The People's Perspective on Medicine

Will Pain Reliever Interact with Anticoagulant?

Might your pain reliever interact with your other medicines? It is smart to find out before you take it. The gel form seems less likely to cause trouble.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most popular pills in the drugstore. People can buy them without a prescription and use them to treat nearly any type of pain. Although the label warns against use for more than ten days except under medical supervision, not everyone pays close attention to such warnings. But you should. Could that pain reliever interact with other medicines you take?

Could Your Pain Reliever Interact with Your Anticoagulant?

Q. My “tennis” elbow has come back with a vengeance. It has been bothering me for quite a bit longer than it ever has in the past.

I can’t use oral NSAIDS because I take Eliquis, but my primary care physician says I can use the diclofenac sodium topical gel (1%) for as long as I need it. She knows I take a blood thinner. Is this really okay?

A. You are right to avoid oral pain relievers such as ibuprofen or naproxen, since these NSAIDs can cause gastrointestinal irritation. With apixaban (Eliquis) in your system, you could end up with a bleeding ulcer. (See what we have written about this possibility here.) In addition, naproxen also enhances the absorption of Eliquis, increasing its blood levels (Frost et al, British Journal of Clinical Pharmacology, Oct. 2014).

Your doctor is right about diclofenac gel, however. Drug interaction experts Drs. John Horn and Philip Hansten have written about NSAID and anticoagulant interactions.

They note that

“The use of topical NSAIDs is not considered to increase the risk of bleeding” (Pharmacy Times, Dec. 21, 2017).

Learn More:

We discuss the pros and cons of topical diclofenac (Voltaren Gel) as well as salsalate and nondrug approaches in our eGuide to Alternatives for Arthritis.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
Alternatives for Arthritis
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This eGuide describes nondrug alternatives for arthritis with the latest scientific studies to document anti-inflammatory activity. This comprehensive online guide (too long to print) adds the science behind ancient healing traditions.

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And oil has not helped my pain at all.

If I was taking Pradaxa or coumadin I would find a naturopathic or holistic doctor who might be able to help me get off these drugs and on to a good quality fish oil. Fish oil makes your blood platelets slippery so they are less likely to stick together and form clots. Another great way to thin you blood is to donate blood three or four times a year if you qualify. Donated thick blood is replaced by nice new thin blood. You’re not only helping yourself but also someone who needs the blood. I read a study that showed that people that donate blood three or four times a year reduce their chances of a heart attack or stroke by 80%. Yes, that’s eighty percent. You might also research a product called Nattokinase. It is an enzyme derived from Natto, a soy based cheese. It will travel in your blood doing nothing until it encounters the beginning of a clot which it will promptly devour. It’s very inexpensive and harmless. Great insurance for anyone who must sit for long periods such as on an airplane. A 100 mg capsule lasts four to five
hours. Great way to prevent deep vein thrombosis.

I take a small dose of clonazepam at bedtime. I’ve tried to gradually stop taking it, but the withdrawal is awful, so my doctor said to just stay on the small dose.Because clonazepam is sedating, I’m wondering whether CBD oil is safe for me to use for the arthritis in my knees. Several people who use it for their sore joints have said that the CBD oil doesn’t help the pain much, but because it’s sedating, the CBD oil makes them sleep very well at night.

I wonder if I can ever use CBD oil for my arthritis, because I can’t seem to get entirely off the clonazepam. I don’t think it’s safe to take two sedating medications. Pharmacists I’ve asked about it don’t know. Not enough research on it, I guess. I’m a senior citizen with some heart palps, and cutting back on clonazepam is just too difficult for me to stop it completely. I wish the doctor who first prescribed clonazepam had told me that if I only used it once in awhile, I wouldn’t have trouble stopping it now. Some of my friends (two are nurses) also have the same problem. They haven’t been able to stop taking it either.

For neuralgic pain in my toes I have been using CBD oil for a couple of years, 15 drops under the tongue, last night to no avail. So doubled the dose and still not good. Added Advil 400 mg., melatonin, and finally, as a last resort at 2 in the morning, a sleeping pill. Would be greatfull if someone has cure for non-diabetic neuropathy that generally only occurs at night. Thanks.

Try to find a good acupuncturist He or she will be able to help you out even with Chinese medicines.,

Good luck.

I am not using any anticoagulant. However, you may want to consider and use a compounded prescription cream. I have a cream which is compounded which I use for a pinched nerve and knees when they flare-up. It has been very effective. The cream has baclofen, gabapentin, lidocaine, etc. There are many different drugs that can be compounded. It is expensive and my insurances doesn’t cover the cost but is well worth it. I would work with your PCP and pharmacist to determine what might work. Everyone has different needs and some remedies work and some don’t. Best of luck. I try not to use NSAIDs because of a sensitive stomach and acid reflux.

What are the options for those of us who use anticoagulants (I use Pradaxa) when we need to reduce pain and inflammation – like joint pain? Voltaren topical cream does not work for me.

Acetaminophen (APAP or paracetamol) can be used for short-term, occasional relief. It reduces pain, though it has little impact on inflammation.

I use CBD cream and get relief in about five minutes. Has been a lifesaver since I am on coumadin and have to be very careful with medications and treatments.

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