Drug interactions
NSAID + warfarin
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Overview
Additive bleeding risk; NSAIDs impair platelet function and injure GI mucosa. Some (e.g., celecoxib) may increase INR via CYP2C9 effects. Clinically significant hemorrhage risk.
Mechanism of action
Pharmacodynamic additive antithrombotic effect (platelet inhibition, GI injury) ± pharmacokinetic effects (CYP2C9 inhibition/protein-binding displacement with some NSAIDs) → ↑ anticoagulation/bleeding.
Clinical management
Avoid if possible. If needed, use lowest dose/shortest duration; consider non-NSAID options (acetaminophen ≤2 g/day with caution). Add PPI gastroprotection; monitor INR within 3–5 days and for bleeding.
Drug reference
References
- Warfarin Sodium Prescribing Information — FDA Label
- Warfarin: Drug Interactions — Lexicomp
- Warfarin: Drug interactions and management — UpToDate
Frequently asked questions
Can I take NSAID with warfarin?
The interaction is rated: Major. Additive bleeding risk; NSAIDs impair platelet function and injure GI mucosa. Some (e.g., celecoxib) may increase INR via CYP2C9 effects. Clinically significant hemorrhage risk.
How serious is the interaction between NSAID and warfarin?
The interaction is rated: Major. Evidence level: High.
How is the interaction between NSAID and warfarin managed?
Avoid if possible. If needed, use lowest dose/shortest duration; consider non-NSAID options (acetaminophen ≤2 g/day with caution). Add PPI gastroprotection; monitor INR within 3–5 days and for bleeding.
Why do NSAID and warfarin interact?
Pharmacodynamic additive antithrombotic effect (platelet inhibition, GI injury) ± pharmacokinetic effects (CYP2C9 inhibition/protein-binding displacement with some NSAIDs) → ↑ anticoagulation/bleeding.
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