Coumadin and Alcohol: Why is It a Dangerous Mix?

Medically Reviewed By Kayla Loibl | Last Edited : November 12, 
| 4 Sources

Mixing Coumadin and alcohol is extremely dangerous and should be avoided at all costs

coumadin and alcohol

Coumadin and alcohol can be a potentially life-threatening mix. Coumadin is a drug that thins your blood and makes your blood less likely to form clots. Because Coumadin is a powerful blood anticoagulant, mixing Coumadin and alcohol may produce a serious condition enhancing the availability of Coumadin in the bloodstream.

Major hemorrhages are more frequent in alcohol users, and internal hemorrhaging could occur as a result of drinking and taking Coumadin, bleeding that is prolonged and severe enough to be life-threatening.


Anticoagulants are blood thinners prescribed to people who suffer from arterial or venal blood clots. Individuals prescribed Coumadin have usually experienced heart attacks, strokes or other blood-clotting disorders that facilitates the formation of blood clots.

Problems Caused by Mixing
Alcohol and Coumadin

Also known as Warfarin, Coumadin carries several risks when taken even without the additional detrimental effects of alcohol. It could cause severe bleeding that can cause life-threatening conditions and even cause death. Problems potentially exacerbated by individuals taking Coumadin and alcohol include:

  • Organ or tissue hemorrhaging
  • Gangrene or necrosis (infrequently)
  • Birth defects in women who are pregnant
  • General uncontrollable bleeding
  • Bleeding gums (especially if gingivitis is already present)

When to Avoid Coumadin

Those who suffer from the following issues should not take Coumadin:

  • Alcoholism
  • Aneurysms
  • Bleeding ulcers
  • Bacterial heart inflammation (bacterial endocarditis)
  • Anemia
  • Hemophilia

Coumadin and Alcohol Interaction

For any kind of drug to successfully repair a medical condition, it must infiltrate the bloodstream and find its way to the area needing remedied, whether it is tissues, organs or muscles.

As it metabolizes and eventually passes via the liver and kidneys, the drug loses most of its effectiveness, which is why patients need more doses if the condition has not been rectified. Similarly, the ethanol in alcohol behaves much like medication, circulating through the blood, influencing neuronal and neurotransmitter activity before it is ultimately metabolizes and flushes from the body.

However, alcohol negatively disturbs the availability of pharmaceuticals such as Coumadin.

Common drug-alcohol interactions involve the following:

  • One or more drinks over the course of two to four hours may prevent metabolization of medications by competing for enzymes responsible for processing specific substances introduced into the body. This potentially creates a situation in which the patient is at risk for suffering from deleterious side effects from the drug due to prolonging its availability in the bloodstream.

  • In contrast, alcoholics taking Coumadin are constantly using these enzymes necessary for drug metabolization, which means a steady supply of alcohol in the body will decrease the medication’s availability and essentially render it ineffective.

  • Someone who has recently abstained from drinking may require more of the drug than normally prescribed due to this elevated utilization of enzymes. In addition, the activation of these enzymes cause by alcoholism may facilitate conversion of certain drugs into toxic substances which can produce liver damage, as well as possible impairment to other organs.

In addition to Coumadin and alcohol incompatibly interacting with each other, Coumadin also conflicts with other medications that alcoholics frequently take for hangovers, heartburn, muscle aches and illnesses resulting from a depressed immune system.

These over the counter medications include Motrin, Aleve, Advil, Tylenol, Zantac and Nuprin. Because these drugs contain high amounts of aspirin, another known blood thinner, the anticoagulant effects of Coumadin are intensified, potentially resulting in hemorrhaging from pre-existing conditions such as ulcers or undetected internal bleeding.

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Problems Facing Alcoholics Who Take Coumadin

Passing out while bleeding from a cut, even it is a small one, is a feasible possibility as well. Anticoagulants thin the blood by impeding protein production in the liver, which assists in blood clotting.

It's essential to understand the role that vitamin K pays in warfarin treatment and a balanced diet. Vitamin K governs the manufacturing of these proteins, or cofactors, which allows blood to freely flow throughout the body without any type of clotting process taking place. This means when a break in the skin occurs, blood will continue to seep from the wound without the interference of clotting substances.

It is entirely possible for someone who is mixing Coumadin and alcohol to cut themselves while shaving, then pass out and literally bleed to death if they remain unconscious long enough.

Chronic, heavy drinking results in cognitive and vestibular issues making alcoholics susceptible to accidental self-injury, such as falling, cutting themselves and bumping into things. When mixing Coumadin and alcohol, the risk of profuse and uncontrollable bleeding increases if someone who is drunk cuts themselves shaving or is involved in an automobile accident.

This presents another reason why you should never consume alcohol while taking anticoagulants, in addition to the many other warnings given in regards to this dangerous combination of drugs and alcohol.

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Lead Writer/Reviewer : Kayla Loibl

Licensed Medical Health Professional 


I am a Mental Health Counselor who is licensed in both New York (LMHC) and North Carolina (LCMHC). I have been working in the Mental Health field since 2015. I have worked in a residential setting, an outpatient program and an inpatient addictions program. I began working in Long Island, NY and then in Guelph, Ontario after moving to Canada. Read More


Mayo Clinic. Warfarin side effects: Watch for interactions.

Medline Plus. Warfarin.

NCBI. Identifying the Risks of Anticoagulation in Patients with Substance Abuse. October 2013.

Medline Plus. Taking warfarin (Coumadin).

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