If I take 200 mg Ibuprofen for about a week, will my INR be drastically affected?

[Sherryl]

I currently take 12 mg of warfarin a day to keep my INR between 2.5 and 3.5. I was prescribed Flexiril & Hydrocodone for lumbar radiculopathy sciatica about a week ago. I've taken as little of the Flexiril as possible & am taking only 1/2 of the Hydrocodone when needed at bedtime. My INR on 11/22 was 2.6 before I began taking these meds. On 11/29 it was 3.2. I have taken 200 mg of Ibuprofen the past couple of mornings. Will the Ibuprofen likely cause a drastic rise in my INR level if I continue to take it daily instead of the other meds?

ATS Aortic Valve (11/08/05
Annuloplasty Ring in Mitral

 

[Freddie]

From DrugDigest.com

IBUPROFEN (in Ibuprofen Capsules) may interact with WARFARIN SODIUM (in Warfarin Tablets)

Blood clotting normally occurs in response to a cut or other types of injuries to protect the body from excessive bleeding. Platelets, a type of cell found in the blood, are involved in helping the blood to clot when it is needed. Ibuprofen may interfere with the platelets' ability to work properly. It may also damage the lining of the stomach, particularly when used for a long period of time, and this may increase the risk of developing a bleeding ulcer. Warfarin is generally used to prevent your blood from "coagulating" or forming blood clots. When ibuprofen and warfarin are used at the same time, your blood may be much less likely to clot and this may increase the risk of excessive bleeding. If it is necessary to use ibuprofen while you are taking warfarin, your doctor may want to monitor you closely for signs of bleeding. Let your doctor know if your bowel movements appear black or tarry, or if you are having any stomach pain. Blood tests can be used to make sure that you are getting the right amount of warfarin. If you are experiencing problems, it may be necessary to adjust the dose of warfarin. Your doctor may also consider stopping therapy with ibuprofen.Discuss this potential interaction with your healthcare provider at your next appointment, or sooner if you think you are having problems.

This interaction is well-documented and is considered major in severity.

 

[Freddie]

IBUPROFEN (in Hydrocodone and Ibuprofen) may interact with WARFARIN SODIUM (in Warfarin Tablets)

Blood clotting normally occurs in response to a cut or other types of injuries to protect the body from excessive bleeding. Platelets, a type of cell found in the blood, are involved in helping the blood to clot when it is needed. Ibuprofen may interfere with the platelets' ability to work properly. It may also damage the lining of the stomach, particularly when used for a long period of time, and this may increase the risk of developing a bleeding ulcer. Warfarin is generally used to prevent your blood from "coagulating" or forming blood clots. When ibuprofen and warfarin are used at the same time, your blood may be much less likely to clot and this may increase the risk of excessive bleeding. If it is necessary to use ibuprofen while you are taking warfarin, your doctor may want to monitor you closely for signs of bleeding. Let your doctor know if your bowel movements appear black or tarry, or if you are having any stomach pain. Blood tests can be used to make sure that you are getting the right amount of warfarin. If you are experiencing problems, it may be necessary to adjust the dose of warfarin. Your doctor may also consider stopping therapy with ibuprofen.Discuss this potential interaction with your healthcare provider at your next appointment, or sooner if you think you are having problems.

This interaction is well-documented and is considered major in severity.

 

[Sherryl]

Thank you for your response. That's what I thought. I'll stop taking the Ibuprofen so as to not cause further problems.

 

[Protimenow]

For a few days last week, I was taking between 200 mg and 800 mg of Ibuprofen for severe dental pain. I was also taking Amoxicillin. Both medications can cause the INR to increase.

My testing during and after this period didn't show any major rises. (Of course, because Ibuprofen has a different effect on the blood than Warfarin does, these effects may not show up as INR). I didn't see any extra sensitivity to impact, or unexpected bruising.

FWIW -- Vicodin is acetaminophen - Tylenol - plus codeine. It may not have much effect on your INR.

In my case (and maybe yours, too), I found that a few ibuprofen did a better job than Vicodin. Because I didn't plan to take it for more than a couple days, I really didn't detect any issues. I'm not sure that completely discontinuing Ibuprofen is necessary or appropriate--especially if you're experiencing a lot of pain. Of course, if I had a doctor, I would ask for some advice on this.

I also don't think that taking one 200 mg Ibuprofen in the morning will do anything 'drastic' to your INR.

 

[tom in MO]

Ibuprofen and other NSIDs are not allowed for me due to warfarin. I've been told this by my internist, my orthopedist and my cardiologist. Home monitoring didn't make a difference to them.

 

[Bina]

NSAIDs usually affect platelets in the blood and not coagulation, but the combined effect can be dangerous if taken long term.
Last month I needed to take a regular Ibuprofen at bed time for a painful hip, it was only a few nights, and my INR was just fine.
Check with your doctor.

 

[Protimenow]

Ibuprofen and other NSIDs are not allowed for me due to warfarin. I've been told this by my internist, my orthopedist and my cardiologist. Home monitoring didn't make a difference to them.

Sometimes doctors want to cover their butts. If they told you it was safe to take ibuprofen - or any NSAID - and something even vaguely related to a coagulation issue happened - they may be scared of getting sued. I've seen conflicting reports about acetaminophen (Tylenol) interacting with clotting. If you DO take iboprofen against medical advice, and something happened, these hyperconservative doctors would be relatively protected against legal action.

Ultimately, the decision whether or not to use Ibuprofen or another NSAID is up to you. However, in personal experience, I've had no remarkable issues with my INR or with bleeding/clotting when I took Ibuprofen for a few days. The signs of hemorrhaging are pretty dramatic - and it will probably take a LOT of NSAID over a short period of time to see these signs. In my own personal experience, I have taken Ibuprofen for pain, as needed. I've monitored my INR (although platelet changes don't show up in INR testing), and have had no negative experiences from using both medications concurrently.