What happens if I accidentally take ibuprofen with Eliquis?

October 7, 2025 •

4 min read

Research has shown that combining nonsteroidal anti-inflammatory drugs (NSAIDs) with oral anticoagulants can significantly increase the risk of bleeding, sometimes by twofold or more. This is a critical concern for anyone asking, "What happens if I accidentally take ibuprofen with Eliquis?"

Quick Summary

Combining Eliquis and ibuprofen drastically increases bleeding risk, especially gastrointestinal bleeding, due to their combined effect on blood clotting. Seek immediate medical advice and watch for signs of severe bleeding after an accidental dose.

Key Points

Elevated Bleeding Risk: The combination of Eliquis (a Factor Xa inhibitor) and ibuprofen (an NSAID that inhibits platelets) creates a heightened and dangerous risk of bleeding.
Seek Immediate Medical Advice: If you accidentally take ibuprofen with Eliquis, stop the NSAID immediately and contact your doctor or pharmacist for guidance on monitoring and next steps.
Watch for Bleeding Symptoms: Be vigilant for signs of internal bleeding, such as black or tarry stools, vomiting blood, unusual bruising, or severe headaches, and seek emergency care if they occur.
Use Safer Pain Relief Alternatives: The safest and most recommended over-the-counter alternative to ibuprofen for individuals on Eliquis is acetaminophen (Tylenol).
Consult Before Taking NSAIDs: Never take oral NSAIDs like ibuprofen or naproxen without explicit clearance from your healthcare provider while on Eliquis, even for a short duration.
Consider Topical Options: Topical NSAIDs like diclofenac gel may be an option for localized pain, but only with a doctor's approval due to reduced systemic absorption.

The Dangerous Interaction of Ibuprofen and Eliquis

Eliquis (apixaban) is a powerful anticoagulant, commonly known as a blood thinner, prescribed to prevent dangerous blood clots in patients with conditions like atrial fibrillation or deep vein thrombosis. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used widely for pain, fever, and inflammation. The combination of these two medications is generally not recommended and can be dangerous, significantly elevating the risk of a major bleeding event.

A Dual-Action Blood-Thinning Effect

To understand the danger, it helps to know how each medication affects the blood clotting process:

Eliquis (apixaban): This drug acts by inhibiting Factor Xa, a protein in the blood's coagulation cascade that is essential for the formation of blood clots. By blocking this factor, Eliquis prolongs the time it takes for blood to clot.
Ibuprofen (NSAID): Ibuprofen also affects blood clotting, but through a different mechanism. It inhibits cyclooxygenase (COX) enzymes, particularly COX-1, which reduces the synthesis of thromboxane A2, a molecule that promotes platelet aggregation. In addition, NSAIDs like ibuprofen can compromise the integrity of the stomach lining, making it more susceptible to damage from stomach acid and increasing the risk of ulcers and bleeding.

By taking Eliquis and ibuprofen together, you are disrupting the body's hemostatic (clotting) balance through two separate pathways. Eliquis impairs the coagulation cascade, while ibuprofen interferes with platelet function and damages the protective lining of the stomach. This creates a synergistic effect that markedly increases the potential for serious hemorrhagic events, including internal bleeding that can be life-threatening.

High Risk of Serious Bleeding

The most significant risk of combining Eliquis and ibuprofen is the increased potential for severe bleeding. Studies have confirmed this, with one meta-analysis showing a nearly twofold increased risk of gastrointestinal bleeding when anticoagulants are combined with NSAIDs. This risk is not limited to external wounds and includes potentially life-threatening internal bleeding.

Signs and symptoms of excessive bleeding to watch for include:

Unusual or easy bruising
Bleeding gums or frequent nosebleeds
Red or black, tarry stools
Vomit that looks like coffee grounds
Red or brown urine
Severe headaches
Dizziness or weakness

Immediate Steps to Take After Accidental Co-administration

If you have accidentally taken ibuprofen while on Eliquis, it is important to take the situation seriously. The following steps should be taken immediately:

Do not take another dose of ibuprofen or any other NSAID.
Call your doctor or pharmacist immediately for advice. Explain what happened, including the dose of ibuprofen you took and when. They can provide specific instructions based on your medical history and current regimen.
Go to the emergency room or seek urgent medical care if you took a high dose of ibuprofen, have a history of gastrointestinal problems, or experience any symptoms of severe bleeding. Do not wait for symptoms to worsen.
Monitor yourself carefully over the next 24-48 hours for any of the signs of bleeding listed above. Keep a low-impact schedule to avoid injuries that could lead to bleeding.

Safe Pain Relief Alternatives to Ibuprofen

Because of the high risk of interaction, it is essential for those on Eliquis to know what pain relief options are safe. The most common and widely recommended alternative is acetaminophen (e.g., Tylenol).

Acetaminophen: Unlike ibuprofen, acetaminophen works primarily in the central nervous system to relieve pain and reduce fever and does not interfere with platelet function or irritate the stomach lining. It is considered the safest over-the-counter option for mild to moderate pain relief for individuals on anticoagulants.
Topical NSAIDs: For localized pain, such as in a specific joint, a doctor might approve a topical NSAID gel (e.g., diclofenac gel). These are applied directly to the skin, and less medication is absorbed systemically, meaning less enters the bloodstream. However, this should only be done with a healthcare provider's explicit permission.
Non-Pharmacological Therapies: For chronic pain management, alternatives like physical therapy, therapeutic exercise, heat/cold packs, and massage can be effective without any drug interaction risks.

Comparing Pain Relief Options for Eliquis Users


Pain Reliever	Interaction with Eliquis	Bleeding Risk	Common Use Case
Ibuprofen (Advil, Motrin)	High interaction: Interferes with platelet function and harms stomach lining.	Significantly increased risk.	Avoid while on Eliquis.
Acetaminophen (Tylenol)	No interaction: Works via a different mechanism.	Minimal increased risk.	First-line choice for mild-to-moderate pain.
Aspirin (NSAID)	High interaction: Also inhibits platelet aggregation.	Significantly increased risk.	Avoid unless prescribed for antiplatelet therapy by a doctor.
Naproxen (Aleve) (NSAID)	High interaction: Another NSAID with similar risks to ibuprofen.	Significantly increased risk.	Avoid while on Eliquis.
Topical NSAIDs (e.g., Diclofenac)	Low systemic absorption.	Slightly increased risk (doctor supervision needed).	Localized joint or muscle pain.

Conclusion: Prioritizing Patient Safety

While an accidental dose of ibuprofen might not cause an immediate severe reaction, the combined effects with Eliquis create a significantly elevated risk of dangerous bleeding. The immediate priority is to cease any further intake of NSAIDs and contact a healthcare provider for guidance. Always consult with your doctor or pharmacist before taking any new medication, including over-the-counter products, to ensure it won't interact with your Eliquis prescription. By choosing safer alternatives like acetaminophen and staying vigilant for any signs of bleeding, you can effectively manage pain without compromising your health.

For more information on the interaction of Advil (ibuprofen) with Eliquis, MedShadow Foundation offers detailed insights from medical professionals: Can I Take Advil with Eliquis?.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a healthcare professional regarding any medication use or health concerns.

Frequently Asked Questions

If you took a single dose of ibuprofen with Eliquis, stop taking the NSAID immediately and contact your healthcare provider or pharmacist. Monitor yourself closely for signs of bleeding, and seek immediate medical attention if any occur.

No, it is generally not recommended to take ibuprofen with Eliquis, even for a short duration. The interaction increases bleeding risk significantly, and safer alternatives like acetaminophen are available.

The safest over-the-counter pain reliever to take with Eliquis is acetaminophen (Tylenol), as it does not affect platelet function or increase bleeding risk in the same way as NSAIDs.

Signs of internal bleeding include unusual bruising, red or black tarry stools, vomiting blood or material that looks like coffee grounds, coughing up blood, red or brown urine, and severe or persistent headaches.

The interaction is dangerous because both medications have blood-thinning effects, but through different mechanisms. Eliquis prevents clotting by inhibiting Factor Xa, while ibuprofen inhibits platelet function and can cause stomach irritation. The combined effect drastically increases bleeding risk.

Possibly, but only with your doctor's approval. Topical NSAIDs like diclofenac gel have lower systemic absorption, but still carry some risk. Acetaminophen is a safer alternative.

If you experience any severe bleeding, such as black or tarry stools, or persistent symptoms like a severe headache, you should seek immediate emergency medical attention.

Yes, Eliquis interacts with all oral NSAIDs, including naproxen (Aleve) and aspirin. All of these should be avoided unless specifically directed by a healthcare provider.