Blood Thinners
Ardeparin (Normiflo)
Dalteparin Sodium (Fragmin)
Enoxaparin (Lovenox)
Warfarin (Coumadin)
HeparinSodium (Heparin)
Nutritional Considerations:
Avoid Coenzyme Q10 since it chemically resembles vitamin K and may interfere with the effectiveness of warfarin treatment. (Harris 1995) (Landbo 1998) (Spigset 1994)
Absorption and activity of Warfarin may be decreased by iron, magnesium, and zinc (Holt 1999). Use of these minerals should be spaced at least two hours apart from the use of anticoagulants.
Patients taking anticoagulant therapy (Warfarin) should consult with their physicians before using chondroitin sulfate. (Chavez 1997)
Avoid over 60 gms (2 ozs) of onions which can increase fibrinolytic activity. (Pronsky 1999)
Avoid excess garlic ,ginger and avocado due to their blood thinning properties. (Pronsky 1999)
Also, be cautious with over 5 gms (5,000 mg) of vitamin C which may reduce warfarin absorption. (Pronsky 1999)
Vitamin K levels are important to the activity of blood thinners. The more vitamin K that is present, the greater the chances of clotting. Since the purpose of the above-mentioned drugs is to lower clotting, foods high in vitamin K such as spinach, cauliflower, brussel sprouts, and egg yolk should be limited or used with caution. Blood levels should be checked routinely. (Harris 1995) (Weibert 1997)
Avoid high dosages of vitamin A or over 400 IU/day of vitamin E. (Pronsky 1999)
Herbal Considerations:
Celery seed, chamomile, cloves, garlic, fenugreek, feverfew, gingko biloba, ginseng, ginger, licorice, papain, and lovage may contribute to blood thinning and should not be used with blood thinners. (Gadkari 1991) (Kleijnen 1992) (Newall 1996)
Do not take papaya with warfarin. An interaction between these has been reported. (Shaw 1997)
Coumadin absorption may be affected by daily use of the following herbs: catnip, comfrey, hops, mullein, peppermint, or slippery elm. (Harris 1995) (Janetzky 1997) (Tatro 1993) (Tyler 1993)
References:
Chavez, M: Glucosamine sulfate and chondroitin sulfates. Hospital Pharmacy, 1997, 52(9): 1,275-1,285.
Gadkari JV, Joshi VD. Effect of ingestion of raw garlic on serum cholesterol level, clotting time and fibrinolytic activity in normal subjects. J Postgrad Med 1991;37:128-31.
Harris JE. Interaction of dietary factors with oral anticoagulants: Review and applications. J Am Dietet Assoc 1995;95:580-84 [review].
Holt GA. Food & Drug Interactions. Chicago: Precept Press,1998, 94.
Janetzky K, Morreale AP. Probable interaction between warfarin and ginseng. Am J Health-Syst Pharm 1997;54:692-93.
Kleijnen J, Knipschild P. Ginkgo biloba. Lancet 1992;340:1136-39.
Landbo C & Almdal TP [Interaction between warfarin and coenzyme Q10.] Ugeskr Laeger, 1998 May, 160:22, 3226-7.
Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health-care Professionals. London: The Pharmaceutical Press, 1996
Pronsky, Zaneta. Food Medication Interactions, 11th edition, 1999.
Shaw, D et al., Traditional remedies and food supplements: a 5-year toxicological study (1991-1995). Drug. Safety 1997, Nov; 17(5):342-356.
Spigset O. Reduced effect of warfarin caused by ubidecarenone. Lancet 1994;344:1372-73 [letter].
Tatro D, ed. Anticoagulants-quinine derivatives. In Drug Interaction Facts. St. Louis, MO: Facts and Comparisons, Jul 1993.
Tyler, V.E.: The Honest Herbal. Haworth, Binghampton, NY, 1993.
Weibert RT, Le DT, Kayser SR, et al. Correction of excessive anticoagulation with low-dose oral vitamin K1. Ann Intern Med 1997;125:959-62.
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