After a particularly active day, your joints might continue to hurt even after you take your usual arthritis pain medication. You may be wary to take another arthritis pill, so you decide to try an over-the-counter joint cream or pain relieving patch. If you are taking warfarin (or brand of warfarin such as Coumadin®), it is important to remember that some alternative solutions and over-the-counter medications may cause interactions.

What are topical pain medications?

Topical pain medications are those creams, gels and sprays that are rubbed into the skin over your painful joints. Because the ingredients are absorbed through the skin, most topical pain medications are used on the hands and knees, since they are closer to the skin’s surface.

Some topical pain medications may contain the following active ingredients:

  • Capsaicin, often found in chili peppers, helps stop the feeling of pain from being transmitted to your brain. Some common examples include Capzasin-P® and Zostrix®.
  • Salicylates are plant hormones that are made into salicylatic acid, which is used as a preservative and commonly used in products like aspirin.1 Some common over-the-counter examples include Aspercreme® and Bengay®.
  • Counterirritants, with ingredients like menthol, camphor and wintergreen, work by creating a feeling of warmth or coolness over the area to temporarily override your ability to feel the pain. Some examples include Icy Hot®, Biofreeze® and Mineral Ice®.

Interactions with warfarin?

Since the topical pain medications are rubbed or sprayed onto the skin, the active ingredients can enter the bloodstream. They have same potential as prescription and standard over-the-counter (OTC) medications to interact with warfarin. While OTC products tend to lack the strength of prescription medications, patients typically are more liberal with their use feeling they carry less risk. Products that contain menthol and salicylates have the potential to interact with your warfarin medication. These ingredients are also found in most oral pain medications containing aspirin.2, 3

You should consult with your doctor regarding the use of any over-the-counter medication or products. Your doctor can help you develop an alternative pain solution to help manage your arthritis.

  1. 1. A.S. Yip, W.H. Chow, Y.T. Tai, K.L. Cheung. Adverse effect of topical methylsalicylate ointment on warfarin anticoagulation: an unrecognized potential hazard. Postgrad Med J1990;66:367-369.
  2. 2. Mark Crowther, Anne M. Holbrook, Renee Labiris. Systematic Overview of Warfarin and Its Drug and Food Interactions. Arch Intern Med/. vol 165. 2005.
  3. 3. Bristol-Myers Squibb Company. Medication Guide for Coumadin Tablets and Coumadin for Injection [Package Insert]. 2009. Princeton, NJ: Bristol-Myers Squibb Company

    COUMADIN® is a registered trademark of Bristol-Myers Squibb Pharma Company. Alere is not affiliated or associated with Bristol-Myers Squibb Pharma Company or the COUMADIN® trademark.


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