Blood Thinner Drugs and Alcohol: A Dangerous Mix?
Warfarin interactions with alcohol
Warfarin (Jantoven) is a commonly used blood thinner (a coumarin oral anticoagulant). It is used to prevent or treat blood clots in veins, arteries, or the heart, which can reduce the risk of stroke, heart attack, or other serious conditions. It can also keep an existing clot from getting larger. Patients with a history of atrial fibrillation (AFib), peripheral artery disease (PAD), heart attack, or knee or hip surgeries at risk for venous thromboembolism (VTE) might be prescribed an anticoagulant.
- Combining alcohol and blood thinner medications such as warfarin can lead to drug interactions. Patients receiving warfarin should avoid acute alcohol intoxication (avoid large amounts of alcohol), but the available information suggests modest alcohol intake (1 to 2 drinks/day) has little effect on warfarin response. It's probably wise to avoid alcohol with warfarin until approved by your doctor. If you chronically drink alcohol or have active liver disease, let your prescriber know.
- Alcohol and warfarin side effects: When warfarin is combined with alcohol, the effects of warfarin can be altered and may lead to a greater risk of bleeding or a decreased warfarin effect. Liver disease may change these effects, too.
- Acutely drinking large amounts of alcohol (binge drinking) can decrease the metabolism (breakdown) of oral anticoagulants and increase the bleeding risk.
- On the other hand, excessive daily alcohol use increases the metabolism of warfarin and can lower its effectiveness, increasing the risk of a clot, a heart attack or stroke.
- The antiplatelet effect of alcohol may increase bleeding risk without effects on the INR, a measure of warfarin effect. Platelets are important blood cells that help your body to form clots when bleeding. An antiplatelet effect may stop blood clots from forming.
- Call your doctor promptly if you have any unusual bleeding or bruising, vomiting, prolonged bleeding from cuts, increased menstrual flow, bleeding of gums from brushing your teeth, nosebleeds, blood in your urine or stools, black stools, headache, dizziness, or weakness.
Antiplatelet medicines and alcohol
Antiplatelet medicines are used to stop blood clots from forming. They are a group of drugs that stop certain blood cells (platelets) from clumping together and forming a blood clot to help stop bleeding.
Alcohol can increase your risk of stomach bleeding caused by aspirin.
- Aspirin, an antiplatelet medicine, can cause stomach bleeding and ulcers, which can be serious. The risk of bleeding is increased if you also drink alcoholic beverages and you take aspirin.
- Check with your doctor if you use aspirin before drinking alcohol. In general, most patients are counseled to avoid alcohol with aspirin use.
You should not drink alcohol with Brilinta (ticagrelor), Effient (prasugrel) or Plavix (clopidogrel) because you will also be taking aspirin, which can lead to stomach bleeding and ulcers, especially if combined with alcohol. You should not be started on these medicines if you have any active bleeding such as a peptic ulcer or bleeding in the brain.
Learn more: Can you drink alcohol while taking Brilinta?
Newer oral anticoagulants
The newer (novel) oral anticoagulants do not have alcohol-drug interactions listed in their product labeling. However, if you consume large amounts of alcohol at one time or drink alcohol on a daily basis, be sure to discuss this with your doctor. Heavy alcohol use may increase the risk of a stomach ulcer or bleeding, and this can be worsened by an anticoagulant.
In addition, some direct-acting oral anticoagulants are broken down in the liver; if you have alcohol-induced liver disease, tell your healthcare provider.
Apixaban, edoxaban, fondaparinux, and rivaroxaban are all classified as Factor Xa inhibitors. Dabigatran is a direct thrombin inhibitor.
Table 1: Direct-acting oral anticoagulants
| Generic name | Brand example |
| apixaban | Eliquis |
| rivaroxaban | Xarelto |
| edoxaban | Savaysa |
| dabigatran | Pradaxa |
| fondaparinux | Arixtra |
Types of Drug Interactions With Alcohol
- ADHD Medications and Alcohol
- Allergies, Cough/Cold Medications and Alcohol
- Antibiotic Medications and Alcohol
- Antidepressant Medications and Alcohol Interactions
- Antipsychotic Medications and Alcohol
- Anxiety Medications and Alcohol
- Bipolar Medications and Alcohol
- Birth Control Pills and Alcohol
- Caffeine, Energy Drinks and Alcohol
- Can You Mix Weight Loss Drugs and Alcohol?
- Cholesterol Medications and Alcohol
- Diabetes Medications and Alcohol
- Enlarged Prostate (BPH) Medications and Alcohol Interactions
- Erectile Dysfunction Medications and Alcohol
- Heart Medications and Alcohol
- Herbal Supplements and Alcohol
- Illicit Drugs and Alcohol Interactions
- Is it safe to drink alcohol with acne medicines?
- Motion Sickness Drugs and Alcohol Interactions
- Pain / Fever Drugs and Alcohol Interactions
- Seizure Medications and Alcohol Interactions
- Should you mix muscle relaxants with alcohol?
- Stomach / Heartburn Medications and Alcohol
- What are the dangers of mixing sleeping pills with alcohol?
Sources
- Immonen S, Valvanne J, Pitkälä KH. The prevalence of potential alcohol-drug interactions in older adults. Scand J Prim Health Care. 2013;31(2):73–78. Accessed April 2, 2022 at doi:10.3109/02813432.2013.788272
- Weathermon R, Crabb DW. Alcohol and medication interactions. Alcohol Res Health. 1999;23(1):40–54. Accessed April 2, 2022 at PMID: 10890797.
- Warfarin Sodium. ASHP Monograph. Oct. 2019. Drugs.com. Accessed April 2, 2022 at https://www.drugs.com/monograph/warfarin-sodium.html
- Havrda DE, Mai T, Chonlahan J et al. Enhanced antithrombotic effect of warfarin associated with low-dose alcohol consumption. Pharmacotherapy. 2005; 25(2):303-7.
- Mukamal KJ, Smith CC, Karlamangla AS et al. Moderate alcohol consumption and safety of lovastatin and warfarin among men: the Post-Coronary Artery Bypass Graft Trial. Am J Med. 2006; 119:434-40.
- Breslow RA, Dong C, White A. Prevalence of Alcohol-Interactive Prescription Medication Use Among Current Drinkers: United States, 1999 to 2010. Alcohol Clin Exp Res. 2015; 39:371-79. Accessed Nov. 10, 2019.
- Hansten PD, Horn JR. Top 100 Drug Interactions 2017; p. 8. A Guide to Patient Management. H&H Publications, Freeland, WA.
- Alcohol Facts & Statistics. National Institute on Alcohol and Abuse and Alcoholism (NIAAA). National Institutes of Health (NIH). Accessed April 2, 2022 at https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
