Cold Medicines Safe With Warfarin

Hello and thank you for your question!

We appreciate you reaching out regarding warfarin in particular since many drugs can significantly affect it, which could lead to serious complications.

You asked about cough/chest congestion medications with warfarin specifically, so we'll start with that, but I'll also take this opportunity to discuss other over-the-counter meds as well that are commonly used for cold symptoms.

Chest Congestion Meds With Warfarin

The most commonly used chest congestion medication over the counter is guaifenesin, which is the active ingredient in the well-known brand name product Mucinex.

The good news here is that guaifenesin is a very safe medication, and has very few reported drug interactions.

It is not known to affect warfarin in any way and is generally regarded as safe to take with it.

Cough Meds With Warfarin

Aside from your cough drop (e.g. Halls, Sucrets, etc...) and natural products (e.g. honey), there is only one cough suppressant medication used in most over-the-counter cough suppressants products, and that is dextromethorphan.

Dextromethorphan is available as a stand-alone ingredient in products like Delsym but is also used in combination with other drugs. For example, it is the cough suppressant in NyQuil and DayQuil.

Dextromethorphan is not known to interact with warfarin. Several studies have evaluated if there is an interaction, and none have been reported.

Pain Relievers With Warfarin

This is where things get a little tricky.

First and foremost, you generally want to always avoid the following with warfarin:

• NSAIDs (e.g. Advil [ibuprofen], Aleve [naproxen])
• Aspirin containing products (including topicals, such as Aspercreme)
• Pepto-Bismol

The above drugs are well-known to have blood-thinning properties of their own, and can significantly increase the risk of bruising and bleeding.

Unless directed by your doctor, you should not be combining warfarin with NSAIDs, aspirin, or Pepto-Bismol (which contains a compound similar to aspirin).

Now, the other commonly used pain reliever over the counter is Tylenol (acetaminophen).

While certainly a safer option than what I have listed above, several studies have shown that high doses of acetaminophen, taken over 10 to 14 days, can increase the effects of warfarin, which can increase the risk of bruising and bleeding.

Overall, Tylenol is generally the pain reliever of choice if you are taking warfarin, but, you certainly want to talk with your doctor about what a safe dose is for you.

Nasal Decongestants

The two commonly used nasal decongestants over the counter are:

• Pseudoephedrine [Sudafed]
• Phenylephrine [Sudafed PE]

Nasal decongestants are among the top over-the-counter drugs you need to be concerned about when it comes to drug interactions since they can raise your blood pressure.

Having said that, there are no known interactions between these decongestants and warfarin. They are considered safe to use together.

Final Words

Thanks again for reaching out to us! I hope this answer helped you.

As I discussed above, warfarin isn't known to interact with cough/chest congestion medications (dextromethorphan; guaifenesin), so you're safe in that regard.

However, I don't know the entire medical situation or other drugs you could be taking, so I do recommend speaking to your doctor or the pharmacist that fills your medications.

Lastly, I wouldn't recommend taking any dietary supplements or herbal products without, again, talking to your doctor or pharmacist, as many ingredients (such as vitamin K) can have major interactions with warfarin.