coumadin question

[lemons]

I know several here have been on it. What foods do you need to avoid? I can only remember cherries, mango, and grapefruit... but think there were others.

He's already being consistent with vitamin k, but there are some fruits that can spike the INR.

Thanks!

[pugz]

Leafy greens i believe? womet knows

[lemons]

Greens are under control and consistent. We learned the hard way that some fruits will make the INR jump high...like 11.3, when it should be 2.

[mlt]

Spinach, kale, dark leafy greens. I wanted to eat those so I just made sure I ate the same amount every day. Which was harder than I expected.

[Deleted]

You want to keep your greens consistent. This includes spinach, collards, Brussels sprouts, broccoli, etc.

It's a misconception that you want to avoid these types of foods. If you were previously eating a lot and then all of the sudden stop when you start coumadin then this can mess with your INR levels.

[aurora]

It's been 10 years since I was on it but the only fruit I remember is grapefruit. Keeping leafy greens consistent was the biggie. My dr also said to avoid alcohol but I don't think that was related to INR levels.

[womet]

Yup, I was on coumadin for 7 months after my pulmonary emboli. The thing to keep in mind is that everyone reacts differently. The general advice is to keep you intake of Vit K consistent from day to day. However, that doesn't always work. For me, I couldn't keep my INR within therapeutic range even when I was eating nearly the same thing each day. So my doctor told me to cut out greens as much as possbile while I was on coumadin. That worked for me, but might not be something that you need to do. 

I used this guide to help me figure out Vit K levels on foods. It was so helpful. I had a copy on the fridge and a copy in my purse. Let me know you have any other questions. 

[Pibs]

Tropical fruits can all elevate INR -- pineapple, papaya, mango, pomegranate, cranberries, grapefruit; any of those in juice form. Also guava. I've had two patients in to see me in the past month that have had high INRs and they'd both been drinking guava juice. We couldn't find reputable documentation about a drug-food interaction, but it seems that it may exist. Guava juice is often mixed with other tropical juices, too, so maybe that's why they were high.

[Pibs]

Sept 27, 2014 11:52:44 GMT -5 aurora said:

It's been 10 years since I was on it but the only fruit I remember is grapefruit. Keeping leafy greens consistent was the biggie. My dr also said to avoid alcohol but I don't think that was related to INR levels.

Alcohol is super interesting.  In people who never drink, or binge it shoots INRs through the roof.  In people who drink chronically or excessively it can decrease INR, or not really have an effect.  And there isn't a well known reason for this.

[lemons]

Sept 27, 2014 12:30:40 GMT -5 Pibs said:

Tropical fruits can all elevate INR -- pineapple, papaya, mango, pomegranate, cranberries, grapefruit; any of those in juice form. Also guava. I've had two patients in to see me in the past month that have had high INRs and they'd both been drinking guava juice. We couldn't find reputable documentation about a drug-food interaction, but it seems that it may exist. Guava juice is often mixed with other tropical juices, too, so maybe that's why they were high.

This is what I was having trouble finding via Google. Is it just juices and dried fruits?

We usually pick wild cranberries in the fall for baked goods like muffins and scones. Will this impact his INR? What about canned cranberries cooked over turkey breast in the crockpot? That's also a fall favorite. :-)

[CloudBee]

Grapefruit was always a big no-no, for me.

[Pibs]

Sept 27, 2014 19:35:27 GMT -5 lemons said:

Sept 27, 2014 12:30:40 GMT -5 Pibs said:

Tropical fruits can all elevate INR -- pineapple, papaya, mango, pomegranate, cranberries, grapefruit; any of those in juice form. Also guava. I've had two patients in to see me in the past month that have had high INRs and they'd both been drinking guava juice. We couldn't find reputable documentation about a drug-food interaction, but it seems that it may exist. Guava juice is often mixed with other tropical juices, too, so maybe that's why they were high.

This is what I was having trouble finding via Google. Is it just juices and dried fruits?

We usually pick wild cranberries in the fall for baked goods like muffins and scones. Will this impact his INR? What about canned cranberries cooked over turkey breast in the crockpot? That's also a fall favorite. :-)

Yeah, a lot of interactions aren't documented well and they're more just things that we learn as we see it happen in people over and over again.  It would include fresh fruit, as well as dried, cooked, and the juice.  I think juices are the easiest for people to go overboard on because it seems so concentrated compared to what you'd get in the actual fruit.

Cranberries can increase INR -- same as for the canned and cooked over turkey breast.  Apparently it's not unusual for INRs to spike the week after Thanksgiving, just like they've been doing now that football season has started.    That said, I saw someone last week who drinks cranberry juice every day and has been within goal for months and months.  If you want to do the wild cranberries (because that sounds amazing!) in muffins or over turkey, just have an idea of how much he's eaten and let whomever is managing his warfarin know.  It might be that he doesn't eat enough to have a real effect on his INR.  Or, it could go up, in which case you know and can either decrease the amount he's eating or adjust the warfarin dose a bit. 

Remember warfarin is kind of a big picture drug, depending on the setting the person is in.  If they're not in the hospital, we tend to look at things over the course of the week - the total dose of warfarin, the amount of greens that have been eaten, etc.  Changing things up one day may not have a significant effect, but the same change made every day for a week may.  I don't ever want my patients to miss out on something they love to have, just like I don't want them to force themselves to eat greens every single day when they hate them -- I'd rather see them back a little bit more often and get their warfarin adjusted so they can live the lifestyle they want.

[thebulldog]

Sept 27, 2014 12:18:17 GMT -5 womet said:

Yup, I was on coumadin for 7 months after my pulmonary emboli. The thing to keep in mind is that everyone reacts differently. The general advice is to keep you intake of Vit K consistent from day to day. However, that doesn't always work. For me, I couldn't keep my INR within therapeutic range even when I was eating nearly the same thing each day. So my doctor told me to cut out greens as much as possbile while I was on coumadin. That worked for me, but might not be something that you need to do. 

I used this guide to help me figure out Vit K levels on foods. It was so helpful. I had a copy on the fridge and a copy in my purse. Let me know you have any other questions. 

Hey...i had pulmonary emboli too...
Was it Bc related?

i be typing from me phone. typos and grammer dont count.

[aurora]

Sept 28, 2014 8:35:11 GMT -5 thebulldog said:

Sept 27, 2014 12:18:17 GMT -5 womet said:

Yup, I was on coumadin for 7 months after my pulmonary emboli. The thing to keep in mind is that everyone reacts differently. The general advice is to keep you intake of Vit K consistent from day to day. However, that doesn't always work. For me, I couldn't keep my INR within therapeutic range even when I was eating nearly the same thing each day. So my doctor told me to cut out greens as much as possbile while I was on coumadin. That worked for me, but might not be something that you need to do. 

I used this guide to help me figure out Vit K levels on foods. It was so helpful. I had a copy on the fridge and a copy in my purse. Let me know you have any other questions. 

Hey...i had pulmonary emboli too...
Was it Bc related?

i be typing from me phone. typos and grammer dont count.

I can't speak for womet, but mine was. Or at least we think it was, since I had no other risk factors.

[rbp]

Wow--I am on Coumadin now, and no one told me about any of this but grapefruit (this actually interacts with LOTS of drugs) and the leafy greens! Well, the NP I saw said to keep my alcohol consumption consistent, haha. I have one drink maybe 5x/week and haven't had a problem. But now I know to avoid tropical fruits!

[Pibs]

Sept 28, 2014 9:34:33 GMT -5 rbp said:

Wow--I am on Coumadin now, and no one told me about any of this but grapefruit (this actually interacts with LOTS of drugs) and the leafy greens! Well, the NP I saw said to keep my alcohol consumption consistent, haha. I have one drink maybe 5x/week and haven't had a problem. But now I know to avoid tropical fruits!

You don't have to avoid if you normally have them.  Just don't binge and eat one of those bags of dried mangoes from Costco every day for two weeks without telling your NP.    And if they're a rare thing in your diet otherwise, keep it in moderation and remember that you ate it just in case you're high.

Other interesting things that have Vitamin K in them that people don't think about:  V8 juice (it's not green, but think about the ingredients), avocado, Boost & Ensure type drinks, and some chewable calcium supplements, like Viactiv. 

[womet]

Sept 28, 2014 8:35:11 GMT -5 thebulldog said:

Sept 27, 2014 12:18:17 GMT -5 womet said:

Yup, I was on coumadin for 7 months after my pulmonary emboli. The thing to keep in mind is that everyone reacts differently. The general advice is to keep you intake of Vit K consistent from day to day. However, that doesn't always work. For me, I couldn't keep my INR within therapeutic range even when I was eating nearly the same thing each day. So my doctor told me to cut out greens as much as possbile while I was on coumadin. That worked for me, but might not be something that you need to do. 

I used this guide to help me figure out Vit K levels on foods. It was so helpful. I had a copy on the fridge and a copy in my purse. Let me know you have any other questions. 

Hey...i had pulmonary emboli too...
Was it Bc related?

i be typing from me phone. typos and grammer dont count.

No. I haven't been on BC for nearly a decade now. And I had been in the hospital just before that for my gastroparesis. I had a feeding tube put in and was not moving around much. Even though I was on blood thinners, I wound up in the ED with the PEs 4 days after being discharged. Based on all of the tests run, my PEs were probably just a random fluke. 

[lemons]

When I talked to his clinic today, I asked about cranberries and he said please don't. I asked about muffins or scones with cranberries and he sighed and said well, preference is no, but I can't stop you. I said ok I will avoid all things cranberry this fall/winter. He said thank you!!!

So no cranberry picking for us this fall :-)

[drloretta]

Broccoli has always been a no-no for my dad

[ladyk]

Weed

Seriously, it will raise your INR. Don't ask me how I know. *whistles*

I'm on Coumadin for the rest of my life (or some other thinner) due to recurrent DVTs. This most recent evolution I've been on it almost 5 years.

Other things with Vitamin K or interact with Coumadin (at least how it affects me-ask your doc): broccoli, Multi-V Bolthouse juice (It's so freaking tasty though!), protein powders, brussel sprouts, green tea (i was drinking a lot before) (vitamin K), pepto and salon pas or other arthritis patches (both have aspirin in them), day/nyquil (lowers my INR), higher doses of vitamin E, valerian, Gabba, CoQ10, CLA, L-Carnitine, arnica and a few other supplements and herbs that I've researched. My NP is very good about me asking about random items and telling me yes/no/maybe.

If you're looking for a multi vitamin, prenatals are the only ones I've found without any added Vitamin K. If you're looking for a good anti inflammatory alternative, 4oz of tart cherry juice a day has done wonders for me and it's not affected my INR.

[julygal]

Most the PPs covered it, but fish oil can also affect INR. If it is taken consistently, it shouldn't be a problem. However, changing the dose or even the brand can affect INR.