Is Ibuprofen a Blood Thinner? Plus 6 More FAQs About NSAIDs and Blood Thinners

If you have a fever or tweak your back, it’s likely that you’ll turn to a nonsteroidal anti-inflammatory drug (NSAIDs) to help you feel better. NSAIDs are medications that treat pain, swelling, and fever. They include common over-the-counter (OTC) medications such as aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve).

But NSAIDs can raise your risk of bleeding. And that risk is even higher if you’re also taking a prescription blood thinner. But what are blood thinners? And are NSAIDs blood thinners, too? Read on for answers to these and more questions about NSAIDs and blood thinners.

1. What is a blood thinner?

Blood thinners are medications that treat or prevent unwanted blood clots. There are two main types of blood thinners: anticoagulants and antiplatelet medications.

Anticoagulants include medications such as warfarin (Coumadin, Jantoven) and apixaban (Eliquis). They’re often a first-choice option to treat and prevent blood clots caused by surgery, certain heart conditions, or if you’ve had clots in the past.

Antiplatelet medications include clopidogrel (Plavix) and ticagrelor (Brilinta). They’re typically taken to prevent strokes and heart attacks caused by platelets sticking together to form a clot.

In most cases, you’ll take either an antiplatelet or an anticoagulant medication. But you may need to take both in certain situations.

Read more like this

Explore these related articles, suggested for readers like you.

Are Advil (Ibuprofen) and Aspirin the Same Thing?

Naproxen (Aleve) vs. Ibuprofen (Advil): Which Is Better?

What Pain Relievers Can I Take if I Have Heart Failure?

Ibuprofen, Naproxen, and More: The 8 Most Common NSAIDs

View more

2. Is ibuprofen a blood thinner?

Not exactly. It’s true that ibuprofen and other NSAIDs can make it harder for your blood to clot. And this can raise your risk of bleeding while you’re taking them. But this is generally considered a side effect, not a therapeutic effect. As mentioned, NSAIDs treat fever, pain, and swelling — they’re not taken to prevent blood clots.

There is one exception to this, though. Low-dose aspirin is considered an antiplatelet medication. It’s sometimes recommended on its own or with prescription blood thinners to help prevent blood clots.

Keep in mind that there are both OTC and prescription NSAIDs to be aware of. Common examples include:

• Ibuprofen (OTC and prescription-strength)

• Naproxen (OTC and prescription-strength)

• Aspirin

• Celecoxib (Celebrex)

• Indomethacin (Indocin)

• Meloxicam (Mobic)

• Diclofenac (Cambia, Flector)

• Ketorolac

3. What are the risks of taking NSAIDs with prescription blood thinners?

The main risk of combining NSAIDs and prescription blood thinners is an increased risk of bleeding and heart attack. This makes taking NSAIDs riskier for people who also take blood thinners than for those who don’t.

Increased bleeding risk

If you’re taking a prescription blood thinner, one of the biggest concerns is bleeding. As mentioned, NSAIDs can also raise your risk of bleeding. So taking these medications together makes your bleeding risk even greater.

Keep in mind that just because some NSAIDs are available without a prescription doesn’t mean they're risk-free. Even common OTC NSAIDs, such as ibuprofen and naproxen, pose a danger if you take them with prescription blood thinners.

Since you can buy these medications OTC, your prescriber may not know you’re taking them and won’t be able to warn you of their risks. So in 2009, the FDA started requiring that all OTC products containing NSAIDs add a warning about bleeding risks to their label. This warning helps make sure you’re aware that the product may not be safe for you.

Increased risk of heart attack

Bleeding isn’t the only problem with taking NSAIDs and blood thinners together. NSAIDs seem to increase the risk of heart attack on their own. But the risk is higher if you’ve had a heart attack in the past and take NSAIDs (other than low-dose aspirin) along with a prescription blood thinner. In this case, your risk goes up after taking NSAIDs for just a few days.

4. Which blood thinners interact with NSAIDs?

All prescription blood thinners interact with NSAIDs. Most come as oral tablets or capsules, but there are injectable blood thinners, too.

Common examples of prescription blood thinners include:

• Warfarin

• Apixaban (Eliquis)

• Dabigatran (Pradaxa)

• Rivaroxaban (Xarelto)

• Edoxaban (Savaysa)

• Clopidogrel

• Prasugrel (Effient)

• Ticagrelor

• Enoxaparin (Lovenox)

• Fondaparinux (Arixtra)

Many people with chronic heart conditions or complicated Type 2 diabetes take a blood thinning medication. If you’re unsure if you’re taking a blood thinner, review your medication list with your pharmacist or prescriber before taking an NSAID.

5. What OTC medications contain NSAIDs?

While you might know to be cautious with pain relievers, a surprising number of OTC medications also contain NSAIDs that you may not be aware of. Cough and cold products, sleep aids, and upset stomach medications all commonly contain NSAIDs. This is why, as we’ll discuss later, checking the ingredients on an OTC product’s label is an important step to take before making a purchase.

Cough and cold products

Cough and cold products often contain several ingredients to help relieve multiple symptoms at once. They often include an NSAID to help lower a fever or ease muscle aches.

Common examples of cold remedies that contain NSAIDs include:

• Advil Cold & Sinus (ibuprofen / pseudoephedrine)

• Aleve-D Sinus and Cold (naproxen / pseudoephedrine)

• Alka-Seltzer Plus Cold (aspirin / chlorpheniramine / phenylephrine)

Keep in mind that many cough and cold products contain acetaminophen (Tylenol), which isn’t an NSAID. It’s usually a safer choice if you’re taking a blood thinner. But it’s best to read the label carefully and ask your pharmacist if the cough and cold product you’ve selected is safe to take with your other medications.

Sleep aids

There are many OTC sleep products available. And some OTC sleep aids also contain NSAIDs such as ibuprofen and naproxen. They’re marketed for people with sleep troubles caused by aches and pains.

Examples of these products include:

• Advil PM (ibuprofen / diphenhydramine)

• Motrin PM (ibuprofen / diphenhydramine)

• Aleve PM (naproxen / diphenhydramine)

• Excedrin PM (aspirin / acetaminophen / diphenhydramine)

Most retailers also sell generic or store-brand versions of these products, so be sure to ask a pharmacist if your sleep aid contains any NSAIDs before taking it. And keep in mind that if you aren’t in pain, a sleep aid that doesn’t contain a pain reliever is likely a better choice altogether.

Headache and migraine relief

OTC products for headaches and migraines often contain a combination of aspirin, acetaminophen, and caffeine. But other NSAIDS, such as ibuprofen, are also found in these types of OTC medications.

Some well-known OTC headache medications that contain NSAIDs include:

• Excedrin Migraine (acetaminophen / aspirin / caffeine)

• Advil Migraine (ibuprofen)

• Aleve Headache Pain (naproxen)

• Motrin IB Migraine (ibuprofen)

• Goody’s Extra Strength Headache Powder (acetaminophen / aspirin / caffeine)

These may also have generic and store-brand equivalents. So it’s a good idea to double-check with a pharmacist before taking an OTC headache medication if you’re trying to avoid NSAIDs.

Products for upset stomach

Some OTC products for upset stomach contain salicylates (a product like aspirin) or aspirin itself. These ingredients are both NSAIDs.

Some examples include:

• Pepto-Bismol (bismuth subsalicylate)

• Alka-Seltzer (citric acid / aspirin / sodium bicarbonate)

• Kaopectate (bismuth subsalicylate)

Again, pharmacies will often carry generic versions of these products. So it’s best to have a pharmacist double-check the product you’re interested in taking before purchasing it.

Menstrual cramp relief

Some OTC products that can help relieve menstrual period bloating and cramps contain NSAIDs. These products might include aspirin, ibuprofen, or naproxen, but they often also offer NSAID-free versions.

For example, Pamprin Max Pain + Energy contains aspirin (an NSAID), acetaminophen, and caffeine. But Pamprin Multi-Symptom is NSAID-free and contains acetaminophen, pamabrom (to reduce bloating), and pyrilamine (an antihistamine). Midol also reformulated all of their products to be NSAID-free.

Just be cautious if you select a store-brand “menstrual relief” product. They may have a different combination of ingredients and could include an NSAID. Ask your pharmacist if you’re unsure.

6. How can you tell if you can take an OTC medication with a blood thinner?

One of the first steps in choosing OTC medications safely while taking blood thinners is learning if an OTC product contains an NSAID. The best way to do this is by carefully reading the “drug facts label” on the package.

How to read a drug facts label

A drug facts label tells you important information about the OTC medication you’re considering, including:

• Active ingredients list and how much of each is present

• What the medication is for

• How to take the medication (when, how, and how often)

• Warnings about who shouldn’t take it

• 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,” or “ibuprofen.” Another ingredient to look for is “salicylates.” The words “NSAID” or “nonsteroidal anti-inflammatory drug” should also be next to the ingredient name.

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. You can see an example of an NSAID drug facts label on the FDA’s website.

If you’re ever unsure, ask your pharmacist for help. They can tell you if the product you’re looking at contains an NSAID.

Good to know: OTC medications that include salicylates are not required to have the FDA warning of bleeding risks on their drug facts label. But there should still be a section that indicates you should avoid the product if you’re taking a blood thinner. This is why it’s a good idea to read all sections of the OTC label very carefully, or ask a medical professional for help.

7. Are there alternatives to OTC medications with NSAIDs?

Yes, most OTC medications will also have options that are NSAID-free, depending on the symptom you’re experiencing.

Pain relief

If you’re looking for an alternative pain reliever to an NSAID, acetaminophen (Tylenol) may be a safer option. Many of the products listed earlier have versions that contain acetaminophen instead of an NSAID. This includes cold remedies, sleep aids, and menstrual cramp medications. Keep in mind that acetaminophen has risks of its own, so it’s a good idea to check with your prescriber or pharmacist before taking it.

Upset stomach

If you’re looking for an alternative medication for an upset stomach, there are a few NSAID-free options. Tums (calcium carbonate), Mylanta (aluminum hydroxide / magnesium hydroxide / simethicone), or Rolaids (calcium carbonate / magnesium hydroxide) can help with heartburn or acid reflux symptoms. Emetrol (phosphorylated carbohydrate) and Dramamine (dimenhydrinate) can ease nausea or motion sickness. And Imodium A-D (loperamide) is available to manage occasional diarrhea.

Why trust our experts?

Written by:

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP, has over a decade of experience as a pharmacist, professor, and researcher. She was a full-time clinical professor in the pharmacy practice department at D’Youville School of Pharmacy before subsequently joining the faculty of the pharmacy practice department at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences.

Edited by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Our editorial standards

Meet our experts