Spondylitis Association of America
Posted By: efran Medications with Warfarin - 10/26/12 02:02 PM
Do any of you take Warfarin, and take a biologic or other meds for your inflamation, since NSAIDS aren't allowed?

My husband is taking Warfarin for six months or more for a pulmonary embolism and can't take Celebrex. He can take Vicodin but the pain is really getting him down.

I take Celebrex or Tramadol myself for AS and have not taken anything stronger, so all I know is what I've read in the forum.

He had a sudden onset of arthritis at age 27, which they call osteoarthritis, but I believe it is Reactive Arthritis or Psoriatic Arthritis. His arthritis is service related.

Also, is anyone on "Tricare for Life" getting coverage for biologics?
Posted By: JenInCincy Re: Medications with Warfarin - 10/26/12 02:43 PM
Hi - you may want to start a separate thread in the Military & Veterans forum about Tricare coverage, to get more attention to that part of your question.

If his only diagnosis is OA and his rheumy is unwilling to consider spondyloarthropathy as an additional diagnosis it's quite possible that insurance would not approve an anti-TNF medication, because anti-TNFs aren't indicated for OA.

What does it mean when you say his arthritis is "service related?"

The pain of OA may have an inflammatory component but has a large mechanical component; so NSAIDs might not be necessary for him. NSAIDs do have anti-inflammatory properties but they also have analgesic properties. Has he had relief from NSAIDs in the past? What about Tylenol?

It doesn't appear that there is a strict contraindication against Celebrex for people taking warfarin. Looks like the doc would have to manage him closely and tweak the doses of both to achieve therapeutic efficacy at the lowest possible dose and risk of side effects. Maybe it is worth asking the question...

http://www.drugs.com/interactions-check.php?drug_list=2311-0,560-284

I randomly chose another (nonselective) NSAID to check for interactions, naproxen, and it turns out that this one DOES have a major risk of interactions.

http://www.drugs.com/interactions-check.php?drug_list=2311-0,1690-2613

Maybe it would be worth getting a second opinion from another rheumy - if he does indeed have ReA or PsA hopefully they would recognize it and offer treatment with an anti-TNF?

In the meantime - you said he can take Vicodin; but does he? For now, that sounds like the best course of action, though I'm sure the thought of chronic opioid use is unpalatable to him (lots of us here share the love/hate relationship with pain meds!) But if it would manage his pain and improve his quality of life it seems it could be worth doing. I know it has been for me.
Posted By: Ken Delano Re: Medications with Warfarin - 10/26/12 03:18 PM
Originally Posted By: efran

My husband is taking Warfarin for six months or more for a pulmonary embolism and can't take Celebrex. He can take Vicodin but the pain is really getting him down.

He had a sudden onset of arthritis at age 27, which they call osteoarthritis, but I believe it is Reactive Arthritis or Psoriatic Arthritis. His arthritis is service related.



Does he have a service connected disability for arthritis?

Celebrex can interfere with the bodies ability to clot. I had to stop using it very recently due to surgery. He needs to talk to his Dr's so he can get his pain to a manageable level. There are other pain meds.
Posted By: efran Re: Medications with Warfarin - 10/26/12 08:30 PM
Thanks for your replies.

He has a service connected disability (caused by or occuring during active duty) for arthritis, but has never seen or been referred to a rheumatologist, just the VA. It came on suddenly and severely within days of going from a temperate climate to Labrador with 40 below. Until a few years ago he got all his health care and prescriptions there, and I kept after him to see outside doctors under Medicare and Tricare for Life.

I have tried to get him to see my rheumatologist.

It is typical for the PCP to say arthritis or fibromyalgia, as in my case.

Celebrex is the only arthritis med that has ever helped him, and the VA won't pay for it. We got it at the local pharmacy through Tricare for Life.

He says Tylenol doesn't do a thing for him.

He is prescribed 500mg vicodin 1 or 2 as needed every six hours, but I can't get him to take it regularly. I think 1 three times a day would probably help him. I took a lot more than that after a bad accident and had no trouble getting off it.

He probably doesn't need biologics, but I was wondering about it.
Posted By: JenInCincy Re: Medications with Warfarin - 10/26/12 08:33 PM
Well, if he won't even take Vicodin or go to a rheumatologist for a thorough work-up and proper diagnosis, you probably don't need to worry about biologics just now smile

I know how frustrating it can be to see a loved one choosing not to make the choices that would seem best ... and you can't make them do it! I hope he'll take some ownership for the direction of his health and well-being soon.
Posted By: efran Re: Medications with Warfarin - 11/02/12 10:26 PM
He is doing much better now.

He saw his heart doctor, and he encouraged him to take the Vicodin.
Posted By: NotMeToo Re: Medications with Warfarin - 11/03/12 02:49 AM
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