Is there an anti-inflammatory that can be taken with Eliquis?

In this article:

• What anti-inflammatory drugs can you take with Eliquis?
• Anti-inflammatory medications to avoid while taking Eliquis?
• Alternatives to manage inflammation while on Eliquis

In this article

• What anti-inflammatory drugs can you take with Eliquis?
• Anti-inflammatory medications to avoid while taking Eliquis?
• Alternatives to manage inflammation while on Eliquis

Blood clots are a serious medical concern that can cause many other conditions, including heart attack, stroke, deep vein thrombosis, and more. So for people who have had heart disease, blood vessel conditions, certain cancers, and major surgeries, prescription anticoagulants like Eliquis (apixaban) might be necessary. Taking Eliquis with some common anti-inflammatory drugs increases the risk of bleeding—but certain combinations are safer than others. Below, we’ll outline which anti-inflammatories are safe, which to avoid, and safer alternatives.

What anti-inflammatory drugs can you take with Eliquis?

Some anti-inflammatory medications can affect the way blood platelets work, and when you combine that with the anti-clotting effects of a blood thinner like Eliquis, it can increase the risk of internal bleeding. However, some anti-inflammatories are safer than others, and might be fine to take with blood thinners. 

You should consult a healthcare provider before combining any drug with Eliquis. They’ll be able to provide medical advice on the safest choices for anti-inflammatory treatment. That said, here are a few over-the-counter and prescription drugs that are typically safer options for Eliquis patients. 

OTCs safe to take with Eliquis

• COX-2 inhibitors: “If anti-inflammatory treatment is absolutely necessary, I advise taking short courses of selective COX-2 inhibitors, such as celecoxib (Celebrex), under close supervision,” says Dr. Rohit Vuppuluri, DO, interventional and vascular cardiologist at Chicago Heart & Vascular Specialists. “These tend to have a lower risk of stomach bleeding compared to older NSAIDs, though the bleeding risk is still present.”

• Topical diclofenac: This is technically a non-steroidal anti-inflammatory drug (NSAID), which is usually unsafe to take with Eliquis. However, as a topical NSAID, its systemic absorption and risk of internal bleeding is lower than its oral counterparts. It still poses some risk, though, so it should only be taken under medical supervision. 

• Hydrocortisone cream: Like topical diclofenac, these corticosteroid creams (Cortizone-10, etc.) are less likely to affect blood platelets. But you should still ask a doctor before using them. 

• Antihistamines: Drugs like diphenhydramine (Benadryl), loratadine (Claritin), and cetirizine (Zyrtec) aren’t technically anti-inflammatories, but if your inflammation is allergy-related, they can help. They’re not known to interact with anticoagulants or cause an increased risk of bleeding. 

• Acetaminophen (Tylenol): This drug doesn’t work on inflammation, but inflammation is often associated with pain, and it’s an extremely common pain reliever—one that’s generally safe to take with blood thinners, per Dr. Vuppuluri. 

Prescription medications you can take with Eliquis

• Some corticosteroids: These drugs, like prednisone or dexamethasone, are powerful anti-inflammatory drugs that work by suppressing the immune system. They might make Eliquis slightly less effective or cause an even higher risk of bleeding, but for some people, they’re the best option. 

• Non-acetylated salicylate drugs: Medications like salsalate and choline magnesium trisalicylate are similar to NSAIDs, but have fewer antiplatelet effects and a lower risk of bleeding. Yet Eliquis patients should still use them with caution and under the care of a healthcare provider. 

• Disease-Modifying Antirheumatic Drugs (DMARDs): Typically prescribed for rheumatoid arthritis and other autoimmune or inflammatory conditions, drugs like methotrexate and leflunomide aren’t contraindicated for people taking blood thinners. However, certain ones—specifically JAK inhibitors—may increase the risk of venous thromboembolic events (VTEs). 

Anti-inflammatory medications to avoid while taking Eliquis?

The medicines to avoid are NSAIDS like ibuprofen, aspirin, or naproxen. A study of over 50,000 venous thromboembolic event patients found that taking NSAIDs alongside an oral anticoagulant doubles the risk of bleeding. This is because NSAIDs inhibit cyclooxygenase (COX) enzymes, which help produce prostaglandins—compounds that contribute to clotting in the stomach lining. 

When prostaglandins aren’t available to protect the stomach, the risk of gastrointestinal bleeding increases. Combine that with the existing bleeding risk that Eliquis poses, and it can cause a dangerous interaction, especially for people who are already prone to bleeding. 

“If an oral NSAID is absolutely necessary, I recommend keeping the dose as low as possible and to be used for the shortest amount of time, with protection from a proton pump inhibitor and close monitoring of symptoms for bleeding signs such as dark stools, bruising, or fatigue,” says Dr. Elizabeth Rubin Ribak, MD, clinical advisor at Embers Recovery. “I also recommend taking extra caution with elderly patients and those with kidney disease, anemia, or previous GI bleeding.”

Here are several NSAIDs to avoid while taking Eliquis or other anticoagulant drugs:

• Ibuprofen (Advil, Motrin)
• Naproxen (Aleve)
• Meloxicam (Mobic)
• Diclofenac (oral)
• Indomethacin
• Ketorolac

“Generally, the safest approach is to avoid systemic NSAIDs, rely on acetaminophen and topical treatments, and support overall inflammation control with hydration, movement, and nutrition,” Dr. Rubin Ribak says. “Ultimately, I believe that inflammation management in patients who require anticoagulants should focus on minimizing systemic drug exposure while preserving comfort and function.”

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Alternatives to manage inflammation while on Eliquis

Medications are an extremely common and effective way to deal with inflammation, but there are alternative methods that can also help, and an informed healthcare provider can help you choose ones that might work for you. Some treatment options include:

• Joint injections: An authorized healthcare professional can administer certain types of injections to treat joint inflammation caused by arthritis or other medical conditions. These injections can include corticosteroids, hyaluronic acid, Platelet-rich plasma, stem cells, and more. 
• Tropical remedies: We’ve already covered topical medications, but research has suggested that the external use of aloe vera, comfrey, witch hazel, marshmallow root, and other herbs may help specifically with skin inflammation. Turmeric, capsaicin, and menthol rubs may also help. 
• Ice: It’s part of the classic RICE (rest, ice, compression, elevation) therapy for injuries because it doesn’t just reduce pain, it also decreases inflammation. 
• Dietary changes: For people with chronic inflammation or inflammatory conditions, a diet rich in anti-inflammatory foods can help. Per Dr. Vuppuluri, foods that can help fight inflammation include “fruits, vegetables, omega-3 fatty acids, and whole grains.” 
• Physical therapy: Primarily for injury recovery and chronic pain, physical therapy uses a variety of techniques like exercise, heat/ice, massage therapy, and electrical stimulation to reduce pain and swelling. 

Some people swear by certain over-the-counter remedies, but according to Dr. Vuppuluri, “patients on blood thinners need to be careful when taking over-the-counter ‘natural’ anti-inflammatories, like ginkgo biloba, garlic, and turmeric supplements in high doses, which can also thin the blood and compound the bleeding risk.”