Which tea won't affect my INR?

[Warfarinking]

hello, I recently ordered http://www.amazon.com/gp/product/B003D4IYSU/ref=oh_details_o00_s00_i00?ie=UTF8&psc=1 which is Chamomile Nights and it's a herbal type of tea. I heard green tea affects INR, but I'm not sure if the one I ordered does or does not. Could anyone explain to me which teas usually won't have much of an affect on my INR? I will be drinking this everyday so it's something I really feel like I should know so I can adjust my diet. Thank you.:biggrin2:

 

[pellicle]

Hi

I had never heard of Tea effecting it, so I googled it (of course I'm a relative newbie to warfarin anticoagulation). What I found leads me to ask: how much are you intending to drink?

please note the quantity involved (I underlined it)

http://www.ncbi.nlm.nih.gov/pubmed/10332534

Abstract
OBJECTIVE:
To report a case of the inhibition of the effect of warfarin by green tea.
CASE SUMMARY:
A 44-year-old white man was receiving warfarin for thromboembolic prophylaxis secondary to a St. Jude mechanical valve replacement in the aortic position. The patient had an international normalized ratio (INR) of 3.20 approximately one month prior to entering our clinic, and an INR of 3.79 on entering our clinic. Twenty-two days later his INR was 1.37. One month later the patient's INR was 1.14. It was subsequently discovered that the patient began drinking one-half to one gallon of green tea per day about one week prior to the INR of 1.37. On discontinuation of the green tea, the patient's INR increased to 2.55.
DISCUSSION:
Warfarin produces anticoagulation by inhibiting production of the vitamin K-dependent clotting factors (i.e., factors II, VII, IX, X). The exogenous administration of vitamin K inhibits the effect of warfarin and reduces a patient's degree of anticoagulation. Green tea can be a significant source of vitamin K and thus antagonize the effect of warfarin.
CONCLUSIONS:
Warfarin is a highly effective oral anticoagulant, but it requires close monitoring to prevent complications. Patients receiving warfarin need to be routinely questioned about their intake of vitamin K-containing foods and beverages.
PMID: 10332534 [PubMed - indexed for MEDLINE]

From what I know, I'd be more cautious about grapefruit juice than tea. Grapefruit contains a compound which inhibits a body enzyme which effects "bioavailablity" of drugs (how much of what you put into your mouth gets into your blood)

http://en.wikipedia.org/wiki/CYP3A4#Inhibition_through_grapefruit_ingestion

Inhibition through grapefruit ingestion

In 1998, various researchers showed that grapefruit juice, and grapefruit in general, is a potent inhibitor of CYP3A4, which can affect the metabolism of a variety of drugs, increasing their bioavailability.[12][13][14][15][16] In some cases, this can lead to a fatal interaction with drugs like astemizole or terfenadine.[13] The effect of grapefruit juice with regard to drug absorption was originally discovered in 1989. The first published report on grapefruit drug interactions was in 1991 in the Lancet entitled "Interactions of Citrus Juices with Felodipine and Nifedipine" and was the first reported food-drug interaction clinically. However, the effect became well-publicized after being responsible for a number of deaths due to overdosing on medication.[17

 

[Freddie]

According to the DrugDigest website:

CHAMOMILE (in Chamomile) may interact with WARFARIN SODIUM (in Warfarin Tablets)

Anticoagulants, such as warfarin, are taken to reduce the risk of blood clots. Roman chamomile has not been associated with problems, but chemicals in German chamomile also may decrease blood clotting. When German chamomile is taken together with warfarin, the risk of excessive, possibly dangerous, bleeding may increase. Individuals who take warfarin should not take German chamomile. If both are taken, more frequent blood tests may be needed to make sure that blood is clotting properly. Those who experience problems may need to stop taking German chamomile until after warfarin is discontinued. Discuss this potential interaction with your healthcare provider at your next appointment, or sooner if you think you are having problems.

This interaction is well-documented and is considered moderate in severity.

According to the "LIVESTRONG" web sit and the Cleveland Clinic:

Ginger and Other Herbal Teas

Other herbal teas also affect warfarin in your body. Ginger tea, for example, may magnify warfarin's effects, raising your risk for bleeding and bruising, according to "The Essential Herb-Drug-Vitamin Interaction Guide," by George T. Grossberg and Barry Fox. Your blood clotting time, known as the international normalized ratio, or INR, is used to monitor warfarin's effectiveness. Numerous herbal teas can cause your INR to be too high or too low, according to the Cleveland Clinic. Do not consume chamomile, sweet clover, sweet woodruff or tonka bean tea when you take warfarin because these affect your INR. Other herbs that are sometimes used in tea and affect INR include echinacea, fenugreek, ginseng, passion flower and red clover. Consult your doctor before trying any herbal tea.

Do check with your doctor first. Chances are that your okay to have 2 or 3 cups a day, just don't have a couple of gallons everyday.

 

[pellicle]

I forgot to ask ... do you self test?

 

[Warfarinking]

What I got from all this is to avoid german chamomile, don't drink a gallon of tea a day and i'll be okay! And no, I don't self test. I test once a month with my INR DR.

Thank you everyone for the great input.

 

[pellicle]

Thank you everyone for the great input.

and the research question was fun too ... so thanks to you too

 

[Protimenow]

As a person who once thought that, once your INR was stable, and your diet and activities were consistent, frequent testing wasn't necessary, I now feel that weekly testing is SAFER than just testing monthly. An INR test -- any INR test -- is a snapshot of what your INR is at the time that you test. Doing a test monthly doesn't give you any idea what your INR was a week, or two weeks, or three weeks before the testing. If you start something like green tea - or anything else that may influence your INR - and don't do anything to detect whether or not there are changes in your INR - relying only on monthly testing -- you could be putting yourself at risk of something really bad.

Personally, I suggest that you get a meter -- there are some that are fairly affordable on eBay (and I have some that I may even be interested in parting with), and you can also get fresh strips on eBay and from other retailers. Ultimately, you are responsible for your own life, and I am no longer comfortable with believing that a once a month snapshot of my INR is really providing an adequate picture.

There was a time when the process of testing was kind of a bother -- you had to go to a lab, park your car (or take public transit to the lab), wait for a lab tech to take your blood, make the trek back home, and wait - perhaps a day or two - to get your results. It was probably fairly expensive. For many people, it was a pain that should be put off as much as possible. With the availability of meters for self-testing, this has gone away. An INR test could be as close as your kitchen, or living room, or bathroom, or wherever you are comfortable running the test. Once the meter is paid for, the test usually costs less than $6 or $7 unless you waste a strip, and you know right away what your approximate INR is. Other than financial concerns, and the fact that some people aren't candidates for self-testing, I see little reason why a person can't test weekly and have a better track of INR than a once monthly snapshot.

If you change meds (add an antibiotic or over the counter pill), or change diet, or do other things that you are concerned might raise or lower your INR, confirmation may be as close as your personal meter. I strongly suggest that you consider self-testing.

 

[Cooker]

Eat and drink what you want when you want ... dose the diet ... I have been on the same dose for seven years and have always been in rage ... the key is consistency and moderation ... don't let warfarin run your life ... :thumbup:

 

[tom in MO]

Please note the product you are taking is not "green tea."

The product description specifically states "Stash Premium Chamomile Nights Herbal Tea is soothing and relaxing as its name implies, this flowery, delicate chamomile blend has a minty-lemony taste. Enjoy a cup before bedtime as a relaxing caffeine-free nightcap. Herbal teas contain no true tea leaves, but are created from an international collection of herbs and spices such as Moroccan rosebuds, Oregon mint, tropical hibiscus, cinnamon from Indonesia, and more." The product ingredients are "Chamomile; Spearmint; Lotus Leaves; Lotus Flower."

The above warning for chamomile may be pertinent.

My cardiologist and the pharmacist/instructor at the hospital said to avoid herbal teas w/o first contacting my warfarin prescriber. Regular teas and coffee were OK, just the herbal ones. The pharmacist said that the major problem with herbal teas is the pharmacological activity of many is unknown, not that they are specifically a problem. However, per Freddie, there is a warfarin warning on one of your tea's ingredients.

 

[Warfarinking]

As a person who once thought that, once your INR was stable, and your diet and activities were consistent, frequent testing wasn't necessary, I now feel that weekly testing is SAFER than just testing monthly. An INR test -- any INR test -- is a snapshot of what your INR is at the time that you test. Doing a test monthly doesn't give you any idea what your INR was a week, or two weeks, or three weeks before the testing. If you start something like green tea - or anything else that may influence your INR - and don't do anything to detect whether or not there are changes in your INR - relying only on monthly testing -- you could be putting yourself at risk of something really bad.

Personally, I suggest that you get a meter -- there are some that are fairly affordable on eBay (and I have some that I may even be interested in parting with), and you can also get fresh strips on eBay and from other retailers. Ultimately, you are responsible for your own life, and I am no longer comfortable with believing that a once a month snapshot of my INR is really providing an adequate picture.

There was a time when the process of testing was kind of a bother -- you had to go to a lab, park your car (or take public transit to the lab), wait for a lab tech to take your blood, make the trek back home, and wait - perhaps a day or two - to get your results. It was probably fairly expensive. For many people, it was a pain that should be put off as much as possible. With the availability of meters for self-testing, this has gone away. An INR test could be as close as your kitchen, or living room, or bathroom, or wherever you are comfortable running the test. Once the meter is paid for, the test usually costs less than $6 or $7 unless you waste a strip, and you know right away what your approximate INR is. Other than financial concerns, and the fact that some people aren't candidates for self-testing, I see little reason why a person can't test weekly and have a better track of INR than a once monthly snapshot.

If you change meds (add an antibiotic or over the counter pill), or change diet, or do other things that you are concerned might raise or lower your INR, confirmation may be as close as your personal meter. I strongly suggest that you consider self-testing.

I agree with what you said, but I have an INR doctor that tells me on what to do/when to to test. If it was up to me I would go every week but she said she can't let me do that because I've been stable for so long. I always thought I needed some expensive machine to self-test at home, I know nothing about strips; care to share some light on how I can get them/from where/how much they go for?

 

[sue943]

I am not sure if it was on here or another site but I remember a woman posting to say that she had huge problems with bruising (I think) which were attributed to Chamomile oil that she had been bathing in for the past week, a gift to her. She was told by a doctor that Chamomile should be avoided when on warfarin.

I just Googled and came up with the following...

"Chamomile and Warfarin a potentially dangerous mix

Doctors in Canada have warned that people taking warfarin to prevent blood clots should stay away from products containing Chamomile. In the article provided by Reuters UK the doctors go on to state the case of a 70 year old woman taking warfarin who developed severe internal bleeding after applying chamomile lotion and drinking chamomile tea.

Although known to react with garlic, onion and ginger this is the first documented case of a reaction with chamomile.

Louise Pilote from McGill University health Centre in Montreal advised patients "to make their Doctors and pharmacists aware of what prescribed and herbal products they consume so that potentially harmful interactions can be identified."


Source : Reuters UK
Date : 4/05/2006"

Another says...

"Chamomile

The herb chamomile contains substances in the coumarin family. Some coumarins have blood thinning actions that could interact with warfarin. One case report exists of a person in which it appears that combined use of chamomile and warfarin led to internal bleeding."


I would suggest you do some Googling before you start drinking Chamomile tea.

 

[Freddie]

Sue943, you have an excellent memory. The member you are referring to is Zipper2.

Warfarinking, you best check with your doctor.

 

[Protimenow]

It certainly doesn't hurt to have your own meter, and to do testing if you're concerned with any changes that you may be making--and make these changes slowly, just in case the chamomile (or whatever) actually DOES have an effect on your INR.

If you DO have an issue, you can, of course, check with your MD (if you have one). Starting slowly with any product that MAY have an effect on your INR is certainly the best approach.

(It's not always pointed out, but warfarin/coumadin is derived from Red Clover (or, at least, it was at one time), so leafy plants that may have some similarity to the clovers could, conceivably, also be sources of Coumarins)

 

[sharon]

Hi Warfarinking,
This April will be 17 years since I had my AVR surgery. Green tea has never been a problem for me. I read that only if you eat the tea leaves themselves will there be any problem.
Sharon
St. Judes AV 4/97

 

[Cur1769]

hello, I recently ordered http://www.amazon.com/gp/product/B003D4IYSU/ref=oh_details_o00_s00_i00?ie=UTF8&psc=1 which is Chamomile Nights and it's a herbal type of tea. I heard green tea affects INR, but I'm not sure if the one I ordered does or does not. Could anyone explain to me which teas usually won't have much of an affect on my INR? I will be drinking this everyday so it's something I really feel like I should know so I can adjust my diet. Thank you.:biggrin2:

Green tea and highly caffeinated things effect your INR. If it is something you are drinking every day your warafin clinic should be able to account for it and adjust you dose.

 

[almost_hectic]

Green tea does nothing to my INR even if I drink a gallon of it

 

[user 15848]

We all metabolize this thing in different ways, i drink 4 espressos a day and nothing happens to INR, have a cup of tea, it goes down, no big deal, just take more warfa, just wanted to say that different things act on different ways on different people, nothing new, just a thought

 

[Mister_James]

Just came across this old thread.

We all focus on vitamin K and warfarin and we forget that clotting is affected by other things as well.
The main ingredient in Aspirin is also found in ginger. They do affect platelet aggregation and therefore will affect clotting time.
Anything in moderation is fine.

 

[Amy]

Green tea affects my INR. I read about a woman who was sensitive to black tea, on Warfarin. It is something I consider if my INR is a bit high - did I forget to drink my green tea this week? - and usually that’s the case. (Note: I drink really strong jasmine tea without ever removing the tea leaves from the mug - yum)

Now the two glasses of gluhwein I had for Christmas (over the course of two days) that caused a jump to 4.3? That was more surprising and a bigger difference than I ever notice with the green tea. Think I’ll have to be satisfied with just a sip next year. I know people say ‘eat what you like’ but for some people, doing that is just asking for extra unnecessary complications.

 

[KLS39]

My cardiologist said it was okay for me to have chamomile tea and I found one with no other ingredients. I have it every night so if it was affecting my INR we would have corrected my dose a long time ago.