Personal experience with (Gin &) Tonic and impact on INR?

[Guest]

Hi all. I have a question about Tonic Water and your own personal experience of it's impact on your INR.

I know that Quinine interacts with Coumadin (increases INR) and that Tonic Water contains Quinine. So theoretically Tonic Water would increase your INR. However, Tonic Water contains very small amounts of Quinine (83mg/litre).

Have you had any experience with Gin & Tonics affecting your INR?

I'm interested because my INR has just jumped from 3.0 to 4.1. I was actually expecting it to have dropped because my Vitamin K intake had increased slightly and I've been doing more exercise. The only other change I can think of is that I've been having a G&T or two in the evenings...

 

[pellicle]

I like a G&T

I occasionally go through phases where I like tonic in a hot day. Drank a liter in a day a few times, no observable difference.

Never observed any change how many litres are you anticipating drinking?

In the United States, the US Food and Drug Administration (FDA) limits the quinine content in tonic water to 83 ppm[SUP][3][/SUP] (83 mg per liter if calculated by mass), while the daily therapeutic dose of quinine is in the range of 500–1000 mg,[SUP][4][/SUP] and 10 mg/kg every eight hours for effective malaria prevention

​​​​​​So about 10 litres every 8 hours of tonic water may see you in a situation where there may be a quinine interaction.


Self test, and know thyself.

There is a saying, give a man a fish and he eats for a day, teach a man to fish...

Self test and you will become confident; learn to fish

Changes in INR are normal and attempting to identify the specific culprit is like identifying the origin of a fart in a crowded elevator.

I recommend you read my blog post here
http://cjeastwd.blogspot.com/2017/01/2016-inr-data.html
That should give you a feel for the sorts of fluctuations likely

Lastly while 4.5 will make for better bruises it's not a big deal. Do not make a major change to anything, perhaps reduce your daily dose by 1 or 2mg (depending what it is normally) test again next week.

 

[latearrival]

OP here. Thanks for taking the time to reply!

I do self test and have been on warfarin for 5 years. My INR is pretty stable but I can't help trying to work out who farted in that elevator when it suddenly drops or jumps. I took a few mg less the next day and am back on track again.

Going back to the G&T though (intellectual curiosity only now), I'd gone from rarely having one to having two a day for three days. Let's say 1 litre over 3 days. It was the only lifestyle change I could think of.

So about 10 litres every 8 hours of tonic water may see you in a situation where there may be a quinine interaction.

I know about the quinine content and the malaria prevention amount, but how have you arrived at the quantity needed for an interaction with warfarin? I could find no data on this.

 

[RobThatsMe]

Hi LateArrival,
Like you I enjoy a few drinks in the evening, and my INR has always been extremely stable, averaging 2.5 - 2.8, and my dose has almost always been 4 mg/day.
This year, I decided to kick off the New Year with a "Dry-out January", I tested after one week, and my INR had dropped to 1.7. All through the month I continued testing every 3 - 4 days as I brought my INR back into range. My latest dose that seems to be working well is 5 mg on Mon-Weds-Fri, and 4 mg on all other days. This schedule is now keeping me at 2.6.
I have always said and practiced, my rule while on Coumadin which is, "What ever you consume, consume consistently, whether it's food or drink. So, it looks like that rule has some good basis. Now, in Feb, I'll have to go back and test often again as I get back to my regular habits, and INR in February.

Cheers,
Rob

 

[pellicle]

Hi

Going back to the G&T though (intellectual curiosity only now), I'd gone from rarely having one to having two a day for three days. Let's say 1 litre over 3 days. It was the only lifestyle change I could think of.


I know about the quinine content and the malaria prevention amount, but how have you arrived at the quantify needed for an interaction with warfarin? I could find no data on this.

I missed what your variance was and and by how much it jumped and farted as an actual number. I also missed the INR readibg frequency.

As you may observe on my blog sometimes my INR plays ball and sometimes it doesn't. As long as my weekly readings are within the 2~3 range I have found doing nothing to my dose the better option. I have argued many times here (with supporting evidence) that tweaks to your dose can set you up on a seesaw of INR variances.

As to arrival at the dose interaction as well as the fda sure I quoted I assumed that the "may cause interactions" of drug documentation was "usual clinical doses", as it would be the only thing clinicians would be interested.

It is my observation that there is much myth and ******** associated with this and that micro dose of food effecting INR. The same non scientific non rigorous methods are how "old wives tales" about Echinacea tea curing the flu... (for instance)

 

[pellicle]

Jeeze Rob

Theres your problem right there

This year, I decided to kick off the New Year with a "Dry-out January",

Gonna have a glass of red right now!

 

[RobThatsMe]

Jeeze Rob

Theres your problem right there


Gonna have a glass of red right now!

I'll toast to that..., soon, almost the end of the month,,., Hmmmm, I should have picked February, it would have been a few days shorter, LOL!!

Cheers,
Rob

 

[pellicle]

I'll toast to that..., soon, almost the end of the month,,., Hmmmm, I should have picked February, it would have been a few days shorter, LOL!!

on the topic of consistency I've found that I like the idea of consistency to prevent me from becoming a "home drinker" ... so I have one beer and one wine or 2 beers and no wine.

Beer = 500ml can
Wine = 200ml glass

thats most days of the week ... rarely do I drink more sometimes less

I have done an entire month without any and my INR settled back to the same as it was (without chaning the dose significantly)

latearrival here is some data to chew on (if you happen to be interested)
I measure weekly and the X axis is week of year numbers LHS Y axis is INR RHS Y axis is dose

there have been months where (cos I'm a data freak) I have measured twice weekly and in the distant past every 2 days (which I abandoned because it wasn't showing me significantly better information.

 

[latearrival]

Thanks for sharing the charts. Data freak indeed!

I have argued many times here (with supporting evidence) that tweaks to your dose can set you up on a seesaw of INR variances.

Funny you should say that because I experienced this in my first few years when I kept trying to adjust my dose so that I'd hit 3.0, the middle of my target range (2.5-3.5). If I was above or below 3.0, I'd tweak my dose. Looking back, it was a disaster!

Now, I don't touch the dose as long as I'm anywhere in the 2.5-3.5 range. My INR is much more stable.

I still find big jumps for no apparent reason frustrating though and I can't help but go on a 'who farted' quest

For now, I'm going to continue with my occasional G&Ts.

 

[LondonAndy]

Gonna have a glass of red right now!

.... And I fancy a G & T

(And I don't need to worry about the fart question - when my shortness of breath started that resulted in the AVR, I thought it was pollution here in London and I invested in a good quality air filter machine. It claims to remove 99.95% of pollutants, including pollen and viruses, and has a detector that increases fan speed if pollution increases. Even if I fart under the covers, within seconds the fan has sped up to deal with it!)

 

[jwinter]

Not a daily drinker here but I do like a glass of wine or beer. I have only been theraputic for a month but I have told the girls at coumadin clinic when I had a few drinks and it doesn't seem to be a big problem.. I think if anyone is a heavy drinker they should let the doctor or people that help monitor your warfarin know. I have yet to hear anyone get upset about it.

 

[pellicle]

Hi

Thanks for sharing the charts. Data freak indeed!

Welcome
And as Popeye says : "I yam wot I yam"

Now, I don't touch the dose as long as I'm anywhere in the 2.5-3.5 range. My INR is much more stable.

Yep, naturally there seems to be some sort of rhythm going on.

BTW why 2.5~3.5?

I still find big jumps for no apparent reason frustrating though and I can't help but go on a 'who farted' quest

Me too, you may notice a few spikes in there treated with a dose change (and what that change was). In particular that big spike in mid 2015, I attributed to paracetamol as I occasionally have a neck injury flare up.

For now, I'm going to continue with my occasional G&Ts.

I concur, the best way to go is live life and keep one hand on the steering wheel (as opposed to none) . Checking INR regularly and adjusting in a minor way as needed is a minor penalty to pay for freedom and longevity

As long as one is in range all is good, I use the research findings to set my range that I accept. [IMG2=JSON]{"data-align":"none","data-size":"full","src":"https:\/\/c2.staticflickr.com\/4\/3868\/14626794599_442e809525_o.jpg"}[/IMG2]

 

[pellicle]

.... And I fancy a G & T

​Even if I fart under the covers, within seconds the fan has sped up to deal with it!)

I have a friend who would probably be a good tester for that

 

[Agian]

Even if I fart under the covers, within seconds the fan has sped up to deal with it!)

For real? Does this actually happen?

 

[pellicle]

For real? Does this actually happen?

well I have a respirator mask that has activated charcoal filters that is rated to "organic vapors" ... I once had to pick up a festering rotting cane toad that had died while being eaten by a rat under my washing machine (while we were away camping on summer). The Rat had had the good sense to go and die somewhere else the cane toad had had no choice in the matter.

It was so repulsively pungent my wife could not go into the laundry (even I gagged a bit) but with the filters on my face it was undetectable.

so yes

 

[Agian]

The Rat had had the good sense to go and die somewhere else the cane toad had had no choice in the matter.

It was so repulsively pungent my wife could not go into the laundry (even I gagged a bit) but with the filters on my face it was undetectable.

so yes

Why did the rat die?

 

[pellicle]

Why did the rat die?

I only assume it died because it ate the poison glands

 

[LondonAndy]

For real? Does this actually happen?

Yes! When I first read the comment in an Amazon review I thought they were exaggerating. But lo - I soon found it was true. Not always, but sometimes.

 

[pellicle]

Yes! When I first read the comment in an Amazon review I thought they were exaggerating. But lo - I soon found it was true. Not always, but sometimes.

does it depend on how much "greens" you've eaten ... or is it more legumes and beans?

I propose we need a metric for this ... the INR of gas. A documentary on the matter

"None are less visible than those we decide not to see"


Taking Care of Business

 

[LondonAndy]

does it depend on how much "greens" you've eaten ... or is it more legumes and beans?

I propose we need a metric for this ... the INR of gas. A documentary on the matter

It would certainly be useful if we had an antidote for when our Gas INR is out of range! I look forward to seeing your regular measurement charts ....