Motrin and coumadin

[chief911]

Doc says I can take motrin while I am weening myself from the percocet. How much of an effect does motrin have on INR and how much should I take (or limit myself to) a day? I am going to talk with the coumadin clinic before I start taking it, but wanted some opinions before I get there.

Thanks, Chief

 

[geebee]

You should look at Al's website but, basically, Motrin should be avoided. My understanding is it does not affect the INR but it can cause gastrointestinal bleeding and coumadin can make that very dangerous.

However, wait until Al comes in to be sure.

Pretty much the same issue as with aspirin.

 

[Lisa in Katy]

I've always been told no motrin. I would stick with Alleve, which I'm told doesn't have a problem with Coumadin.

 

[Guest]

Your doc is wrong - dead wrong. Motrin is the anti-inflammatory most likely to cause problems. It does not affect the INR. It erodes the lining of the stomach and causes bleeding without any warning. The medical literature is full of these kinds of reports. This sounds like a doctor who depends on drug sales reps for continuing education.

There are no reports of Alleve causing bleeding. It appears much safer.

You are to be commended for trying to get off Percocet.

 

[ccrawford]

Al is the pro and I'm just a patient, but although there have never been any documented incidences of bleeding from interaction with Aleve, there is at least one individual who believes that Aleve was directly responsible for a very heighted INR, and some of the manufacturers do carry some information about interaction on their data sheets. A good time to try it would be a few days before your next test then you can see for yourself.

 

[ccrawford]

Just to be sure of my memory, I checked drugdigest.org who has a drug interaction service at their web site. They say that the interaction between Coumadin and Sodium Naproxen (Aleve) is well documented and major in severity. When I used it, I ran up my INR to about 6.9 before figuring out what was going on. Hope this helps.

 

[Guest]

I know that Chris and I have disagreed over this before.

Any effect Alleve has on clotting should be on platelets and therefore not show up on the INR.

These drugs are classified as Non-steroidal Anti-inflammatory Agents (NSAIDS). The FDA requires a warning for this entire family of drugs. I cannot find where there is any medical journal that shows and harm actually done to anyone with this combination.

I agree that is possible but not probable.

 

[ccrawford]

Somewhere inbetween my posts and Al's is the truth about Aleve, and I hope somebody can get to the bottom of it, and share the results. Be assured that there is no adversity between myself and Al - he is a godsend to this website and although I have never met him face to face, I love him dearly !!!! Chris

 

[Guest]

Chris, I feel as though I know you too.

A nurse asked me today if he offended me the other day with a remark he made. I said that I didn't remember what he had said and asked him to repeat it. He couldn't remember what he had said either but thought that I looked offended. I told him that patients come in all day long and try to get in digs and I get my share back. This morning I saw a patient's picture in the paper - he announced that he is running for city council. I was thinking that I hadn't seen him for awhile. Sure enough he cam in today and hadn't tested since April. My comment, "Hitting the campaign trail and thought you'd better look up your friends at the Coumadin Clinic, huh?" He fired back something about needing votes. We had a good laugh.

There is a police officer who comes and always lets out a big yell when he has a student doing his finger stick. When I saw him arrive the other day I told the young woman student not to let him get the best of her but to let out a karate yell when she stuck his finger. We nearly had to have housekeeping come and mop the floor ...

Bottom line - I enjoy the give and take. Nobody will every get to the bottom of it. We just have to disagree in a friendly way.

 

[Marty]

We can disagree without being disagreeable!

 

[tobagotwo]

Both Motrin (ibuprofen) and Aleve (naproxen sodium) have mentions on their labels that the product may cause stomach bleeding.

Motrin labels warnings more thoroughly, as the warning about possible stomach bleeding is placed in the general warnings, and by pointing out that you should see a doctor before taking it if you are on anticoagulants. Other ibuprofen products include Advil, Medipren, Nuprin, Act-3, Brufen, Nurofen and many store-brand names.

For some reason, Aleve places its warning about possible stomach bleeding in the alcohol warning section. It doesn't mention anticoagulants specifically, only a general mention of any other drugs taken regularly. Naproxen sodium is also available as Naprosyn or in store-name brands, as it is also open to generic manufacturers.

Another NSAID OTC pain reliever that I favor for backaches, Orudis (ketoprofen) has warnings about not using with Coumadin.

These products do not affect INR or platelet clotting, but do have some risk for stomach bleeding, which can become serious for Coumadin/warfarin users. Likely, most folks on ACT (AntiCoagulant Therapy) will get away fine with occasional use of these products as suggested by their doctors. However, it's much less likely that they would get away with continuing use of these products. The problem is, you have no way of knowing if you are "most folks." So, bypassing these options altogether is a safer path, if you are on ACT (Coumadin or warfarin).

Acetaminophen (Tylenol and many other brands and store brands) carries little risk of stomach irritation, and tends to be less interactive with other drugs. However, overdosing can happen easier and can be quite serious with acetaminophen products, so follow the label instructions. If your doctor has you taking higher doses, follow your doctor's instructions.

It always seems to me that there should be other painkillers besides opioids and acetaminophen that will work for ACT patients.

Best wishes,

 

[ccrawford]

I've emailed Al and we are trying to understand each others perspectives so we can be a little more uniform in presenting the proper type of warnings regarding various drugs. There are a couple of very different methodologies working here and maybe we'll all be better off if we can mutually understand them. At least that's the goal.

 

[Joel]

Ibuprofen vs Coumadin

Ibuprofen vs Coumadin

This is an interesting discussion. I was discharged from the Hospital with 800mg three times a day prescription of Ibuprofen for pain. In the same discharge instructions, it said not to take Ibuprofen. I called the hospital, and talked to the staff cardiologist who wrote the script and asked for a clarification on the contradiction. He said "Yes, there is a risk of stomach bleeding, just make sure to eat something with the pill and watch for stomach bleeding symptoms."

That was 6 weeks ago. My script ran out a couple of weeks ago, and have continued with over the counter strength since then. I am now off of these pain meds completely.

When I had my followup visit with the Surgeon - I explained that Pre-surgery I regularly used Ibuprofen for pain. I have a bad knee and on a busy day of running up and downs stairs or working in the yard, I would take Ibuprofen. Usually on an empty stomach.

He gave me his blessing on using OTC Ibuprofen for pain periodically.

Is this because I've been a regular user and had no side effects? Or as I continue to take this med am I increasing the risk? I will only take it on a full stomach or with food.

His nurse also explained that Ibuprofen would raise my INR. I did notice as I stepped down the Iburofen dose, my INR dropped with the same coumadin dosage. This could just be coincidental though.

It sounds like you guys are getting significantly different info/opinions than I am. I will pursue this with my PCP on Tusday - just to get another opinion that will confuse thing even more...

 

[ccrawford]

Joel - I'm not trying to fuel any fires or anything because Al is a tremendous resource for this forum, its just that we come at the issue from different approaches. I am not a pharmacist and have absolutely no training in this area. I just happen to be interested in the broad spectrum issues surrounding coumadin and have been working with the topic for almost three years, maybe in preparation to do a book ,god willing. Here's some web sites you can visit to check out coumadin interactions with other drugs - its these and the data sheets that influence my comments. Try www/drugs.com , www.rxlist.com , and www.drugdigest.com If you want, tell the forum what you find out when you visit these sites and explore the interactivity between coumadin and (for example) naproxen sodium (aleve) If you do this, then you'll see where I'm coming from. If I'm ill informed, so be it and I will issue my sincere apologies. Chris

 

[Joel]

Well, I visited my PCP yesterday and his opinion is 180 degrees opposite from my surgeon. No Ibuprofen - He doesn't even seem to like it for people who aren't on anticoagulation. He talked about renal failure, etc.

So - If I follow his instructions Ibuprofen is out. Only Acetaminophen.

Go figure.