NutriStack
Ibuprofen and Warfarin, a caution.
NSAIDs increase bleeding risk with warfarin through dual mechanisms: antiplatelet effects and GI mucosal damage. Ibuprofen also inhibits CYP2C9, potentially increasing warfarin levels.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
Same shape as the other 1,729 pairs in the public database.
From the interaction database
What the row says.
Every entry follows the same shape: what is happening, the mechanism, the recommendation, and the primary literature.
At a glance
- Pair type
- Caution
- Evidence (highest tier)
- Strong
- Source citations
- 4 sources
- Stack Score effect
- −5 to your Stack Score (per scored caution row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Caution · Strong evidence
Caution
What is happening. NSAIDs increase bleeding risk with warfarin through dual mechanisms: antiplatelet effects and GI mucosal damage. Ibuprofen also inhibits CYP2C9, potentially increasing warfarin levels.
Mechanism. NSAIDs inhibit platelet COX-1 (additive bleeding risk with warfarin anticoagulation), cause GI mucosal damage (creating bleeding sites), and may inhibit CYP2C9-mediated warfarin metabolism.
Recommendation. Avoid concurrent use when possible. If necessary, use the lowest NSAID dose for the shortest duration. Consider acetaminophen as an alternative. Monitor INR more frequently.
Sources (4)
- Knijff-Dutmer EA et al. Platelet function is inhibited by non-selective NSAIDs but not by cyclooxygenase-2-selective inhibitors in patients with rheumatoid arthritis. Thromb Haemost. 2002. PMID 12071243
- Wang M, Zeraatkar D, Obeda M, Lee M et al.. Drug-drug interactions with warfarin: A systematic review and meta-analysis. British Journal of Clinical Pharmacology. 2021. PMID 33769581
- Tan E, Braithwaite I, McKinlay CJD et al.. Comparison of Acetaminophen (Paracetamol) With Ibuprofen for Treatment of Fever or Pain in Children Younger Than 2 Years: A Systematic Review and Meta-analysis.. JAMA Network Open. 2020. PMID 33125495
- Miroshnychenko A, Ibrahim S, Azab M et al.. Acute Postoperative Pain Due to Dental Extraction in the Adult Population: A Systematic Review and Network Meta-analysis.. Journal of Dental Research. 2023. PMID 36631957
Stack Score
How this pair moves the number.
Effect on the composite score
If both Ibuprofen and Warfarin are in the same stack, this pair applies −5 to your Stack Score (per scored caution row).
The full algorithm, the clamping rules, and four worked stacks are documented at /methodology/stack-score.
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