Drug & supplement interaction

Chiropractic + Warfarin

Warfarin brand name: Warfarin.

Moderate Interaction
The bottom line Moderate

Chiropractic has a moderate interaction with Warfarin. Chiropractic cervical spine manipulation can increase the risk of spinal epidural hematoma in patients taking warfarin.

Read the full interaction report
SeverityModerate
LikelihoodPossible
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Chiropractic and Warfarin

Here is the interaction we found between these two, with the evidence behind it.

Moderate

WARFARIN (Coumadin)

Chiropractic cervical spine manipulation can increase the risk of spinal epidural hematoma in patients taking warfarin.
There are at least two reports of spinal epidural hematoma in patients taking warfarin who have received chiropractic cervical spine manipulation. Advise patients taking warfarin not to receive cervical manipulation treatment.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the simple version. Warfarin is a blood thinner, so your blood clots more slowly than usual. That's exactly the point of the medicine, but it also means that if a blood vessel gets injured, you can bleed more than someone not on warfarin. Neck (cervical) manipulation, where a chiropractor adjusts the upper spine, involves quick, forceful movements right near delicate blood vessels.

There are a couple of reported cases where people on warfarin developed bleeding around the spinal cord (a spinal epidural hematoma) after neck adjustments. That's rare, and the evidence is just a few anecdotes, but the consequences can be serious, things like sudden neck or back pain, weakness, numbness, or trouble moving. Please talk with your doctor or pharmacist before getting any neck manipulation while you're on warfarin.

References
  1. Whedon JM, Quebada PB, Roberts DW, Radwan TA. Spinal epidural hematoma after spinal manipulative therapy in a patient undergoing anticoagulant therapy: a case report. J Manipulative Physiol Ther 2006;29:582-5. PubMed

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Chiropractic Also Interacts With Other Medications

Chiropractic has 1 moderate known drug interaction in our database — the Warfarin one above is one of them. If you take anything else, check it against the full list below.

Taking anything else?

Check Another of Your Medications Against Chiropractic

Covers the 2,830 medications we’ve checked against Chiropractic. Pick one to open its full report.

From our Q&A

Questions About Chiropractic or Warfarin

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Chiropractic or Warfarin, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Warfarin

This page covers Chiropractic only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Warfarin page lists 361 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Alfalfa (major), American Ginseng (major), Beer (major) and Cannabis (major).

By severity: 16 major · 301 moderate · 44 minor.

From our pharmacist’s overview on the Warfarin page

“People take warfarin to prevent dangerous clots, and many are the same people reaching for glucosamine for sore joints or a multivitamin containing vitamin K, which makes this a list that deserves genuine respect. Of the 361 supplements on file for warfarin, 16 carry a major rating, and the danger runs in both directions: some add to w…”

Reviewed by 2 · Jul 18, 2026

Open the Warfarin interaction page

How much people look this up

Where Chiropractic and Warfarin Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Chiropractic
Steady interest

#1,438 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Warfarin
Top 10

#4 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Treatment approach

About Chiropractic

What is Chiropractic?

  • Low back pain
  • Neck pain
  • Tension and certain headaches
  • Joint and muscle pain
  • Posture and mobility concerns

Chiropractic is a licensed health profession that treats muscle and joint problems mostly through hands-on spinal manipulation, not a dietary supplement or herb. There is reasonable evidence it can help short-term low back pain and neck pain in many people, but it is not a cure-all, and you should see a qualified provider and rule out serious causes of pain first.

Read the full Chiropractic monograph & all interactions
Medication

About Warfarin

What Is Warfarin Used For?

Brand name: Warfarin

Warfarin sodium tablets and Jantoven tablets are both used to prevent and treat venous thrombosis (blood clots in the veins) and pulmonary embolism (a clot in the lungs). They are also used to prevent clot-related complications in people with atrial fibrillation (an irregular heart rhythm) or who have had a heart valve replaced.

In people who have had a heart attack, warfarin is used to reduce the risk of death, another heart attack, stroke, or other clotting events. It does not dissolve an existing clot, but it helps prevent the clot from growing and stops new dangerous clots from forming.

See full Warfarin drug information
Keep checking

Other Drugs & Chiropractic

Browse every other medication we’ve checked against Chiropractic — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
1Moderate
0Minor
2,828No known interaction
Moderate

1 interaction

No interaction 2,828 drugs checked — show the list
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

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Pharmacist Counseling Corner

Having Chiropractic While Taking Warfarin: Common Questions

Can you have Chiropractic while taking Warfarin?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
How serious is the Chiropractic and Warfarin interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Still Have a Question About Warfarin and Chiropractic?

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.