too long ago. I didn't know it could cause a problem and had been using it through the summer. I don't THINK I have any bleeding ulcers or whatever in my stomach from it, but I'm kinda watching for signs... My doc wasn't too concerned at the point he told me to stop it.

Now I use Tylenol exclusively and it seems to do fairly well. I have a prescription for Celebrex but haven't filled it yet.

I always got a REALLY tight chest feeling when I took Aleve, almost like someone was squeezing my heart and lungs. I never liked that about it, made me wonder what it might be doing to my heart, if anything.

I THINK Asprin Free Excedrine's safe, but I don't really know, best to ask a doc.

 

[tobagotwo]

Aspirin-free Excedrin is just acetaminophen (Tylenol, non-NSAID). Extra strength Excedrin itself is a mix of acetaminophen, aspirin, and caffeine.

Tylenon has no history of causing bleeding by itself. It is a low-interaction pain reliever. I don't know its effects on INR or interactivity with Coumadin. It is one of the few pain relievers that doesn't block the effects of aspirin therapy.

 

[Guest]

Bob, you have a lot of technical knowledge about medications. Have you had pharmacy training?

Acetaminophen may or may not cause an elevated INR. The only thing that has been shown to happen was that if you suddenly started taking more than about 19 Extra Strength (500 mg) tablets per week, then you had a fairly high risk of having an INR >6. But no cause and effect was ever established. I have discussed this with Dr. Elaine Hylek who was the lead author of the article.

 

[Sherry]

Harpoon mentioned a tight feeling in his chest after taking Aleve. What would that be? Al? Bob? Perhaps an allergic reaction? I'm a little hesitant to take it now.

 

[ccrawford]

Sherry - Be very careful if you start taking Aleve. I started using it routinely and found that my INR had climbed into the high 6.o's. While Al has seen no record of serious bleeds, his web site, and others warn that it does increase the INR. If you start to use it routinely, I'd get a test at one and two week intervals until you are comfortable. I beleive the data sheet for Aleve also mentions its interactivity - I know the OVHC clinic warns against its use. Hope this helps. Chris

 

[ccrawford]

I just checked the data sheet for Aleve and it does warn about interactions with Coumadin. It also warns that Aleve can reduce the effectiveness of both Ace inhibitors and Beta blockers. All of this puts it squarely on my "no-no" list.

 

[Sherry]

Hello,Chris. If I use it at all, I'll use it sparingly. Actually, I only popped an advil three times in a two month period. I don't think I'd ever use something daily, other than my rat poison, of course

 

[Guest]

Alleve is a non-steroidal anti-inflammatory (NSAID). The FDA requires a caution statement on all NSAIDs about warfarin. These class statements do not mean that anything has actuially been reported.

 

[Bryan B]

In case anyone read the post I deleted and are wondering why...after reading the link I provided a little closer I realized it was more of an ad than an informative article. Also, I decided I shouldn't be giving out "helpful information". I have worked in the field of pharmacy for close to 20 years, but I'm not a pharmacist and I'm not taking Coumadin...so I decided to keep my mouth shut...which is not always an easy thing for me to do.