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Key takeaways
Tylenol is the safest over-the-counter (OTC) pain medication to use with Eliquis.
Using NSAIDs while on Eliquis is not advised, as it increases the risk of bleeding.
Discuss your full list of medications with your healthcare provider to avoid unwanted side effects.
Eliquis is a blood thinner approved by the FDA to lower the risk of strokes and blood clots. It is a Factor Xa inhibitor, which disrupts blood clot formation in the blood clotting cascade. It is used in people with conditions like atrial fibrillation (irregular heart rhythm). Doctors also prescribe it to prevent or treat deep vein thrombosis (DVT) or pulmonary embolism (PE), especially after hip or knee replacement surgery.
Tylenol is the safest OTC pain medication to use with Eliquis. NSAIDs are not recommended as a pain reliever while on Eliquis, as the combination may increase the risk of bleeding via 2 separate, yet additive, mechanisms.
What over-the-counter pain medications can you take with Eliquis
When you experience mild or moderate pain like headaches, the usual thing most people do is to reach for an over-the-counter (OTC) pain medication. But with Eliquis, you must be mindful of which pain reliever you use because of the risk of drug interactions. That said, the following are some pain medicines that may be safe for use with Eliquis:
Tylenol
Tylenol, brand-name acetaminophen, is an over-the-counter medicine for relieving mild and moderate pain. “If a patient needs something for pain relief, I will recommend Tylenol, because it is generally safer and does not increase bleeding risk when taken at the recommended dose,” says Christopher Yi, MD, board-certified vascular surgeon at MemorialCare Orange Coast Medical Center in Fountain Valley, CA.
Topical pain relievers
“Topical pain relievers like lidocaine patches are minimally absorbed systemically and are generally safe for localized pain for people on Eliquis,” says Gail Clifford, MD, and medical consultant at ARRC LED.
OTCs you should not take with Eliquis
Nonsteroidal anti-inflammatory drugs (NSAIDs) are a class of medications for relieving pain and inflammation. Some common NSAIDs, such as aspirin, ibuprofen, and naproxen, are available over the counter. “I advise patients to avoid NSAIDs with Eliquis because they can increase the risk of bleeding. While they don’t interfere with how Eliquis works in the body, they can make it more likely for them to bleed or bruise,” Dr. Yi says.
Researchers found that the interaction between NSAIDs and oral anticoagulants such as Eliquis and warfarin can double the risk of internal bleeding in the gut (digestive tract), brain, lungs, and urinary tract. This bleeding also increases your risk of anemia. Therefore, experts advise to completely avoid using NSAIDs while on Eliquis, or to consult with your healthcare provider if there are no suitable alternatives.
You should also avoid taking Tylenol combination products, such as Advil Dual Action (acetaminophen and ibuprofen) and Excedrin (acetaminophen, aspirin, and caffeine), due to the additional ingredients (which are NSAIDs) that increase the risk of bleeding.
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Guidelines for using OTC pain medications with Eliquis
If you need to use OTC pain medications while on Eliquis, here are four important tips to reduce the risk of adverse effects:
Read medication labels
To be on the safe side, read your medication label carefully. If any information is unclear, reach out to your healthcare provider for clarification. The medication label has all the information you need about active ingredients, side effects, and drug interactions, to help you take Eliquis with OTC pain meds safely and correctly.
Take your medications as directed
Follow the instructions provided by your healthcare provider regarding the dose and timing of medication administration. If you need to take your medication at the same time each day, set a reminder on your phone to avoid forgetting. If you miss a dose of Eliquis, skip the missed dose if it is almost time for the next scheduled dose; do not double it.
Monitor for side effects
Keep in touch with your healthcare provider if you experience any side effects while using Eliquis with an OTC pain reliever. The most common side effects of Eliquis are bleeding, and these include nose bleeds, gum bleeds, heavy menstrual bleeding, and unusual bruising. If these adverse effects start and persist, contact your healthcare provider. More serious side effects include severe headaches, dizziness, allergic reactions, vomiting blood that may appear like coffee grounds, and low blood pressure. Seek emergent medical help if you notice anything unusual.
Consult with your doctor or pharmacist
Talk to your healthcare provider before using any OTC pain relievers with Eliquis. They can help you choose a safe option to lower your risk of side effects. Also, share a complete list of your prescription medicines (e.g., selective serotonin reuptake inhibitors, other anticoagulants like warfarin, antiplatelet drugs like aspirin), plus any herbal remedies, vitamins, or supplements to avoid harmful interactions.
Additionally, discuss your medical history, such as the presence of heart disease, kidney problems, and liver disease, as they may need to adjust doses. If you are seeing multiple doctors for different conditions, keep each of them in the loop about all the medications you take.
- NSAIDs raise bleeding risk in patients taking blood thinners, News Medical (2024)
- Christopher Yi, MD, board-certified vascular surgeon at MemorialCare Orange Coast Medical Center
- Gail Clifford, MD, medical consultant at ARRC LED.