Living with von Willebrand disease (VWD) presents unique challenges, especially when it comes to managing bleeding risks. This genetic disorder affects the blood’s ability to clot properly, so even minor injuries can be a cause for concern. One important aspect of managing von Willebrand disease involves being aware of medications that can make bleeding symptoms worse.

It’s essential to talk openly with your health care team and pharmacist about any medications or supplements you’re taking or considering. Certain drugs can interfere with blood clotting, increasing the risk of severe bleeding. Sometimes even common medications can be risky. One MyHemophiliaTeam member asked, “I have elbow pain constantly. Can I take ibuprofen?”

Read on to learn about nine types of medications that people living with VWD should avoid.

1. Anticoagulants

Anticoagulants thin the blood to prevent clots but can make bleeding worse in people living with VWD. Examples of these drugs include:

• Warfarin (Coumadin, Jantoven)
• Heparin
• Rivaroxaban (Xarelto)
• Apixaban (Eliquis)
• Dabigatran (Pradaxa)

These medications may be prescribed to people who are at high risk of heart attack or stroke, among other health conditions.

Warfarin, for example, reduces the body’s ability to produce vitamin K-dependent clotting factors, making it harder for blood to clot. Heparin, rivaroxaban, apixaban, and dabigatran also interfere with clotting and increase the risk of severe bleeding. This is particularly dangerous for people with VWD, because their blood already has difficulty clotting properly. Regular monitoring and dosage adjustments are often required for those who need anticoagulants.

2. Nonsteroidal Anti-Inflammatory Drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for all sorts of reasons, from minor headaches to more serious pain. NSAIDs can be bought over the counter (OTC) or prescribed by a doctor. Examples include aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve).

NSAIDs can interfere with platelets, small blood cells that are important for clotting. These drugs block the cyclooxygenase enzymes (COX-1 and COX-2), which help produce thromboxane. This substance helps platelets stick together to form clots, so inhibiting it increases bleeding risk in people with VWD. Aspirin is especially problematic because it has a long-lasting effect on platelets.

Alternatives like acetaminophen (Tylenol) are often recommended for pain relief in people with VWD.

3. Selective Serotonin Reuptake Inhibitors

Selective serotonin reuptake inhibitors (SSRIs) are often prescribed for depression and anxiety. These medications are commonly referred to as antidepressants. Examples include the following:

• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Paroxetine (Paxil)
• Vortioxetine (Trintellix)

SSRIs are believed to reduce platelets’ amount of serotonin, a hormone that helps them stick together and form clots. Because of this action, SSRIs can make you more likely to bleed, particularly in the gastrointestinal tract. If you have VWD, you might be able to take these medications, but your doctor will monitor you for any unusual bleeding or bruising.

4. Vitamin E

People often use vitamin E to support healthier hair, skin, and nails, but high doses can interfere with clotting and increase the risk of bleeding. Vitamin E can stop platelets from sticking together to form clots, making bleeding last longer. Vitamin E is found in many OTC supplements and should be used with caution. Be sure to tell your health care provider about any supplements you take so that you can avoid potential interactions.

5. Herbal Supplements

Many herbal supplements have blood-thinning properties. For instance, garlic and ginkgo biloba keep platelets from clumping, while ginger and turmeric can interfere with how the body stops bleeding. These effects can make the tendency to bleed even worse in people with VWD.

Many other supplements also increase the risk of bleeding, and some can interact with prescription medications. Always check with your doctor or pharmacist before you try a new nutritional or herbal supplement.

6. Antiplatelet Drugs

Antiplatelet drugs are often prescribed after a heart attack or some types of surgery, such as placement of a stent to open arteries. These drugs prevent platelets from clumping and forming clots. Examples include:

• Clopidogrel (Plavix)
• Ticagrelor (Brilinta)
• Prasugrel (Effient)

Although these drugs help reduce the risk of heart attack and stroke, they can significantly increase bleeding risk in people with VWD. If you’re taking antiplatelet drugs, you should be closely monitored and may need to have regular blood tests to keep you safe.

7. Certain Antibiotics

Some antibiotics can affect platelets or interact with other medications to increase bleeding risk. A few of the main offenders among antibiotics include penicillin, amoxicillin, ciprofloxacin, and sulfamethoxazole-trimethoprim (Bactrim).

For example, sulfamethoxazole-trimethoprim can disrupt platelet function and slow the process of clotting. Other antibiotics keep gut bacteria from producing vitamin K, a nutrient that’s necessary for development of clotting factors.

You should inform your doctor about your VWD diagnosis before starting any antibiotic treatment. The bleeding risks associated with antibiotics differ from person to person.

8. Chemotherapy Drugs

Some chemotherapy agents, such as methotrexate and cyclophosphamide, can reduce the number of platelets in the blood, making it more difficult for blood to clot. People undergoing chemotherapy should work closely with their oncology team (cancer care providers) to manage any bleeding risks.

9. Desmopressin Acetate

Desmopressin acetate (DDAVP) is used to treat mild to moderate VWD by stimulating the release of von Willebrand factor (VWF) from blood vessel walls. However, DDAVP isn’t suitable for all people with VWD, especially those with type 2 VWD. In people with this subtype, VWF causes platelets to be removed from the bloodstream too quickly, so DDAVP can decrease platelet count. If your doctor considers you a good candidate for DDAVP, they’ll monitor you regularly to be sure it’s used safely.

Key Tips for Managing von Willebrand Disease

Navigating VWD can be difficult enough without having to worry about medication interactions. Here are some key tips to keep in mind:

• Check with your doctor before starting any new medication or supplement to ensure it won’t interfere with your condition or treatment. Always make sure your health care team is aware of your VWD diagnosis.
• Watch carefully for any signs of increased bleeding, such as unusual bruising, prolonged bleeding from cuts, or blood in your urine or stool. Report these symptoms to your doctor immediately.
• Check OTC medications for hidden NSAIDs or blood thinners. Commonly used cold and allergy medications may contain ingredients that can increase bleeding risk.
• Maintain an updated list of all your medications and supplements, including dosages, and share it with all your health care providers. This helps prevent potential drug interactions and keeps you safe.
• Consider wearing a medical ID bracelet or carrying a card that indicates you have VWD. This provides critical information in an emergency situation and alerts medical personnel to your condition if you’re unable to communicate.
• Keep updated on new treatments and medications that may affect your condition. Join support groups or associations related to VWD to stay connected with others who understand your experiences and can share information.

Be Open With Your Doctors

If you’re living with VWD, it’s essential that all your health care providers are aware of your condition. This is particularly important before any surgical procedures, including dental work, because planning ahead can significantly reduce bleeding risks.

Additionally, when picking up prescription or OTC medications, always inform your pharmacist about your VWD diagnosis. Keeping an open line of communication can help your doctors tailor your treatment plan to best manage your condition and avoid complications and potential drug interactions.

Talk With Others Who Understand

MyHemophiliaTeam is the social network for people with hemophilia and their loved ones. On MyHemophiliaTeam, more than 6,600 members come together to ask questions, give advice, and share their stories with others who understand life with von Willebrand disease.

Are you living with von Willebrand disease? Do you avoid taking certain medications? Share your experience in the comments below, or start a conversation by posting on your Activities page.