Multivitamin and Coumadin

[Stuart]

I had my mitral valve replaced three months ago with a St. Jude mechanical, and I'm on Coumadin. I've managed to get my INR balanced with weekly testing while staying away from most of the high vit-K foods.

I have been taking multiple vitamin supplements for many years prior to my surgery, and I wanted to know if it is wise to continue, considering the interaction of several of the vitamins and herbs with Coumadin. I have read many of the posts regarding this subject, including Al Lodwick's page. I understand that as long as one keeps his vitamin intake constant, the Coumadin dose can be adjusted to keep the INR in range. However, there are herbs (and possibly vitamins) which increase anti-coagulation by reducing platelet aggregation but do not affect the INR of a PT test, such as Ginko Biloba.

I have a large supply of the Rite-Aid multiple vitamin "Whole Source". The amounts of the vitamins it contains which can possibly conflict with Coumadin are:

Vit. K 80 mcg
Vit. E 60 IU
Vit D 400 IU
Vit C 120 mg
Vit A 7500 IU
Ginkgo Biloba 25 mg

Is it worth restarting this vitamin?

 

[Karlynn]

The Vit. K and the Gingko will effect Coumadin and lower your INR.

However, the key is not in not eating anything with Vit. K or taking anything that will lower your INR, but to do it consistantly and don't suddenly stop taking or eating those things that lower it.

If you have been taking those vitamins since your replacement, don't stop them. Or if you want to stop them, do it gradually and test weekly.

If you love greed salads, or spinach, or avacados etc, eat them, just do it consistantly, not just every now and then. I'll have a salad a couple of times a week. The times when my INR is a too high, I'll treat myself to a nice spinach salad.

Ross' favorite saying is "Dose the diet, don't diet the dose." Eat what you want and adjust your Coumadin accordingly. Just be consistant.

 

[Karlynn]

I should also mention that many of us like to keep our INR on the higher end of the range (with mitral, more towards 3.5), so that we have a little wiggle room for things we like to eat occasionally, that may lower the INR.

 

[Guest]

If you do restart the vitamin, you will need to get your INR checked every week until you get it in range for two weeks in a row. 80 mcg of vitamin K daily is enough to have a large effect on your warfarin dose.

 

[Stuart]

I should also mention that many of us like to keep our INR on the higher end of the range (with mitral, more towards 3.5), so that we have a little wiggle room for things we like to eat occasionally, that may lower the INR.

That's a good idea Karlynn. I miss eating lettuce in my salads, so I'll just use it as an INR reducer when it gets too high.

 

[geebee]

That's a good idea Karlynn. I miss eating lettuce in my salads, so I'll just use it as an INR reducer when it gets too high.

Gosh, Stuart, I hope this doesn't mean you don't eat lettuce when you want to???

You can have lettuce (and spinach and the like) every day if you want them. You just need to adjust your coumadin if your INR changes. Please don't deny yourself wonderful salads worrying about INR. That's why they have testing and dosage adjustments.

Usually when most of us talk about eating spinach salads to reduce an INR, we are talking about ADDITIONAL to what we already eat consistently. I eat salads at least 3 times a week and sometimes more. Again, the trick is not to alter your eating habits too much without being mindful of possible INR changes.

 

[Karlynn]

So many physicians scare the heck out of you when you start Coumadin by saying "don't eat this, stay away from that". As I said previously, the key is consistancy. Don't eat salads daily for 2 weeks, test, then not eat any salads for another 2 weeks.

Increasing exercise lowers your INR, but it would be silly for us not to exercise because we don't want to lower our INR. Exercise, test regularly and adjust Coumadin accordingly.

I've been on Coumdin for over 13 years and I can say I really don't think too much about what I eat or drink and how it effects my Coumadin, unless I'm making an intentional change in my diet.

My mother-in-law was just recently on Coumadin after a hip replacement. We had them over for dinner and she passed up the salad and a glass of wine, both of which I know she loves. She said that her Coumadin clinic told her not to eat green vegetables or salads and not to drink alcohol while she's on the Coumadin. I nearly blew a gasket. I told her to eat and drink what she darned-well pleased and to let them adjust her Coumadin dose accordingly. Even though she knows I've taken Coumadin for a long time, she deferred to her clinics instructions. But then again, this was the same clinic that drew her INR on a Thursday and didn't phone in the dosage adjustment to the pharmacy for almost a week.

 

[danielgilboa]

Hi Stuart,

Welcome, you seems to be new in the neigborhood, although 3 month old "valver".

I also have a st Jude mitral mechanical valve. After I got my INR stable around the 3-3.5, I re started my regular multi vit that has 25mcg of vit K. I did need to make a slight adjustment to my dose.

The thing is that once you are stable with your vitamins, they become as important to take as the coumadine. I ran out of vitamins and skipped 3-4 days to find my INR hit 5.1.

I join the above on keeping the INR at the high end (3.5 for me), so I feel free to eat green stuff. The pay off is more bruising and hematomas.

 

[McCln]

The best multi-vitamin, with no vitmain k at all. Be sure to read the label of any multi-vitamin you take. With the vitiamin k, it increases the inr. So read the label carefully. Good luck.

 

[Guest]

Vit K decreases the INR so the earfarin dose has to be increased

 

[Stuart]

Thanks for all of your advice.

Now that I've gotten balanced with a low vitamin K diet, I'll start eating the greens I like and see how much I need to increase the rat poison dose. I've also just stopped taking Amiodarone, and I know that this requires more Coumadin when this drug is stopped. I'll hold off on the vitamins for now.

 

[Guest]

The amiodarone can take as long as six months to wear off. You may not need to adjust the dose until 2006 if you just stopped it.