What medicines or supplements can increase bleeding risk with aspirin?
Aspirin can raise the risk of stomach bleeding and other bleeding. That risk is higher when you combine it with other blood-thinning medicines or certain anti-inflammatory drugs.
Avoid or check first: other “blood thinners”
Do not combine aspirin with prescription anticoagulants (unless your clinician specifically told you to). Examples include:
- Warfarin (Coumadin/Jantoven)
- Apixaban (Eliquis)
- Rivaroxaban (Xarelto)
- Dabigatran (Pradaxa)
- Edoxaban (Savaysa)
Also be cautious with antiplatelet drugs such as:
- Clopidogrel (Plavix)
- Prasugrel (Effient)
- Ticagrelor (Brilinta)
Avoid or check first: other NSAIDs (pain/anti-inflammatory drugs)
Nonsteroidal anti-inflammatory drugs can add to the stomach/bleeding risk when taken with aspirin. Examples include:
- Ibuprofen (Advil, Motrin)
- Naproxen (Aleve)
- Diclofenac
- Indomethacin
- Other NSAIDs
Be careful with “aspirin-like” OTC combinations
Some cold/flu or pain products contain aspirin or similar ingredients. Combining them can raise the dose of aspirin unintentionally.
What vitamins or supplements should you avoid with aspirin?
Some supplements can affect bleeding, either by increasing bleeding tendency or by interacting indirectly.
Common supplements people are often advised to avoid or ask a clinician about before using with aspirin include:
- Vitamin E (high doses)
- Fish oil/omega-3 supplements (especially at higher doses)
- Garlic supplements
- Ginkgo biloba
- Turmeric/curcumin supplements (especially higher-dose extracts)
If you take a multivitamin, also check the label for added vitamin E or omega-3 amounts and avoid high-dose “extra” versions unless your clinician approves.
If you take aspirin for heart protection, does it change what you should avoid?
Yes. Low-dose aspirin is sometimes prescribed to prevent blood clots. If you are taking it for a cardiovascular reason, you should not stop or add other medicines (especially other antiplatelet or anticoagulant drugs) without your prescriber. This is also where NSAID timing matters—some NSAIDs can interfere with aspirin’s anti-platelet effect if taken in a certain schedule (your pharmacist can help you time doses safely).
What happens if I accidentally take a supplement or medicine that shouldn’t be mixed?
Get medical advice urgently if you have signs of bleeding, such as:
- Black/tarry stools or blood in stool
- Vomiting blood or vomit that looks like coffee grounds
- Unusual bruising, nosebleeds that won’t stop
- Blood in urine
- Severe or persistent stomach pain
- Sudden weakness, dizziness, or severe headache
For severe symptoms, go to urgent care or the emergency department.
Quick safety checklist to follow
- Check labels for hidden aspirin (common in some cold/flu and pain products).
- Don’t add NSAIDs for pain without asking if you’re on aspirin (especially regularly).
- Before adding vitamins/supplements (especially vitamin E, fish oil/omega-3, ginkgo, garlic), ask your pharmacist or clinician whether your dose is safe with your aspirin plan.
To tailor this to you
What aspirin are you taking (low-dose 81 mg vs pain-dose), and for what reason (heart/stroke prevention, arthritis pain, etc.)? Also list any prescription medicines and the names/doses of vitamins or supplements you take, and I can flag the most relevant ones to avoid or adjust.