Warfarin and anti-inflammatories

[techguy]

I've been on warfarin therapy for about 4 1/2 years now and am doing pretty well, thanks in large part to at-home testing. However, I have been having an issue with severe tendinitis in my elbow and it is affecting my job.
I went on Naproxen for about 5 days and monitored my INR which stayed between 2.5 and 3.2 (Mitral valve replacement). In doing some research I have read that either Celebrex or Trilisate (choline magnesium salicylate) might be better for treating the inflammation, and contacted my cardiologist regarding this. His office stated the usual disclaimer that all anti-inflammatories should only be used for "a couple days."
In trying to research this, I did read somewhere that there are different mechanisms by which the clotting takes place and that different drugs can affect each part of the process.
My question is this: Do Celebrex and Trilisate (or even Naproxen)affect the clotting in such a manner that it would change my INR, or do they have an interaction on another part of the process that would go undetected by INR testing? Thank you for any information you can provide, as my doctor does not seem to be completely up to date with warfarin therapy!

 

[Ross]

Let me check me crystal ball.

CELECOXIB (in Celebrex) may interact with WARFARIN SODIUM (in Coumadin Tablets)

Although the cause of this potential interaction is not clearly understood, celecoxib may increase the anticoagulant effect of warfarin. Warfarin is generally used to prevent your blood from "coagulating" or forming blood clots. When celecoxib 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 these drugs are taken together, your doctor may want to monitor you closely when therapy with celecoxib is started or stopped, or when the dose of celecoxib is changed. 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.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.

WARFARIN SODIUM (in Coumadin Tablets) may interact with NAPROXEN (in Naproxen Sodium 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. Naproxen 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 naproxen 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 naproxen 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 naproxen.Ask your healthcare provider about these drugs and this potential interaction as soon as possible.

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

Last Updated:February 2009



No listing for Trisilate.

Last Updated:February 2009

 

[Nancy]

My husband was on Coumadin for years and years, and the only over the counter pain med he could ever take was Tylenol, and not too much of that either, because it affects the liver, and Coumadin is metabolized in the liver.

He had arthritis, and often had pain.

Maybe there is something that would work for you, though. Have you contacted your Internal medical doctor?

 

[Ross]

The Celebrex will cause the INR to rise, but I've taken Naproxen and I've never seen any change. The main deal with it is eating your stomach into a bleeding event.

 

[techguy]

Thanks for the responses! One website I was on had the following statement:

"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 full text of the document is at:

http://www.medicinenet.com/script/main/art.asp?articlekey=9093

After reading that, it was apparent to me that this information differed from what my cardiologist's office was saying, and I was just looking for some verification either way. Thanks again, Ross and Nancy

 

[Ross]

Well even the pros seem confused on what "May" happen with Celebrex. Best thing to do is, if you start it, test 3 or 4 days later to see if it really is doing anything to your INR.

 

[neil]

ross when it comes to anti coag your the boss

 

[KristyW]

About 4 years ago I had an inflamed brachial nerve. It was extremely painful and my Dr. put me on Celebrex. I questioned him about interactions with my warfarin and his response was, this IS an anti-inflammatory that I could take. Just make sure that I take it with food. I noticed no change in my INR (which makes sense as INR is used to measure warfarin's affect only.) Some drugs we take and food we eat affect how warfarin works, (those are the ones that mess with INR), others affect bleeding in other ways (platelets etc.)

 

[techguy]

Well I contacted my cardiologist's office once again with more information that I obtained regarding Celebrex, choline magnesium trisalicylate and salsalate and after a couple days his response was that, yes, those would be acceptable to take as an anti-inflammatory, as long as I tested after a few days and then once a week for awhile (kudos to Ross-maybe you should hang out a shingle and start practicing!).
I'll start taking them as soon as I can the script filled and see how my INR does. Thanks to all for the responses.

 

[Lisa in Katy]

I've taken Aleve (naproxen) with no problem. I've taken Mobic (meloxicam) with no problem. I've taken Vioxx (rofecoxib) with no problem. Vioxx is the only one I took for an extended period of time, although I've taken the others 3-4 days in a row. I believe Celebrex is similar to Vioxx, without the problems that caused it to be taken off the market.

 

[aussigal]

I have the same problem with my elbow (had it for many years now) and have tried several "cures" for it including cortisone shots which have been great, ice, heat, nurofen/ibuprofen and other similar tablets...all the NSAIDS I tried raised my INR but I was told as long as my INR was kept in range and I adjusted my doseage to account for the nasaid then I would be fine. From memeory my INR went up about 1 whole point so I dropped my warafrin dose a little and all was well. Eventually after a few months my elbow recovered enough to let me drop the NSAID and I have been coping with just regular ice/heat, rest and elastic support bandage.

 

[Ross]

ross when it comes to anti coag your the boss

Not really. I've learned an awful lot from Al Lodwick, though he says he learned from all of us. I'm still wrong on occasion, but I can proudly say that I and a few others here, have brought many people into range and stable when no one else could.

 

[catwoman]

Not really. I've learned an awful lot from Al Lodwick, though he says he learned from all of us. I'm still wrong on occasion, but I can proudly say that I and a few others here, have brought many people into range and stable when no one else could.

Ross:

Do you just suppose it's because you have personal knowledge of the drug, rather than just textbook knowledge?

 

[Bina]

That's right Marsha.
Sometimes "hands on" experience is superior to memorizing textbooks.

 

[Ross]

I've searched Al Lodwick's site for a dosing chart, but been unable to find it.

Can any of you provide the exact link?

Thanks

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

Item #1

 

[Ross]

Ross:

Do you just suppose it's because you have personal knowledge of the drug, rather than just textbook knowledge?

Definately.

 

[Freddie]

I thought Celebrex was for cholesterol?
If not what drug am I thinking of?

 

[Ross]

I thought Celebrex was for cholesterol?
If not what drug am I thinking of?

Crestor perhaps?