NSAIDs: the one everybody gets wrong
Ibuprofen, naproxen, diclofenac, celecoxib and aspirin at anti-inflammatory doses inhibit the prostaglandin signalling that PRP and cell therapies rely on to trigger repair. Laboratory work shows NSAIDs impair platelet activation and may reduce MSC proliferation and differentiation. Most protocols stop NSAIDs 7 to 14 days before injection and for 2 to 6 weeks after. Acetaminophen (paracetamol) is the accepted alternative for pain during the window.
Patients often do not think of aspirin or over-the-counter combination cold products as NSAIDs. Read labels.
Anticoagulants and antiplatelets
Warfarin, apixaban, rivaroxaban, dabigatran, clopidogrel and prescription aspirin are not stopped casually; the risk of stopping (stroke, clot) can outweigh the risk of a bruise at an injection site. The clinic should coordinate with your prescribing physician. For a joint or soft tissue injection, many protocols proceed without interruption, with careful technique; for a bone marrow harvest from the pelvis, a short, physician-directed hold or bridging plan may be used. Tell the clinic before you book, not on the day.
Corticosteroids
Oral prednisone and recent steroid injections suppress the inflammatory phase that biologics are trying to harness and may reduce cell viability at the injection site. Most clinics want at least 4 to 6 weeks since the last steroid injection into the target joint; see steroid washout timing. Long-term oral steroid users need an individualized plan and should not stop abruptly.
Other medications that get flagged
| Medication | Concern | Typical handling |
|---|---|---|
| Fluoroquinolone antibiotics (ciprofloxacin, levofloxacin) | Tendon toxicity; avoid around tendon injections | Avoid for 4 weeks before and after tendon procedures |
| Statins | Theoretical effects on muscle and tendon | Usually continued |
| Bisphosphonates | Bone turnover | Continued; noted for bone-related injections |
| Immunosuppressants (methotrexate, biologics) | Infection risk and cell function | Coordinate with rheumatologist; often continued |
| Metformin | May influence MSC behavior in lab studies | Continued |
| Smoking, nicotine | Vasoconstriction, impaired healing | Stop 2 weeks before and 4 weeks after at minimum |
Supplements
Fish oil, vitamin E, ginkgo, garlic and high-dose turmeric have mild antiplatelet effects and are usually paused 7 days before. Our separate piece on supplements and stem cells covers the longer list. Alcohol is limited for several days before and after.
What to send the clinic before you travel
- Complete medication list with doses, including over-the-counter drugs and supplements
- Date of your last steroid injection into the target joint
- Any anticoagulant and the prescribing physician's contact
- Recent blood work if you have one; many clinics want a basic panel and, for allogeneic products, infectious disease screening
A clinic that does not ask for this list is not running a serious protocol. See how to prepare.
Regulatory status: FDA vs INVIMA
United States (FDA): No stem cell product is FDA-approved for orthopedic, neurologic, or systemic use. Minimally manipulated same-day autologous procedures are marketed under a narrow exemption; culture-expanded cells and most umbilical products are unapproved biologics and the FDA's authority over them was reaffirmed in federal court in 2024. Florida's 2025 law permits certain treatments under state rules but does not create FDA approval.
Colombia (INVIMA): Cell therapies are regulated as advanced-therapy products. Clinics require INVIMA habilitation for the facility and, for laboratory-processed products, product-level authorization or an approved research protocol. Ask to see the INVIMA registration number and verify the treating physician on ReTHUS. "INVIMA registered" for the clinic is not the same as an authorized product.
Frequently asked questions
Can I take ibuprofen after a stem cell injection?
Most protocols say no for 2 to 6 weeks. Use acetaminophen and ice instead.
Do I have to stop blood thinners for a joint injection?
Often no, with careful technique. Never stop an anticoagulant without your prescribing doctor's direction; the clinic should coordinate.
How long after a cortisone shot can I have PRP or stem cells?
Most clinics want at least 4 to 6 weeks; some prefer 3 months for the same joint.
On medications and planning an injection abroad?
Send us your list. We will make sure the clinic reviews it before you buy a flight, not after you land.
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