Warfarin problems with goji juice ? - boards.ie
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30-04-2009, 00:20   #1
Belfast
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Warfarin problems with goji juice ?

Is this true ?

MEDICAL ALERT!! WARNING!! POSSIBLE FATAL DRUG INTERACTION!!

"The prescription drug "Warfarin (Coumadin®)," can cause stroke, heart attack, and death, when taken with goji juice, cranberry juice, avocados, spinach, ginseng and fish oil supplements." If you are taking this toxic chemical, called "Warfarin (Coumadin®)," speak with your doctor, BEFORE consuming any berries, fruits, or vegitables.

http://www.gojitrees.com/warfarinwarning.htm
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30-04-2009, 01:59   #2
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In view of this post and information provided on the alternative health website.

Warfarin is easily affected by many drugs through interaction with the P450 isoenzyme system of the liver and can be affected by many drugs, alcohol and alternative therapies whose incipients also are metabolised by this system.

Discuss any alternative therapies with your GP if you are taking any medications.

Discuss any proposed or concerns with your medications when reading articles on the internet.

This article as their bottom line of health warning for drug-drug interaction proposes that Goji juice can replace warfarin as treatment. This selective presentation of evidence neglects/reflects the fact that warfarin acts on the fibrinogen system and aspirin acts on the anti-platelet system of thrombosis.

It also advocates goji berries as a potential replacement for two extremely well studied drugs.

Common sense dictates that this should be discussed with a qualified medical practioner before changing practise.
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30-04-2009, 12:22   #3
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Sorry I should have been more specific in my question.

What I wanted to know was could the fruits and foods mentioned in the article cause problems when using Warfarin if so would the be a warning on Warfarin packaging soon.

I was just wondering would we start seeing warnings on Warfarin not to use Gojo berries while taking Warfarin.

Just as some medication have warnings not use use grapefruit while using them.

For the record I have never be prescribed Warfarin by my doctor or another blood thing medicine or do I use any blood thinning medicine.

I did not think at any doctor or pharmacist would say people should stop using Warfarin or other prescription drugs and use fruit or plant instead.

To the best of my knowledge if a useful medical property was found in a fruit or plant, the active ingredient would be isolated have to go trough test for safety and efficacy. Then be synthesised and made in to a standardised medical formulation and patented.
It then would have to get approval for the regulatory bodies such a the fda etc.
before proceeding to drug trials and eventual if it passed all of the trials it to would be dispensed like any other prescribed medicine.


Is this web site any better?

http://www.drugs.com/mtm/coumadin.html

What should I avoid while taking warfarin?
You should not take acetaminophen (Tylenol), aspirin, or NSAIDs (non-steroidal anti-inflammatory drugs) unless your doctor has told you to. NSAIDs include celecoxib (Celebrex), diclofenac (Voltaren), ibuprofen (Motrin, Advil), indomethacin, naproxen (Aleve, Naprosyn), piroxicam (Feldene), and others.These medicines may affect blood clotting and could cause serious bleeding in your stomach or intestines.

Avoid sudden changes in your diet. Vitamin K decreases the effects of warfarin. Large amounts of vitamin K are found in foods such as liver, broccoli, brussels sprouts, spinach, Swiss chard, coriander, collards, cabbage, and other green leafy vegetables. Do not change the amount of these foods in your diet without first talking to your doctor.

Avoid eating cranberries, drinking cranberry juice, or taking cranberry herbal products.
Avoid drinking alcohol, which can increase some of the side effects of this medication.

Avoid sports or activities that could result in a bruising or bleeding injury. Use extra caution to avoid cuts when brushing your teeth or shaving.

Last edited by Belfast; 30-04-2009 at 16:03.
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30-04-2009, 16:22   #4
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The second site you listed is an evidence based medicine site so it is more balanced and reliable.

Many, many drugs interact with warfarin and can throw the level and bleeding tendency either up or down. This includes certain antibiotics which are commonly prescribed. This is why it is important to always remind your doctor you are on warfarin whenever they prescribe something. Likewise, check with the pharmacist when buying over the counter meds and also let them know first.

If attending a warfarin clinic, they are a great resource and can help guide you further and give you tips. If they know what you are up to then they usually schedule much more frequent tests of the levels - so if concerned about diet change - letting them know ahead is best.

Regarding Goji - there are many drugs possibilities in the natural world - we occasionally use hirudin blood thinners in people who are allergic to heparin - they come from leeches! Research is important regarding things like Goji because the clotting cascade is enormous - the fibrin system has 13 identified factors and there is also the platelets activation and tissue damage cascade. Certain clots need different blood thinners - artery clots like heart attacks are primarily platelets and leg and lung clots are primarly fibrin so optimal treatment is different.

Goji might hold great promise once the active ingredient is refined and thus correct dose can be given every time.

Last edited by DrIndy; 30-04-2009 at 16:25.
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18-06-2009, 00:42   #5
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My mother passed away last October after being diagnosed with ovarian cancer and went through about 17 months of chemo.

She drank cranbery juice fairly regularly even when she was on warfarin. This was both on the time she went to the Limerick Regional Hospital for the chemotherapy and to Milford Hospice where she spent her last month. She was drinking cranberry juice nearly daily in the view of the nurses and the doctors. Not once was she advised to change her habit.

I have not opened the full article on the 'Interaction between warafin and cranberry juice' by Aston el al., 2006, yet and will read it tomorrow when I get to university.

I know Milford Hospice may have some policy of not interfering with patients habits whether they be smoking, drinking alcohol and diet. But surely the specialists given her the chemotherapy and the warfarin what foods and drinks should be reduced or avoided. Saying that I don't thing they gave her any recommendations of a diet that would help her to cope with the chemo.

There has to be changes in health care from one of treatment or care to one of prevention.

Last edited by YFlyer; 18-06-2009 at 00:50.
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18-06-2009, 02:06   #6
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Quote:
Originally Posted by Belfast View Post

What should I avoid while taking warfarin?
You should not take acetaminophen (Tylenol), aspirin, or NSAIDs (non-steroidal anti-inflammatory drugs) unless your doctor has told you to. NSAIDs include celecoxib (Celebrex), diclofenac (Voltaren), ibuprofen (Motrin, Advil), indomethacin, naproxen (Aleve, Naprosyn), piroxicam (Feldene), and others.These medicines may affect blood clotting and could cause serious bleeding in your stomach or intestines.

Avoid sudden changes in your diet. Vitamin K decreases the effects of warfarin. Large amounts of vitamin K are found in foods such as liver, broccoli, brussels sprouts, spinach, Swiss chard, coriander, collards, cabbage, and other green leafy vegetables. Do not change the amount of these foods in your diet without first talking to your doctor.

Avoid eating cranberries, drinking cranberry juice, or taking cranberry herbal products.
Avoid drinking alcohol, which can increase some of the side effects of this medication.

Avoid sports or activities that could result in a bruising or bleeding injury. Use extra caution to avoid cuts when brushing your teeth or shaving.
In practical terms some of this is just not do-able if you're on warfarin for life.

If you haven't eaten anything with vitamin k and then you're handed a dinner with spinnach do you a) refuse it or b) ring your doctor before you eat it ? As far as I'm aware anti-coagulation clinics and their nurses don't want to give massive lists to people to avoid. There's the obvious ones like "tell anyone prescribing you medication or treating you that you're on warfarin", "don't binge drink" and "don't take aspirin".



With regards the opening post "warfarin can cause stroke"... warfarin is used to prevent blood clots which lead to stroke. There are some odd instances in medicine where the line betwee symptoms and side-effects become blurred (anti-depressants for example) but this one sounds a bit mad.

For patients with a fixed INR target range substituting warfarin (which is prescribed in 1,3 and 5 mg) with a fruit can't be reliable surely ?


Edit: I just realised it said taking warfarin and that goji juice

Last edited by Red Sleeping Beauty; 18-06-2009 at 02:30.
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18-06-2009, 10:02   #7
beeno67
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Quote:
Originally Posted by YFlyer View Post

I know Milford Hospice may have some policy of not interfering with patients habits whether they be smoking, drinking alcohol and diet. But surely the specialists given her the chemotherapy and the warfarin what foods and drinks should be reduced or avoided. Saying that I don't thing they gave her any recommendations of a diet that would help her to cope with the chemo.

There has to be changes in health care from one of treatment or care to one of prevention.
In fairness the chances of cranberry juice having a significant effect on warfarin is very small. Add to that the fact that warfarin is monitored regularly, then unless someone went from drinking no cranberry juice to drinking it constantly and stopped getting their INR checked then I think you can ignore the risk.
Personally I would have been much more annoyed if the hospice were doing silly things like telling my dying mother not to drink cranberry juice.
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18-06-2009, 11:22   #8
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Warfarin is a funny drug - people aim for a target blood thinning property, rather than a fixed dose - so the amount needed to achieve the target varies between person to person and also over time - hence it is constantly monitored to ensure it is stable.

So therefore someone whose diet contains a normally large amount of vitamin K will reach an INR equillibrium much higher than someone who is elderly and lives off sausages and bread. Therefore, it is not neccesarily diet per se - but sudden changes in diet which throw everything out of whack - many foods do interfere with warfarin - but if you eat the same amount of those interfering foods all the time and have your INR constantly monitored - you can still achieve safe control.
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17-07-2009, 08:37   #9
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slightly off topic

Hi, I am looking to purchase Goji Juice over the counter in Dublin. My daughter has been doagnosed with HSP, Henoch Schoenlein PuraPura (sp) Goji is recommended on quite a few forums I have googled. If anyone can offer advice i would be grateful.
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17-07-2009, 11:23   #10
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Unfortunately, no advice can be given on that sort of thing on boards.ie.
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