Advil (ibuprofen) is one of the most popular over-the-counter (OTC) pain relievers, often used to treat minor aches, pains and inflammation. But if you’ve been prescribed Eliquis (apixaban) or other blood thinners, you should consult with your doctor before also taking Advil, due to the increased risk of bleeding when they are combined.
Advil and Eliquis Interactions: Risk of Increased Bleeding
Advil, a brand name for ibuprofen, belongs to a class of medications called non-steroidal anti-inflammatory drugs (NSAIDs). Available both OTC and by prescription, NSAIDs offer pain relief by blocking the enzyme cyclooxygenase-2 (COX-2).
The COX-2 enzyme is activated by inflammation and other disturbances within the body. It induces the production of prostaglandins, hormones that contribute to pain. NSAIDs like Advil work by blocking this process, reducing pain and inflammation.
While inhibiting the COX-2 enzyme is helpful for pain relief, Advil also blocks COX-1, an enzyme that helps with blood clotting and protects the stomach lining. This COX-1 inhibition can result in adverse effects, like stomach ulcers and bleeding. Additionally, continually blocking COX-1 reduces the production of prostaglandin, which helps create stomach mucus and neutralize stomach acid. When there isn’t enough prostaglandin, the stomach lining becomes more vulnerable to the effects of stomach acid, resulting in the potential for ulcers to develop. Ulcers are prone to bleeding, and with the inhibition of COX-1, platelets aren’t able to help mitigate that bleeding.
Due to this risk of gastrointestinal bleeding, taking NSAIDs while on blood-thinning medications (like Eliquis) is not recommended.
Eliquis is prescribed for individuals with an increased risk of heart attacks, strokes or blood clots. As a direct oral anticoagulant, Eliquis inhibits the body’s clotting factors. This prevents the formation of blood clots that can block blood vessels and cause deep vein thrombosis, pulmonary embolism, heart attack, or stroke.
This inhibition of clotting can sometimes cause excessive bleeding from minor injuries, such as a paper cut. “Direct oral anticoagulants do not cause bleeding on their own, but if bleeding starts for another reason, say due to a stomach ulcer in the setting of NSAID use, bleeding may be more severe or last longer,” says Nathan Connell, M.D., chief of medicine at Brigham and Women’s Faulkner Hospital.
What Is a Safer Alternative to Advil?
If you’ve been prescribed Eliquis and are looking for an OTC pain reliever, Dr. Connell recommends Tylenol (acetaminophen) as an NSAID alternative. Unlike Advil, Tylenol doesn’t have blood-thinning properties that might compound the effects of Eliquis.
Interestingly, certain prescription NSAIDs primarily impact COX-2 and not COX-1, notes Dr. Connell, meaning they may be a safer bet for patients taking Eliquis. Celecoxib (Celebrex), for example, is often prescribed for treating pain in individuals with inherited bleeding disorders. However, Dr. Connell emphasizes that these COX-2 inhibitors aren’t right for everyone and require a prescription from a physician.
Topical NSAIDs, such as diclofenac gel, are also an alternative for isolated pain, notes Dr. Connell. “These can be helpful for pain in a specific joint that is bothersome,” Dr. Connell says. “And there isn’t as much absorption into the rest of the body, so the risk of bleeding while on direct oral anticoagulants is thought to be much less.”
