Alcohol and Warfarin: The Dangers of Mixing Alcohol and Anticoagulants

Get Help With Alcohol Addiction

Talk To Someone Now

Call toll free to:

• Find meetings near you
• Discover online or in person meetings
• Get 24 hour information on addiction

800-934-9518

All calls are 100% confidential

Who Answers?

Anticoagulants, or blood thinners, like warfarin may be prescribed to reduce the risk of blood clots, heart attack, or stroke. Mixing alcohol and warfarin can change how warfarin is metabolized, causing potentially serious side effects.

Why Do Alcohol and Warfarin Interact?

Warfarin is prescribed to prevent and treat blood clots in veins that carry blood to the heart, known as myocardial infarction (heart attack). Warfarin blocks vitamin K coagulant factors for deep vein thrombosis, pulmonary embolism, and atrial fibrillation.

A secondary use of warfarin approved by the Food and Drug Administration (FDA) is to treat transient ischemic attacks (symptoms of a stroke).¹

Warfarin is administered orally or by injection and absorbs within four hours. It starts to act as soon as 24 hours but, in some, may take up to 72 hours. The peak therapeutic point for warfarin is between days five and seven. Your doctor will assign your dose according to your medical history and vitals. Your doctor considers:²

• Age
• Other medications
• Underlying health conditions
• Gender
• Body composition

Warfarin labels advise against drinking alcohol.³

Alcohol is a drug that hinders the metabolism of warfarin. Long-term misuse of alcohol induces liver enzymes and makes it difficult for a doctor to prescribe the correct dose of warfarin due to these changes.⁴

What Are the Side Effects of Alcohol and Warfarin?

Even when taken correctly, warfarin can have side effects. Excessive bleeding can occur, putting your life at risk. Other potential side effects include:^{2, 3}

• Gas and other digestive complaints like bloating
• Abdominal pain
• Hives or rash
• Itching
• Blood pressure problems
• Swelling
• Fever
• Rash
• Bruising
• Headaches
• Excessive fatigue
• Hair loss
• Chest pain or pressure
• Death of skin tissues
• Purple toes syndrome
• Allergic reactions
• Liver damage

The FDA warns that eating foods high in vitamin K change how warfarin works for you. This includes leafy greens, vegetable oils, and green vegetables.³

Always talk with your doctor about side effects due to your personal medical history. If you misuse alcohol and warfarin, expect an increase in side effects, as well as new ones that may appear.

The most serious risk associated with warfarin is hemorrhage anywhere on the body. In one study of patients on warfarin who also misuse alcohol, they have twice the risk of significant bleeding, especially gastrointestinal bleeding. It can also cause bleeding to occur much longer than without it.⁵

Alcohol also causes intoxication, increasing the risk of accidents and injuries, as well as damage to organs and tissues. If you are on warfarin, you may experience excessive bleeding with these injuries.^.2

What Are the Risks of Mixing Alcohol and Warfarin?

Doctors prescribe warfarin to approximately two million Americans each year. Of those, 35,000-45,000 go to the hospital with adverse warfarin-related events. Some adverse events result from warfarin sensitivity, and others from medication or substance interactions.⁶ Symptoms caused by mixing alcohol and warfarin would be considered interaction-related adverse events.

Warfarin interactions with alcohol and other medications can lead to short-term symptoms such as:⁷

• Nausea
• Vomiting
• Headaches
• Loss of coordination
• Accidents and injuries

Long-term risks include:⁷

• Internal bleeding
• Heart problems
• Respiratory problems

You may experience additional interactions if you are on other medications in addition to warfarin.⁷ For example, if you are taking over-the-counter medicines for pain (e.g., Tylenol), they can interact with alcohol by causing upset stomach, gastrointestinal bleeding, liver damage, and change in heart rate.

Three, four, or more drugs together increase the risk of a negative interaction. Before taking any substances or medications together, speak to your doctor. For example, when you are prescribed warfarin, find out how much alcohol is ok with warfarin at your current dose.

Another example is with one of the most common prescriptions: antidepressants. The interaction effects of alcohol and antidepressants include: ⁷

• Drowsiness
• Dizziness
• Overdose risk
• Depression increase
• Alcohol effects increase
• Motor skill impairment
• Blood pressure changes

If you take warfarin and an antidepressant, as well as alcohol, you risk hemorrhaging, especially if you lose motor skills and become dizzy. You may be more likely to have an accident or injury that leads to excessive bleeding.

When mixed with alcohol and warfarin, some cholesterol medicines may increase stomach bleeding. Even herbal supplements can change how your body functions. When combined with alcohol, your body systems can become overwhelmed.

Are There Risks of Alcohol and Warfarin Overdose, Dependence, Addiction?

Study results show that 6.5% of people on warfarin also have a substance use disorder—the clinical term for addiction.⁸

Warfarin does not produce mind-altering effects like alcohol. It is a substance that creates urges or cravings to use more if you stop using it. On the other hand, however, alcohol misuse can lead to psychological and physiological dependence, which often happens before an alcohol use disorder develops.

Symptoms of alcohol dependence occur when you try to stop drinking alcohol. These withdrawal symptoms may include flu-like symptoms, shakiness, and uncontrollable cravings. Continued misuse of alcohol, which may happen as an attempt to avoid withdrawal symptoms can lead to an alcohol use disorder.⁹

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides the criteria that addiction treatment professionals use to determine if a person has alcohol use disorder and how severe it is. The criteria include the inability to stop drinking even when you want to, spending an increasing amount of your time seeking or misusing alcohol, and loss of control over how much alcohol you use.¹⁰

Call 800-839-1686 Toll Free. Privacy Guaranteed. No Commitment.

Help is standing by 24 hours a day, 7 days a week.

Who Answers?

Even though you cannot become dependent on warfarin, you can experience warfarin toxicity and overdose. Overdose can happen when using warfarin alone or with alcohol. Warfarin overdose happens due to:⁸

• Intentional adult overdose
• Unintentional overdose
• Pediatric ingestion

Warfarin toxicity is a rare occurrence but can happen to anyone, especially if mixing it with alcohol or other substances.¹¹

Anticoagulant overdose can present with the following symptoms:¹¹

• Excessive or unusual bleeding
• Dark or bloody urine or stools
• Blood clots

Additional signs of warfarin toxicity include:¹

• Spitting up blood
• Heavy bleeding with menstrual period
• Coughing up or vomiting material that resembles coffee grounds
• Bleeding with minor cuts that is difficult to stop
• Bruises or bleeding that is unusual or unexpected
• Gangrene, or skin that is dying or turning colors

Alcohol overdose symptoms include:¹²

• Slowed or stopped breathing
• Slowed or stopped heart rate
• Drop in body temperature
• Mental confusion
• Vomiting
• Seizures
• Clammy skin
• Loss of consciousness

Research shows that the risk of overdose is greater when mixing alcohol and warfarin. However, misuse of either substance is dangerous.

Who Is at Risk for Severe Side Effects of Mixing Alcohol and Warfarin?

Combining alcohol and warfarin is generally considered to be unsafe in any amount. However some individuals may be at higher risk for severe side effects.

Warfarin Resistance

You can be prescribed warfarin and adhere to your medication protocols yet still at risk for blood clotting if you are warfarin resistant. Unfortunately, the only signs of warfarin resistance are blood clots.¹³

Misusing alcohol when you have warfarin resistance may present added risks.

Multiple Medication Interactions

A person taking multiple prescription or over-the-counter medications with warfarin may experience unpredictable effects on bleeding and clotting. The most common potentially problematic medicines are:¹⁴

• Antidepressants
• Aspirin
• Fenofibrate (Triglide, Fibricor, Lipofen), a cholesterol medication
• Antibiotics
• Flu vaccine

Both legal substances, like alcohol, and illicit substances can also interact with any medication you take.

This is thought to be the reason why older adults may be at risk for interactions from mixing alcohol and warfarin—older adults take multiple prescription medications at a higher rate than younger demographics.¹⁴

Medication Errors

Taking the wrong dose or forgetting to take a dose can cause overdose or under-dose effects. Additionally, being given the wrong medication or wrong dosage could cause potentially serious interactions.¹⁴

Underlying Medical Conditions

Certain underlying medical conditions may amplify the interactions of substances. Diabetes, history of stroke, anemia, hypertension, liver disease, and renal failure can increase the risk of worse side effects. ¹⁴

Alcohol Addiction

The DSM-5 criteria for alcohol use disorder includes using alcohol despite knowing of direct health or wellbeing consequences from its use. If you have alcohol addiction, you may be able to stop drinking while taking warfarin without treatment for the addiction, which could put you at risk of experiencing warfarin interactions with alcohol.¹⁰

Call 800-839-1686 Toll Free. Privacy Guaranteed. No Commitment.

Help is standing by 24 hours a day, 7 days a week.

Who Answers?

How Can I Avoid Mixing Alcohol and Warfarin?

If you take warfarin, talk to your doctor about dosing protocols that allow you to consume a specific amount of alcohol at a particular time of day, so it does not interfere with warfarin. Do not drink in excess. Below are suggestions from the National Action Plan for Adverse Drug Event Prevention:¹⁵

• Get help from someone you trust when taking your medicines.
• Keep a daily medication schedule.
• Attend educational courses on managing medications.
• Talk to your doctor and pharmacist about medication management programs. Ask clear questions like, “How much alcohol is ok with warfarin?” or “How much alcohol affects your INR?” and “How long does alcohol affect INR?”
• Read the FDA medication guides for warfarin and your other medications.

If you experience the symptoms of warfarin toxicity or alcohol overdose:¹⁶

• Call 911 for emergency help.
• Call the Poison Control Center for guidance.
• Contact your doctor or local emergency room. A doctor can administer reversal agents for warfarin and warfarin interactions with alcohol. They are:
  • Rapid-acting parenteral anticoagulants
  • Vitamin K
  • Fresh frozen plasma
  • Prothrombin complex concentrates

How Can I Manage Blood Clots and Alcohol Addiction?

Alcohol can worsen health conditions, including those for which you are taking warfarin. The best thing you can do to manage blood clots and alcohol misuse is to seek help. Follow your doctor’s instructions for the condition they prescribed warfarin for, which may include:¹⁷

• Wearing loose clothing
• Wear compression socks
• Elevate your legs
• Eat less salt
• Avoid standing for long periods
• Perform physical therapy exercises
• Take your medicine as prescribed

If you feel concerned that you cannot control your alcohol use in order to safely take warfarin or other medication that limits alcohol consumption, seek an assessment for alcohol use disorder. The first step in managing alcohol misuse and addiction is to get recommendations from a specialized professional. You can do this through an assessment administered by a licensed professional counselor.

We can connect you with an alcohol addiction treatment provider. Call us at 800-948-8417 Who Answers? today. We are here 24/7.

Resources

1. Patel S, Singh R, Preuss CV, & Patel, N. (2021). Warfarin. Treasure Island (FL): StatPearls Publishing.
2. S. Food and Drug Administration. (2011). Coumadin Tablets, Warfarin Sodium Tablets.
3. S. National Library of Medicine. (2017). Warfarin. MedlinePlus.
4. Crader, M.F., Johns, T., & Arnold, J. K. (2021). Warfarin Drug Interactions. Treasure Island (FL): StatPearls Publishing.
5. Roth, J. A., Bradley, K., Thummel, K. E., Veenstra, D. L., & Boudreau, D. (2015). Alcohol Misuse, Genetics, and Major Bleeding Among Warfarin Therapy Patients in a Community Setting. Pharmacoepidemiology and Drug Safety, 24(6), 619-627.
6. S. National Library of Medicine. (2020). Warfarin Sensitivity. MedlinePlus.
7. National Institute of Alcohol Abuse and Alcoholism. (2014). Harmful Interactions: Mixing Alcohol with Medicines.
8. Efird, L. M., Miller, D. R., Ash, A. S., Berlowitz, D. R., Ozonoff, A., Zhao, S., Reisman, J. I., Jasuja, G. K., & Rose, A. J. (2013). Identifying the Risks of Anticoagulation in Patients With Substance Abuse. Journal of General Internal Medicine, 28(10), 1333-1339.
9. S. Library of Medicine. (2021). Alcohol Use Disorder. MedlinePlus.
10. National Institute of Alcohol Abuse and Alcoholism. (2021). Understanding Alcohol Use Disorder.
11. Deaton, J.G. & Nappe, T.M. (2021). Warfarin Toxicity. Treasure Island (FL): StatPearls Publishing.
12. National Institute of Alcohol Abuse and Alcoholism. (2021). Understanding the Dangers of Alcohol Overdose.
13. S. National Library of Medicine. (2020). Warfarin Resistance. MedlinePlus.
14. Amaraneni, A., Chippa, V., &Rettew, A.C. (2021). Anticoagulation Safety. Treasure Island (FL): StatPearls Publishing.
15. Harter, K., Levine, M., & Henderson, S. O. (2015). Anticoagulation Drug Therapy: A Review. The Western Journal of Emergency Medicine, 16(1), 11-17.
16. Agency for Healthcare Quality and Research. (2017). Your Guide to Preventing and Treating Blood Clots.
17. Office of Disease Prevention and Health Promotion. (2014). Anticoagulants. National Action Plan for Adverse Drug Event Prevention. U.S. Department of Health and Human Services. Washington, DC.