Coumadin and Fruit

Is there any fruit that one must stay away from while on Coumadin? I'm not really wanting much to eat right now, but fruit and some of the fruit shakes are sounding good.

I know this is probably a dumb question, but I'm learning.

I've never had an issue with fruit, or any other foods for that matter. There are conflicting reports about cranberries and grapefruit. The key is to eat a diet that you enjoy and test regularly. Don't binge on anything, unless you plan to do it everyday.

Cranberries have been cleared, but grapefruit juice may present a problem. I still drink it, but I wait at least 4 hours after taking my Coumadin before I do. I've had no problems. It can be a real big problem for some other meds, so if your on more then Coumadin, post them all.

Grapefruit juice is not good to drink within a few hours of taking any medication from what I've read. It messes with the absorption or some such thing.

lilteach:

Fruit was one of the few foods I enjoyed immediately post-op -- particularly cantaloupe, pineapple and watermelon.
I must have had thrush post-op (white-coated tongue -- yuck!), which kept me from tasting foods normally. I could taste sweet things very well, so I ate a lot of fruit.
Breakfast was usually a bowl of cantaloupe & pineapple.
Almost 6 years later, I still occasionally get a small bowl of cantaloupe & pineapple for breakfast -- and think of my post-op period when enjoying it!

I have never noticed an interaction between fruit & warfarin. I like whole grapefruit, but John doesn't, so I don't buy it. Don't buy grapefruit juice. I love cranberry juice but seldom buy it.
I believe our warfarin guru -- Al Lodwick -- has said that drinking cranberry juice is OK while taking warfarin, just don't drink it in lieu of all other fluids. It's high in calories so I've bought the calorie-reduced versions.

Pomegranite does act as an anti-coagulant. I drink the juice daily and it only effects me if I also eat the fruit. I have had to make a minor adjustment in my dose.

Fruit?

Fruit?

I drink fruit smoothies frequently following exercise and have never had any issues with adverse affects on my INR. I even eat energy bars that are high in Vitiman K while exercising without significant impact on my INR.

Other's experinces with grapefruit juice probably differ from mine, but I've never noticed any adverse affect on my INR. I do take my coumadin late in the evening and on those occasions when I drink grapefruit juice it's a morning thing. The affect of the juice on how I absorb and metabolize my meds is probably moot due to timing circumstances.

I still subscribe to the concept of dosing one's diet rather than attempting to manage INR with diet. This is simply my perspective and others may disagree.

-Philip

Fruit shakes: Banana, strawberry, mango, etc. are all great. Go for it.

Thanks everyone. I am learning and have been so happy because I have had no issues with my levels.

Tonight we went to Luby's cafeteria and I had a small bowl of fruit salad....chopped apples, grapes, bananas, and peaches....it was so good and wonderful for the taste buds....even hubby enjoyed a bowl.

lilteach3234 said:

Thanks everyone. I am learning and have been so happy because I have had no issues with my levels.

Tonight we went to Luby's cafeteria and I had a small bowl of fruit salad....chopped apples, grapes, bananas, and peaches....it was so good and wonderful for the taste buds....even hubby enjoyed a bowl.

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The longer your on this drug, the more comfortable you become and soon, you'll spot BS stories and myths 10 miles out and start laughing uncontrollably at how stupid they are.

I have a warning not to eat grapefruit on my Lipitor bottle

Old clicker said:

I have a warning not to eat grapefruit on my Lipitor bottle

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Ditto on my warfarin bottles. But that's okay, I don't like the stuff anyways Talk about pucker power eeeish.

lilteach3234 said:

Thanks everyone. I am learning and have been so happy because I have had no issues with my levels.

Tonight we went to Luby's cafeteria and I had a small bowl of fruit salad....chopped apples, grapes, bananas, and peaches....it was so good and wonderful for the taste buds....even hubby enjoyed a bowl.

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Which Luby's in the Houston area?
My cousin lives in Spring. When I've been down there, we've eaten at one off I-45 a little south of 1960.
I love Luby's veggie soup. John swears Luby's cornbread is the best he's ever had.

The labels on my prescriptions have no cranberries on my warfarin and no grapefruit on my simvastatin.

I just looked at the leaflet which is in with my warfarin and it does say that as there in no way of knowing exactly how much was ok, or which brands then it was best to avoid drinking cranberry juices and anyone drinking it for other reasons should speak with their warfarin clinic before stopping or reducing the intake of cranberry juice.

Again, cranberries have been cleared. Perhaps this post will put that case to bed:

Additional evidence has been presented showing the safe use of cranberry products for patients on Coumadin
An article appearing in the Journal of Health-System Pharmacist again evaluated the use of cranberry products and concluded the following:

Reports from the United Kingdom have raised concern over the interaction potential between cranberry juice and warfarin. Warfarin is the most commonly prescribed oral medication for anticoagulation therapy. Cranberry juice is a flavonoid, which has been shown to induce, inhibit, or act as a substrate for the biosynthesis of several cytochrome P-450 (CYP) isoenzymes. Specifically, cranberry juice may inhibit the activity of CYP2C9, the primary isoenzyme involved in the metabolism of S-warfarin. A search of the medical literature identified three peer-reviewed case reports and two peer-reviewed, prospective, randomized, placebo-controlled clinical trials using metabolic surrogates of warfarin (flurbiprofen and cyclosporine) that described possible interactions between cranberry juice and warfarin. Two case reports suggested that cranberry juice increased the International Normalized Ratio (INR) of patients taking warfarin, but neither clearly identified cranberry juice as the sole cause of INR elevation. One case report appeared to show a correlation between the effects of cranberry juice and warfarin metabolism. Both clinical trials indicated the lack of an interaction between cranberry juice and CYP isoenzymes 2C9 and 3A, both of which are necessary in warfarin metabolism. More studies are required to determine the potential interaction between cranberry juice and warfarin (Coumadin ®).

The available data do not seem to show a clinically relevant interaction between cranberry juice and warfarin; however, patients taking warfarin with cranberry juice should be cautioned about the potential interaction and monitored closely for INR changes and signs and symptoms of bleeding.
American Journal of Health-System Pharmacy, Vol. 64, Issue 5, 490-494

Researchers at Tufts University researched cranberry extensively last year and gave cranberry the all clear to be used with patients taking warfarin.

The 2007 Anticoagulation Forum’s national meeting focused an educational seminar on dietary interactive products - including cranberries. Ann Wittkowsky, Clinical Professor [University of Washington School of Pharmacy, Seattle, Washington] led the discussion clearing the safe use of cranberry products, under normal consumption. Dr. Wittkowsky referenced a well designed, double cross-over study (Journal American Dietary Association 2006: 106-2057-61). The study conclusion re-affirmed no interactions were detected and cranberry products do not need to be avoided provided consumption was routine.

Another article: http://warfarinfo.com/cranberry.htm

Ross,

I know that you're right, but unfortunately the danged prescription leaflets list it as a possibly "dangerous interaction". What to do...

KristyW said:

Ross,

I know that you're right, but unfortunately the danged prescription leaflets list it as a possibly "dangerous interaction". What to do...

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Kristy:
When it says POSSIBLY "dangerous interaction," I wouldn't stay up all night worrying about it.
That' s a case of CYA, in the manufacturer's eyes.

Marsha,

I agree with you, and I'd say all the "veterans" here agree with us, but it's the newbies that this really affects. This CYA thing (read insurance and lawyers) is making everyone's life miserable. Pharmaceutical companies must list things that have been cleared of wrongdoing or were at least shown to be benign because someone drank 1/2 gallon of cranberry juice per day for a month (I'm exaggerating) and then something happened to her INR. She wasn't getting regular tests and then had some sort of episode, and it is blamed on the cranberry juice rather than the patient not being educated or compliant. It's frustrating...our doctors and pharmacists should be educating us, but they have so many drugs that there's no way they can remember all these things. So they tell us to make sure we read the "Information" on the prescription and it lists things that may happen, but only to a minute fraction of the population who take this drug and then maybe not to anyone but there may possibly be potential to harm.

We do our best here to inform, but at the same time it can pit a patient against their Dr or pharmacist. "My friends on the internet told me that...etc., etc." and then the Dr. says "I'm the professional...I know better than they do." Now the patient is up in arms over what to do. They want to trust their Dr., but someone's right and someone's wrong, and it's tough to tell your Dr. he's wrong when he's in charge of your more difficult healthcare.

Sorry for the rant.

KristyW said:

Marsha,

I agree with you, and I'd say all the "veterans" here agree with us, but it's the newbies that this really affects. This CYA thing (read insurance and lawyers) is making everyone's life miserable. Pharmaceutical companies must list things that have been cleared of wrongdoing or were at least shown to be benign because someone drank 1/2 gallon of cranberry juice per day for a month (I'm exaggerating) and then something happened to her INR. She wasn't getting regular tests and then had some sort of episode, and it is blamed on the cranberry juice rather than the patient not being educated or compliant. It's frustrating...our doctors and pharmacists should be educating us, but they have so many drugs that there's no way they can remember all these things. So they tell us to make sure we read the "Information" on the prescription and it lists things that may happen, but only to a minute fraction of the population who take this drug and then maybe not to anyone but there may possibly be potential to harm.

We do our best here to inform, but at the same time it can pit a patient against their Dr or pharmacist. "My friends on the internet told me that...etc., etc." and then the Dr. says "I'm the professional...I know better than they do." Now the patient is up in arms over what to do. They want to trust their Dr., but someone's right and someone's wrong, and it's tough to tell your Dr. he's wrong when he's in charge of your more difficult healthcare.

Sorry for the rant.

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Hon I'm still fighting my hospital dietitian over the matter. She simply will not believe it even printed and put in her face.

Ross said:

Hon I'm still fighting my hospital dietitian over the matter. She simply will not believe it even printed and put in her face.

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I know Ross....I know. You just want to strangle someone.