does acetaminophen thin the blood
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does acetaminophen thin the blood
No, Tylenol (acetaminophen) is not classified as a blood thinner-type of drug, but Aspirin (acetylsalicylic acid) is a blood thinner.
Acetaminophen is considered the pain and
fever reliever of choice for most patients receiving oral anticoagulant therapy like warfarin. However, if you are taking a high dose of acetaminophen over the long-term, caution is recommended during combined therapy with warfarin, particularly if high doses of acetaminophen are used for a prolonged period.
If you take warfarin, tell your doctor that you take acetaminophen and contact them if you experience any signs of bleeding like nosebleeds, bruising, headache, dizziness, weakness, pain, prolonged bleeding from cuts or gums after brushing, heavy menstrual flow, unexpected vaginal bleeding, red or dark urine, or red or black (tarry) stools.
Blood thinners
Blood thinners are usually given to people at risk for developing blood clots from conditions, such as abnormal heart rhythms. Use of these lifesaving medications requires caution with other drugs, especially painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) or naproxen (Aleve). But plenty of people take the risk to relieve aches and pains. “Many of the patients who need blood thinners are older and therefore at risk for arthritis, so it’s not infrequent for a patient to be on both a blood thinner and an NSAID,” says cardiologist Dr. Deepak L. Bhatt, a Harvard Medical School professor.
Blood thinners come in two classes: Antiplatelet drugs such as aspirin stop platelets from forming clots. Anticoagulants such as warfarin (Coumadin) and the newer direct acting oral anticoagulants (DOACs) lengthen the time it takes to form a blood clot. NSAIDs affect the way platelets work and could interfere with normal blood clotting. “That could raise the risk of bleeding, especially in the digestive tract. Taking them together with blood thinners raises the bleeding risk even more,” says Dr. Bhatt.
The truth about blood thinners and OTC pain meds
Aspirin and NSAID drugs, like ibuprofen or naproxen (Aleve and others), affect platelets, the specialized blood cells that start clotting the blood when necessary. If both the platelet system and the factor system are decreased due to medication (or underlying clotting
disorder), then the risk for abnormal bleeding goes up. This does not mean people can never
take aspirin or NSAIDs if they are on a medication to reduce clotting risk, but it does mean
that a careful evaluation must be done,
based on a person’s unique circumstances, to determine the safety of doing so. In other words, your doctor should be able to tell you how often, if ever, you can take these over-the-counter pain relievers.
If you can’t take any,
then acetaminophen (Tylenol) is usually the safest bet. However, too much acetaminophen can increase the effect of warfarin (measured by your INR level).
What are the risks of taking NSAIDs while on blood thinners?
Just because some NSAIDs are available without a prescription doesn’t mean that they are without risks. While possible side effects of NSAIDs include stomach upset, high blood pressure, and kidney problems, a big concern for people taking blood thinners is that NSAIDs raise your risk of bleeding. Even common medications like ibuprofen and naproxen pose a danger if you take anticoagulants or antiplatelets.
This change helped communicate this information to the public since these medications can be purchased without a prescription,
meaning your provider may not know you’re taking them. However,
bleeding isn’t the only NSAID risk for people taking blood thinners.
In addition to the higher risk of bleeding, you also have a higher risk of heart attacks if you take both blood thinners and NSAIDs.
This combination of possible problems makes using NSAIDs riskier for people who take blood thinners than for those who don’t.
What is Tylenol (acetaminophen)?
Tylenol (acetaminophen) is an analgesic ( pain reliever) and antipyretic (fever reducer). The exact mechanism of action of acetaminophen is unknown. It may reduce the production of prostaglandins, which are chemicals that cause inflammation and swelling. Acetaminophen relieves pain by elevating the pain threshold, that is, by requiring a greater amount of pain to develop before a person feels it. It reduces fever through its action on the heat-regulating center of the brain. Specifically, it tells the center to lower the body’s temperature when the temperature is elevated.
When used appropriately, side effects with acetaminophen are not common.
The most common side effects are rash, nausea, and headache.
Other important side effects include:
- Hypersensitivity reactions
- Serious skin reactions
- Kidney damage
- Anemia
- Reduced number of platelets in the blood (thrombocytopenia)
Chronic alcohol use may also increase the risk of stomach bleeding. The most serious side effect is liver damage due to large doses, chronic use or concomitant use with alcohol or other drugs that also damage the liver.
Other serious side effects that have been reported include bleeding in the intestines and
stomach, angioedema, Stevens-Johnson syndrome, and kidney damage. A reduction in the
number of white blood cells has also been reported.
The Working of Tylenol
Even though Acetaminophen has been here for over a century, experts are still unsure how it works. There are numerous working hypotheses.
One of the most common effects is that it inhibits certain cyclooxygenase enzymes. Prostaglandins, among other things, transmit pain signals 1 and cause fever.
Acetaminophen, in particular, may inhibit the production of prostaglandins in the neurological system. It does not affect prostaglandins in the majority of the body’s other tissues. This distinguishes Acetaminophen from nonsteroidal-steroidal anti-inflammatory medicines (NSAIDs) like ibuprofen, which also reduces tissue inflammation.
While this is the most widely accepted idea regarding how Tylenol works, scientists are also investigating how it might alter other nervous system components. Serotonin and endocannabinoid receptors are examples of this.
Doctors aren’t sure exactly how Tylenol works, which may seem surprising. However, several drugs on the market today have a similar narrative and are secure when used as prescribed.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of acetaminophen can damage your liver or cause death.
Early signs of acetaminophen overdose include loss of appetite, nausea, vomiting, sweating, or weakness. Later symptoms may include upper stomach pain, dark urine, and yellowing of your skin or eyes.
Overdose symptoms may also include ringing in your ears, headache, diarrhea, hallucinations, fast or slow heart rate, or seizure (convulsions).
How to read a drug facts label?
A drug facts label tells you important information about the OTC medication you are considering. The FDA determines which products must include this information, but all NSAID-containing medications must have this label. The drug facts label tells you:
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Active ingredients and how much of each ingredient is present
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The purpose and use of the medication or what it is supposed to do
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How to take or use the medication (when, how, and how often)
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Warnings about who should not use it
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Inactive ingredients (fillers, dyes, and other substances that don’t affect how the medication works)
First, look in the active ingredients list for the words “aspirin,” “naproxen,” “ibuprofen,” or “salicylate” to know if they are present in the product. These products should also have the words “NSAID” or “nonsteroidal anti-inflammatory drug” next to the active ingredient on the label.
Another section to check is the warning section. Any NSAID-containing products must list a specific warning about the risk of bleeding. This section should also state that people taking blood thinners have a higher risk of this happening. To see an example of an NSAID drug facts label, click here.
However, there should still be a section that indicates people taking blood thinners should avoid using the product. This is why it’s essential to read all sections of the label very carefully.
If you are ever unsure, ask your pharmacist for help reading the label. They can tell you if the product you’re looking at contains an NSAID.
Proper Use
Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. This is especially important for elderly patients, who may be more sensitive to the effects of pain medicines. If too much of this medicine is taken for a long time,
it may become habit-forming (causing mental or physical dependence) or cause an overdose. Large amounts of acetaminophen may cause liver damage.
It is very important that you understand the rules of the Opioid Analgesic REMS program to prevent addiction, abuse, and misuse of hydrocodone and acetaminophen combination. This medicine should also come with a Medication Guide and patient information leaflet. Read and follow these instructions carefully. Read it again each time you refill your prescription in case there is new information. Ask your doctor if you have any questions.
Measure the oral liquid with a marked measuring spoon, oral syringe, dropper, or medicine cup. The average household teaspoon may not hold the right amount of liquid.
This combination medicine contains acetaminophen. Carefully check the labels of all other medicines you are using, because they may also contain acetaminophen. It is not safe to use more than 4 grams (4,000 milligrams) of acetaminophen in one day (24 hours).
