GoodRx Health6 Blood Thinner Interactions You Should Be Aware Of

Blood Thinner Interactions: Key Considerations for Patient Safety

Blood thinners are essential medications for preventing and treating blood clots, but they come with significant interaction risks. This article outlines six crucial interactions that physicians should be aware of when prescribing blood thinners. Understanding these interactions is vital for ensuring patient safety and optimizing treatment outcomes.

Key Points:

1. NSAID Interactions:

• Avoid combining blood thinners with NSAIDs due to increased bleeding risk
• Common OTC NSAIDs include ibuprofen and naproxen
• NSAIDs are often found in OTC products for migraines, menstrual cramps, and cold/flu symptoms
• Advise patients to read OTC labels carefully and consult a pharmacist before taking new OTC products

2. Upset Stomach and Heartburn Medications:

• Some OTC products contain NSAIDs or salicylates (eg, Alka-Seltzer, Pepto-Bismol)
• Cimetidine can increase warfarin levels, raising bleeding risk
• Omeprazole can increase warfarin levels but decrease clopidogrel effectiveness
• Recommend safer options like Tums or Rolaids for patients on blood thinners

3. SSRI Antidepressants:

• SSRIs can increase bleeding risk when combined with blood thinners
• Monitor patients for signs of minor bleeding (e.g., bleeding gums)
• Advise patients to seek emergency care for serious bleeding symptoms

4. Anti-infection Medications:

• Some antibiotics and antifungals can interact with blood thinners
• Examples: ketoconazole, fluconazole, erythromycin, clarithromycin
• These medications can increase bleeding risk with warfarin, DOACs, and ticagrelor
• They may decrease clopidogrel effectiveness, increasing clot risk
• Consider alternative treatments for infections in patients on blood thinners

5. St. John’s Wort:

• Can decrease warfarin and DOAC levels, increasing clot risk
• Advise patients to avoid St. John’s wort while on blood thinners
• Recommend safer alternatives for depression symptoms

6. Other Supplements:

• Many herbal supplements can increase bleeding risk with blood thinners
• Examples: garlic, ginkgo biloba, ginseng, turmeric, fish oil
• Advise patients to consult a pharmacist before adding any supplements

Additional Points:

• Acetaminophen is generally safe with most blood thinners, except warfarin
• Topical antifungal products are safe to use with blood thinners
• Ozempic (semaglutide) does not interact directly with blood thinners but may affect warfarin levels indirectly through dietary changes

HCN Healer Handbook
“Blood thinners are crucial medications for preventing blood clots, but they can interact with many common medications and supplements. It’s important to be cautious with over-the-counter pain relievers like ibuprofen or naproxen, as they can increase your risk of bleeding when combined with blood thinners. Always check with your pharmacist before taking any new medications or supplements, even if they seem harmless. For example, common supplements like fish oil or garlic can also increase bleeding risk. If you need pain relief, acetaminophen is usually a safer option, but always confirm with your healthcare team. Remember, your diet can affect how some blood thinners work, so let us know if you make significant changes to your eating habits. By being aware of these interactions, we can work together to keep you safe and ensure your blood thinner is working effectively.”

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