Several types of medications can increase your risk of bleeding or other complications before a cortisone shot, and your provider will likely ask you to pause or adjust them beforehand. Blood thinners are the most common concern, but anti-inflammatory drugs, certain supplements, and even diabetes medications may need attention. Here’s what to know about each category and why it matters.
Blood Thinners and Anticoagulants
Blood-thinning medications are the primary concern before any injection procedure because they increase the risk of bleeding and bruising at the injection site. The Mayo Clinic advises that if you take blood thinners, you may need to stop them for a few days before a cortisone shot.
Common blood thinners that may need to be paused include warfarin, apixaban, rivaroxaban, and dabigatran. That said, the decision isn’t always straightforward. Research on patients receiving warfarin found that joint and soft tissue injections were safe when blood-thinning levels (measured by a test called INR) stayed below 3. Some clinics now allow patients to continue warfarin within the therapeutic range rather than stopping it entirely. Your provider will weigh your clotting risk against the bleeding risk and make a call specific to your situation.
Antiplatelet medications like clopidogrel (Plavix) fall into a gray area. A retrospective study of 275 spinal injection procedures found zero serious bleeding events in patients who continued their antiplatelet or anticoagulant medications. The evidence increasingly suggests the bleeding risk from cortisone shots is low even when these drugs are continued, but many providers still prefer to err on the side of caution, especially for deeper injections.
NSAIDs Like Ibuprofen and Naproxen
Over-the-counter anti-inflammatory drugs, including ibuprofen (Advil, Motrin) and naproxen (Aleve), have a mild blood-thinning effect because they reduce platelet clumping. This means they can contribute to extra bleeding or bruising at the injection site. Some providers ask you to stop taking them three to seven days before the procedure, though the window varies by practice.
Prescription-strength NSAIDs carry additional concerns. They come with dose-related risks to the cardiovascular system, kidneys, and blood, particularly in older adults who are already more likely to need cortisone shots for joint pain. If you’re taking a daily NSAID for arthritis or chronic pain, let your provider know well before your appointment so they can advise whether and when to stop.
Supplements That Affect Bleeding
Dietary supplements are easy to overlook, but several have real blood-thinning effects. The ones with the strongest evidence for increasing bleeding risk, especially in people already on anticoagulants, include:
- Ginkgo biloba and chondroitin-glucosamine: the most convincing evidence links both to bleeding in patients on warfarin
- Turmeric (curcumin): associated with increased anticoagulant effects
- Melatonin, flaxseed, and grape seed extract: shown in human studies to affect platelet activity and blood clotting
- Chamomile, fenugreek, milk thistle, cinnamon, ginger, bilberry, and peppermint: linked to bleeding events in case reports, particularly alongside blood thinners
Interestingly, fish oil, ginseng, and saw palmetto were long thought to increase bleeding risk, but higher-quality studies have not confirmed this. A large trial of nearly 26,000 participants found no excess bleeding risk from fish oil. Still, it’s worth mentioning all your supplements to your provider and letting them decide what to pause. Most clinics recommend stopping any potentially problematic supplement five to seven days before the procedure.
Diabetes Medications
You won’t necessarily need to stop your diabetes medication before a cortisone shot, but you do need to plan for what happens after. Cortisone gets absorbed into the bloodstream even from a local injection, and it reliably spikes blood sugar in people with type 2 diabetes.
In a study tracking continuous glucose levels after shoulder injections, average blood sugar rose from 136 mg/dL before the shot to 159 mg/dL on day one and 154 mg/dL on day two, then returned to baseline by day three. More concerning, 4 out of 25 patients experienced blood sugar spikes above 350 mg/dL in the first two days. None of those patients required a change in their diabetes treatment or emergency care, but the spikes are significant enough that you should be prepared to monitor your levels closely for two to three days after the injection.
If you use insulin, the conversation is even more important. Your provider may adjust your insulin dose for the days following the shot to account for the temporary glucose increase. Bring this up before the procedure, not after.
Immunosuppressants and Biologics
If you take biologic medications for rheumatoid arthritis or other autoimmune conditions, there are infection-related concerns to consider. Cortisone itself suppresses the immune system locally, and adding that effect on top of a systemic immunosuppressant can increase infection risk at the injection site.
For major surgical procedures, the general guideline is to stop biologic medications for a period equal to twice their half-life. Cortisone shots are far less invasive than surgery, so the rules are less rigid, but your rheumatologist and the provider giving the injection should coordinate. Some biologics, like rituximab, deplete immune cells for months, which means the timing conversation needs to happen well in advance.
When an Active Infection Rules Out the Shot
This isn’t about a medication you’re taking, but it’s closely related: if you’re currently fighting an infection, the cortisone shot itself may need to wait. Active skin infection (cellulitis) at or near the injection site is an absolute contraindication because the needle could push bacteria deeper into the tissue. Septic arthritis and bone infections in the area are also firm reasons to postpone.
If you’re on antibiotics for an infection elsewhere in your body, your provider will assess whether it’s safe to proceed. The concern is that cortisone’s immune-suppressing effects could interfere with your body’s ability to clear the infection. In most cases, it’s better to finish the course of antibiotics first.
What to Tell Your Provider Before the Shot
The simplest approach is to bring a complete list of everything you take, prescriptions and supplements alike, to your pre-procedure appointment or consultation. The medications that matter most are blood thinners, NSAIDs, diabetes drugs, immunosuppressants, and any supplement with potential blood-thinning properties. Your provider needs the full picture to set a safe timeline for what to stop, when to stop it, and when to restart. If your procedure is scheduled on short notice, call ahead and ask specifically about medication adjustments so you aren’t scrambling the day before.