MajorNon-steroidal anti-inflammatory drugs (NSAIDs)×Vitamin K antagonist anticoagulants
Updated · Methodology
Mechanism
Diclofenac (NSAID) inhibits platelet aggregation, injures the gastric mucosa, and weakly displaces warfarin from albumin binding. Additive GI bleeding risk independent of INR.
Symptoms
Gum bleeding, epistaxis, bruising without trauma, blood in urine or stool, menorrhagia. Severe cases include gastrointestinal or intracranial haemorrhage. Risk rises in patients over 65 and with prior peptic ulcer disease.
Management
Avoid chronic diclofenac on warfarin. For analgesia, choose paracetamol (up to 2 g/day for short courses). For chronic NSAID needs, use a selective COX-2 inhibitor (celecoxib) under pantoprazole cover.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- FDA: Warfarin sodium tablet (Amneal Pharmaceuticals LLC) – Prescribing Information (2017)– ; DailyMed setid 558b7a0d-5490-4c1b-802e-3ab3f1efe760
- FDA: Diclofenac potassium tablet (Advagen Pharma Ltd) – Prescribing Information (2009)– ; DailyMed setid 82218d5c-1625-471a-aabe-f43338e5176b
- AEMPS: Ficha técnica: Warfarina (nº registro 63064), sección 4.3 (2023)– AEMPS, CIMA, nº registro 63064, revisión 01/2023, sección 4.3