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Coumadin (Warfarin) Questions and Drug Interactions

CAUTION: Anyone taking Coumadin should be getting regular International Normalized Ratio (INR) blood tests to make sure the dosing is in the safe range. Make sure all your health care providers have a complete list of your medications, including over-the-counter medications, herbals and vitamins.

Can I take Coumadin (warfarin) with:

Acetaminophen with Codeine (Tylenol with Codeine)? Acetaminophen can cause an increase in bleeding. Tylenol is much less likely to cause this than aspirin or NSAIDs (nonsteroidal anti-inflammatory drugs), but the chance is still present. Take as little of the codeine as possible, as this can cause drowsiness, constipation and increase the chance of falling.
Acai Extreme and a Colon Flush?  I would not take any herbal product while taking a blood thinner like warfarin. Talk to your cardiologist or physician.
Adipex (phentermine)? There are no direct drug interactions between Adipex (phentermine) and warfarin (Coumadin).
Alavert (Claritin or Loratadine)? Yes. They may be taken together. Follow you physician's instructions with the Coumadin, and have your INR blood tests done regularly.
Alcohol? Alcohol can affect coagulation time. I would not recommend having alcohol while taking any blood thinner.
Amitriptyline (Elavil)? Concurrent use may result in an increased risk of bleeding. If you have unusual bleeding or bruising, call your doctor.
Amoxicillin? Coumadin has documented interactions with amoxicillin. The likelihood of this happening is slight especially considering the normal duration of amoxicillin is 10 days or less. Take amoxicillin as prescribed until finished.
Amoxicillin and Mucinex (Guaifenesin)? Yes. They may be taken together. Take the amoxicillin until finished.  Take Mucinex as needed with plenty of water.
Amphetamine Salts (Adderall) Yes.

Yes. Take antacids only as needed.

Beano? Yes. Beano can interact with some heart medications.
Benadryl? Yes. Take Coumadin at the same time each day, usually bedtime. Take Benadryl as needed for allergies or to help you sleep.
Benzonatate (Tessalon) . . . will it affect INR? Yes. Take benzonatate as needed and warfarin daily at the dosage instructed. I cannot find any effects of benzonatate on any blood testing, including INR.
Celebrex? No. Celebrex (celecoxib), used for pain and arthritis, and Coumadin, a blood thinner, create an increased risk of bleeding when taken together. Talk with your physician(s). For pain, take Tylenol (acetaminophen) with the Coumadin.
Chlortrimeton? Yes. Chlorpheniramine can cause drowsiness.
Chondroitin? This may result in elevations of International Normalized Ratio (INR) values. Discuss adding over-the-counter medications, vitamins or herbal products with your doctor and pharmacist.
Claritin? Yes. For best results, take Coumadin in the evening or at bedtime and Claritin in the morning.
Cold Medication? Avoid aspirin, any over-the-counter product with any Salicylate drug, and "natural" or herbal products. See our Herbal Supplement Quiz. There are possible interactions with Tylenol (acetaminophen), though not as much as with aspirin, but do not take Coumadin and Tylenol at the exact same time. If you must, take Coumadin two hours apart from any Tylenol product.
Contac? Contac comes in several formulations. Some use acetaminophen as a fever/pain-reliever. Of all the pain-relievers available, acetaminophen (Tylenol) is the safest with Coumadin. Some types of Contac include a decongestant (pseudoephedrine), which can cause an increase in blood pressure and a risk to those with heart problems. Talk to your physician.
Coricidin HBP? If you need something for pain, the acetaminophen in the Coricidin HBP (acetaminophen with chlorpheniramine) is safer than aspirin or ibuprofen products, with Coumadin. Be alert for unusual bruising or bleeding. If this occurs, contact your physician immediately. The antihistamine (chlorpheniramine) does not interact with Coumadin.
DayQuil? Vicks DayQuil Multi-symptom has acetaminophen (Tylenol) in it that can interfere with Coumadin. There may be a slight increase risk of bleeding, but far less than with aspirin or NSAIDs. Talk to your doctor.
Flecainide, Plaquenil, Methotrexate, Synthroid (levothyroxine), Xanax (alprazolam) and Ambien (zolpidem)? There are several moderate possible drug interactions. Xanax and Ambien are therapeutic duplication. Both are in the anxiolytics, sedatives and hypnotics drug classes. Do not take them together. Some people take Xanax during the day and Ambien at bedtime. Coumadin and Synthroid should not be taken at the exact same time. Synthroid should be taken early in the morning at least 30 minutes before breakfast. Both Methotrexate and Synthroid can cause warfarin to work better. Has the same physician written all these prescriptions? If multiple doctors are involved, they should all review this list of medications to assess the situation.
Flexeril? Yes. Flexeril can cause drowsiness.
Gamma-Aminobutyric Acid? Yes.
Glimepiride (Amaryl)? Yes, but there can be an interaction between glimepiride (Amaryl) and Coumadin (warfarin), particularly if the glimepiride was added after the patient is stabilized on the Coumadin. Using these drugs together may make you bruise or bleed more easily. Your physician should closely monitor your Coumadin therapy when any new medicine is added or stopped. Be sure to get your blood checked regularly.
Glucosamine? Concurrent use of glucosamine and Coumadin may result in elevations of International Normalized Ratio (INR) blood test values. Discuss adding any over-the-counter medications, vitamins or herbal products with your doctor and pharmacist.
Halls cough drops? Halls cough drops contain menthol. Concurrent use of menthol and Coumadin may result in reduced anticoagulant effectiveness. Talk to your doctor.
Hoodia? I would never suggest any herbal supplement be taken with Coumadin. I would not suggest purchasing any Hoodia product, unless you know for certain that it came from the bushman tribal area of Africa. You cannot be sure exactly what is in most herbal products, since they are not regulated by the Food and Drug Administration (FDA), as are other medications. See our Herbal Supplement Quiz. Ask your physician to recommend an alternative.
Indomethacin (Indocin)? Concurrent use of indomethacin and Coumadin may result in an increased risk of bleeding. Talk with your doctor.
L-arginine and Ginseng? You may take Coumadin with L-arginine. Do not take Coumadin with ginseng, as the herbal can cause extra blood thinning and uncontrolled bleeding.
Lasix (Furosemide)? Coumadin interacts with almost everything and it can, in certain instances, with Lasix. The interaction occurs if the patient is not having the PT/INR checked regularly, in particular, if the dose of either medication changes.  Lasix, and other diuretics, are given with Coumadin regularly. The important thing to keep in mind while taking Coumadin is that regular blood tests are needed to ensure the proper drug level is present.
Levaquin (Levofloxacin)? Levaquin is a quinolone antibiotic. Using it with Coumadin may make you bruise or bleed more easily. Watch for signs of bleeding, including, but not limited to, increased bruising, bleeding gums, nosebleeds, pinpoint red spots on your skin, or black, tarry stools. Report any of these to your health care provider immediately. Your health care provider should closely monitor your Coumadin therapy when any new medicine is added or stopped. Eye or ear products containing the quinolones do not interact with Warfarin.
Magnesium? Yes. See our Multivitamin Quiz.
Melatonin? Concurrent use of melatonin and Coumadin may result in an increased risk of bleeding. Talk to your physician if you are having trouble sleeping at night.
Methotrexate and prednisone? Yes. Both methotrexate and prednisone have many side effects.
Nasonex (Mometasone)? Because Nasonex (mometasone) is a nasal steroid not oral, the chance of a drug interaction with Coumadin (warfarin) is very small. Watch for bleeding from the nose while using these two medications.
NyQuil There is the slight chance of the acetaminophen (Tylenol) in the NyQuil causing bleeding.
Pain-Reliever? The safest pain-reliever is Tylenol (acetaminophen). There is still a bleeding risk even with Tylenol.
Paxil? Concurrent use of warfarin and paroxetine may result in an increased risk of bleeding. Talk to your doctor.
Serrapeptase (a protease type enzyme that helps the body dissolve blood clots) or Nattokinase, which does the same thing? Do NOT take any of these natural clot dissolving enzymes without talking to your doctor. Neither of these are approved by the FDA as a drug in the United States. They are sold as food supplements. In the scientific literature, there is one common disclaimer: "Nattokinase and Serrapeptase should be avoided by those on blood-thinning drugs and those with bleeding disorders." There are several pharmaceutical thrombolytic agents that are approved in the United States (tPA, Alteplase), but all have a similar warning: "Concurrent use of anticoagulants and thrombolytic agents may result in an increased risk of bleeding."
Sudafed (Pseudoephedrine)? Yes. If you take both warfarin (Coumadin) and Sudafed (pseudoephedrine), your blood will thin and your sinus congestion should become less.
Tramadol (Ultram)? There can be an interaction between Coumadin (warfarin) and tramadol (Ultram). Although an interaction is possible, these drugs are sometimes used together and may make you bruise or bleed more easily. Take the tramadol only as needed. This may cause drowsiness.
Tylenol Extra Strength? Coumadin interacts with almost every medication in some way. Although Tylenol is the drug of choice for mild pain relief or fevers if your are taking Coumadin, large doses (more than 1300 mg/day) for more than 10-14 days may increase the effects of warfarin -- making you bruise or bleed more easily. Single doses or short courses (less than 7-10 days) of Tylenol are probably safe in most patients taking warfarin. The recommended maximum daily amount of Tylenol is no more than 3000mg/day. This is 6 extra-strength Tylenol doses.
Tylenol PM? Yes. Take Tylenol PM as needed and when you can devote 8 hours for sleep. Take Coumadin two hours apart from any Tylenol product.
Vitamin D? Yes.
Wellbutrin or Zyban (Bupropion)? In some cases, using these drugs together may make you bruise or bleed more easily, especially if you are already taking warfarin and begin to take bupropion (Wellbutrin or Zyban). Watch for signs of bleeding, bruising, pinpoint red spots on your skin, or black, tarry stools.
Xanax? Yes.
Zyrtec (Cetirizine)? Yes. Whether taking other medications or not, have your blood tested regularly while on warfarin.

I'm on warfarin and have the flu. What can I take?
Even though warfarin (Coumadin) is one drug that interacts with many other medications, most typical cough and cold medications work well with it. Avoid aspirin and NSAIDs (Advil, Motrin, Aleve). If you must take a fever reducer or something for aches and pain, use Tylenol (acetaminophen) sparingly.

What over-the-counter drug shouldn't I take with Warfarin?
The list of drug interactions with warfarin (Coumadin) is about as long as an encyclopedia. There are also foods (spinach and some other greens) that should be avoided while taking warfarin. Always keep the medication guide from the pharmacy. This should have a list of common types of medications that interact with the specific drug.

Are there any negative effects when taking curumin and warfarin?
Curcumin is the principal curcuminoid of the popular Indian spice turmeric, which is a member of the Ginger family. Taking Ginger, and anticoagulants like warfarin (Coumadin) together may make you bruise or bleed more easily. Avoid taking Ginger-containing dietary supplements with warfarin.

What sleep aid can a person on daily coumadin for atrial fibrillation take? I'm two weeks post knee replacement and still having difficulty sleeping.
There are two over-the-counter sleep aids that do not have any interactions with Coumadin. Melatonin and diphenhydramine (Unisom, Nytol,Vicks zzzQuil, Benadryl).

I take warfarin and bisoprolol for atrial fibrillation. Can I take Mucinex or something similar?
Yes. The Mucinex (guaifenesin) does not interact with either the warfarin (Coumadin) or bisoprolol (Zebeta). Plain Robitussin is a liquid form of guaifenesin.

I am on Coumadin 5mg a day except Tuesdays and Fridays and I'm having a hard time sleeping at night. Will ZzzQuil interact with the Coumadin?
No. There are no direct drug interactions between diphenhydramine and Coumadin (warfarin).

Can I take Tylenol for pain while I'm on Coumadin?
Tylenol (acetaminophen) is the safest over-the-counter pain reliever to use when taking Coumadin (warfarin), however, concurrent use of acetaminophen and warfarin may result in an increased risk of bleeding, so watch for bruising and abnormal bleeding.

I am taking warfarin. What can I take for a backache?
There are several prescription products your physician could prescribe. The only over-the-counter product I would suggest is Tylenol(acetaminophen). The other products may cause bleeding. Even acetaminophen has documented studies showing an increase risk of bleeding with Coumadin (warfarin).  Talk with your cardiologist or vascular physician to get suggestions to ease your back pain. You may want to try some of the topical arthritis rubs or just a warm cloth/compress to ease the aches.

Is there any danger in using a razor to shave, when off warfarin about 7 days?
Being off the drug for a week would reduce the chance of bleeding. Perhaps to be safe, use an electric razor or go to a good barber for your shave.

What happens if I bruise myself while taking Coumadin 5mg?
Bruising is a sign that blood is somehow leaking from the capillaries into the tissue. This can happen due to injury or having slow coagulation of the blood. When taking Coumadin (warfarin), bruising is a sign that the Coumadin level in the blood is not correct. Please contact your physician.

What makes your Coumadin level drop?
Coumadin (warfarin) prevents or inhibits certain factors and enzymes that cause blood cells to coagulate. The higher the Coumadin level, the less the blood clots. The liver metabolizes (breaks down) the Coumadin. Depending on how effective the liver function is, the levels of the Coumadin may very. Many drugs and foods are metabolized by the liver. These sort of compete with each other to be metabolized. Hence, you may have a form of drug interaction. 

I am on warfarin SOD 7.5mg tablets 1/day. I have a severe cold with chest and nasal congestion. Can I take an expectorant safely with my current medication?
There are no drug interactions between warfarin and the most common expectorant, guaifenesin (Mucinex or Robitussin). You may take them together if needed. Drink plenty of water with the expectorant and only take as long as needed.

My mom has been on Coumadin for years. Now she has severe arthritis. She was taking Darvocet for pain, but that's now off the market. She is allergic to morphine and codeine, gets nauseated from Vicodin, and Tylenol doesn't touch the pain. What can she do?
Darvon (propoxyphene) was removed from the United States market in November 2010.  It was removed from the European market a few years before that. Vicodin (hydrocodone with acetaminophen) contains a codeine-related compound, hence she reacted to this too. It sounds like her blood-thinning is stable if she has been on Coumadin (warfarin) for years. She should talk to her doctor about using NSAIDS or trying Celebrex (celecoxib). Do not have her try this without speaking to her doctor first. Until then, she can take Tylenol (acetaminophen) up to 4000mg per day.

I am on Coumadin. What is the best chest congestion medicine I can take?
The more effective expectorant for chest congestion is guaifenesin (Mucinex or plain Robitussin). This has no interactions with Coumadin (warfarin). Drink plenty of water with the expectorant and make sure to have regular INR checks for the warfarin level in your blood.

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