Blood Thinner Drugs and Alcohol: A Dangerous Mix?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on June 14, 2024.

Combining alcohol and blood thinner medications like warfarin may cause you to bleed more easily. If you take warfarin, you should avoid drinking large amounts of alcohol, but the available information suggests modest alcohol intake (1 to 2 drinks occasionally) has little effect on warfarin response, if you have normal liver function.

If you choose to drink while taking warfarin, have the combination approved by your doctor first. If you drink alcohol frequently or drink large quantities, or if you have liver disease, let your prescriber know before treatment starts. You may need a dose adjustment in addition to testing of your prothrombin time (PT) or International Normalized Ratio (INR).

Some healthcare providers recommend against alcohol ingestion completely while taking warfarin.

Call your doctor right away if you have any unexplained bleeding or bruising, nausea or vomiting, blood in your urine or stools, headache, dizziness, or weakness.

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 a 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 who are at risk for a blood clot (a venous thromboembolism) might be prescribed an anticoagulant.

Alcohol and warfarin side effects: Alcohol use is one of the strongest risk factors for major bleeding while on warfarin. 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.
- Drinking large amounts of alcohol (binge drinking) in short period of time (acutely) can decrease the metabolism (breakdown and excretion) of oral anticoagulants and increase the risk of bleeding.
- On the other hand, excessive daily alcohol use (such as with alcoholism) increases the metabolism of warfarin and can lower its effectiveness, increasing the risk of a clot, a heart attack or stroke.
- Alcohol can also alter the effect of platelets and 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, NSAIDs and alcohol interactions

Antiplatelet medicines are used to stop blood clots from forming. They are a group of drugs that stop certain blood cells (called platelets) from clumping together and forming a blood clot to help stop bleeding. Aspirin is a common antiplatelet drug.

Non-steroidal antiinflammatory drugs (NSAIDs) are frequently used pain relievers found as over-the-counter (OTC) and prescription products. Common examples include Advil or Morin (ibuprofen) and Aleve (naproxen). They can also affect platelets and bleeding risk.

Alcohol can increase your risk of stomach bleeding caused by aspirin and other NSAIDs.

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.
If you use aspirin or NSAIDs like ibuprofen, naproxen, indomethacin or diclofenac, check with your doctor before drinking alcohol.
In general, most patients are counseled to avoid alcohol with aspirin. NSAID product labeling (for example, ibuprofen or naproxen) warns against having 3 or more alcoholic drinks every day while using these products. Higher risk patients may need to avoid alcohol completely with NSAIDs.
Call your doctor right away if you have symptoms of bleeding in your stomach or intestines. This includes black, bloody, or tarry stools; coughing up blood or vomit that looks like coffee grounds.

In general, you should not drink alcohol with the antiplatelet agents Brilinta (ticagrelor), Effient (prasugrel) or Plavix (clopidogrel), especially when taking with aspirin, due to the risk of stomach bleeding and ulcers.

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, but it's probably a good idea to limit alcohol intake with these medicines to lower your risk for any serious bleeding. Ask your doctor if you can safely have an occasional drink.

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 for excretion. If you have liver disease or a history of liver disease, tell your healthcare provider.

Table 1: Direct-acting oral anticoagulants

Generic name	Brand example
apixaban	Eliquis
rivaroxaban	Xarelto
edoxaban	Savaysa
dabigatran	Pradaxa
fondaparinux	Arixtra
betrixaban	Bevyxxa

Apixaban, betrixaban, edoxaban, fondaparinux, and rivaroxaban are all classified as Factor Xa inhibitors. Dabigatran is a direct thrombin inhibitor.

Types of Drug Interactions With Alcohol

Sources

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Further information

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