Coumadin and Tylenol

[Lynne1]

Peter has been on Coumaind since May after experiencing A-Fib. At that time he was told it was ok to take Tylenol if he needed pain relief, but of course nothing with aspirin or ibuprofin. Now that he's had the valves done and will continue Coumadin forever, he was told at the hospital not to take Tylenol. We'll check again with cardiologist but just wondering what others' experience has been? I have seen Tylenol on the list of things that can interact with Coumadin but so can a lot of other things that he has been on - like Amiodarone (which he'll thankfully be off of in a few weeks) and alcohol in moderation (he's been allowed 1-2 glasses of wine a night). It seems like the main thing is to always be consistent so when he's tested it's under the same conditions each time. But is there something more specific about tylenol to watch out for?

 

[Ross]

I have no idea why they would tell you no Tylenol when that is just about all that they will let us take. I think someone said something incorrectly to you. Here is the piece from Mr. Lodwicks Website on the subject:

http://www.warfarinfo.com/acetaminophen.htm

 

[Nancy]

The only reason to be careful of Tylenol, as far as I know, is if there is liver problem which can happen with CHF.

Maybe he was told that about Tylenol because both Tylenol and Coumadin are metabolized by the liver, and Tylenol can irritate the liver in higher doses.

Could it be because of another medication interraction, like with amiodarone?

Lots of questions?????????

Perhaps Al will see this thread and shed some light.

 

[Kathy]

The nurse at the Coumadin Clinic told me that Tylenol is the least likely of the pain relievers to have an effect on INR levels, but that I needed to take it consistently. (I couldn't stand prescription pain relievers and their side-effects after surgery.)

I haven't had many headaches lately, so I have gotten along without it. When I return to teaching that won't be the case! I'll look forward to hearing what others have to say about this issue.

 

[bvdr]

Kathy,

Tylenol is the one over-the-counter pain reliever I have my doctor's blessing to take.

 

[Guest]

If you suddenly start taking about 2 extra strength Tylenol (500 mg each) or more per day (and keep up for more than one week) then you have a chance of having an elevated INR.

The keywords are start and chance.

This makes it the safest pain reliever for those on warfarin.

Do not read any story that has a report from Harvard or Dr. Elaine Hylek - the news media greatly misrepresented her owrk and unfortunately when something wrong gets on the internet it comes close to achieving immortality and God's truth.

I have personally asked Dr. Hylek if I had the correct interpretation of her study (the first paragraph of this post) and she agreed that I did.

Dr. Hylek also said that she would never give another videotaped interview again for the rest of her life because they so sensationalized what she said that it was no longer the truth.

Just remember that bad news sells - good news does not. Unfortunately there are some people who purport to manage warfarin that would rather get their "knowledge" from the news than spend the time to read the original articles in the medical literature.

As Kathy noted consistency is the name of the game for managing warfarin. Unfortunately for consistency nobody wants to take a pain medication when they are not in pain. So, if you find yourself requiring 1000 mg or more of Tylenol per day for several days, get your INR checked.

 

[Guest]

*raises eyebrow as topic title grabs my interest*

I'm wondering if this is a YMMV (your mileage may vary) type thing........

My cardiologist is OK with Tylenol.

But, the Coumadin Clinic people tend to "freak out" whenever they find out I've taken Tylenol...

I don't know...I just wish the message from people about this was consistent...LOL.

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[Guest]

Those of you who know my thinking know that I am one of the most easy-going of the people who manage warfarin. Many tend to be very anal. They freak over someone mentioning the name of an interacting drug. Makes for interesting conversations at our conventions.

 

[cookie]

I just returned from my coumadin clinic and informed him that I had been taking Tylonal Sinus for about a week for a bad head cold and he was very nonplused. Tylonal is the one med I can count on. It is metabolized by the liver as is coumadin so long term is probably not recommended, but my protime was right on target even after coming home from a cruise to Hawaii and getting sick! Must be doing something right! LOL

 

[Nan]

I tke Tylenol regularly for shoulder pain, and it does not seem to impact my INR....same levels as prior to taking it. Perhaps it is because it is consistent....but then again, no change from before.

Both my cardio and my primary are aware that I am taking it, don't seem to have a problem.

Sure wish I could take ibuprofen or vioxx or some other anti-inflammatory though!!! Tylenol just doesn't do the job!

 

[tommy]

I'm with knightfan........I like the YMMV acronym.

My cardio says Tylenol is not a problem.

The Coumadin queen (nurse) requires more frequent checks whenever I take anything.

I've had a sinus infection for about five days and have been taking Tylenol and Sudafed (Benadryl at night). My INR this morning was 2.4. So much for elevated INR due to those meds.

 

[ccrawford]

What I typically do is --- Whenever I start taking something new (prescribed or OTC) I always read the data sheet, and I may double check it with the drug interaction web site. If there is any inkling of a problem with Coumadin interaction, then I'll self test the day I start this new drug, and then again in about 5 days to a week. I've failed to do this in the past and had some roller coaster rides, but nothing serious. Hope this helps. Chris

 

[Sunshine susan]

What about Aleve?

What about Aleve?

What about Aleve as it is neither acetaminiphen nor ibuprophen, but a different substance that supposedly does the work of aspirin or ibuprofen is helping with the inflammation as well as the pain? I've never tried it as I am allergic to Aspirin (thus, ibuprophen) and just haven't felt the need to take a chance. Any thoughts? Thanks, Susan

 

[Ross]

Re: What about Aleve?

Re: What about Aleve?

What about Aleve as it is neither acetaminiphen nor ibuprophen, but a different substance that supposedly does the work of aspirin or ibuprofen is helping with the inflammation as well as the pain? I've never tried it as I am allergic to Aspirin (thus, ibuprophen) and just haven't felt the need to take a chance. Any thoughts? Thanks, Susan

http://www.warfarinfo.com/naproxen.htm

 

[ccrawford]

Susan - Aleve was one of those OTC drugs that (in my opinion) caused me to have a roller coaster ride. I don't have my calendar in front of me, but I beleive my INR went up to over 6.0 while routinely taking it. Al Lodwick and I exchanged quite a few emails over this incident. There are no clinically documented cases or trials of Aleve causing problems. It does not add to the work load of the liver to metabolize it, and this is good. My experience with it,however, is that it can cause serious problems. Al added a paragraph to his web site indicating this possibility. If you feel you must try it, then please test your INR when you start, then again in about 4 or 5 days - and let us know the result. Chris

 

[csutherland]

Jerry saw an Ear, Nose & Throat doctor last week for a problem he was having. He gave him sample Flonase and had him pick up over-the-counter Claritin-D. Before taking the first dose of Claritin Jerry called the pharmacy to see if there was any adverse interaction. They assured him there was not.

He's going monthly for INR now and that comes up next week. Hope it's OK. As for Tylenol, he takes a couple occasionally if he has severe headache. Haven't noticed any change that this has caused in INRs.

 

[Les]

I think at times I've eaten Tylenol like M&Ms....no effect on my INR.

 

[Granbonny]

Tylenol

Tylenol

Only pain med I have taken for 18 months. INR always in range. They are now making an 8 hour Tylenol gel tab. 650 mg......Up to 8 hours releif..mine is for old age pains Bonnie

 

[Jane]

I have had to take paracetamol (same as acetaminophen in UK) with codeine for sciatic pain for ages and it does not seem to have any affect on my INR. Some GPs at our local surgery are a bit overcautious about it, but, fingers crossed, my INR is pretty stable. Having said that, I do roughly the same amount of paracetamol and codeine each day, so I know that will explain a lot.