Coumadin sodium is a compound that thins the blood and was originally used as rat poison. Coumadin treatment reduces the risk of thrombosis (blood clots), but makes patients more liable to bleeding, sometimes with serious consequences. Coumadin is effective at reducing the risk of stroke in atrial fibrillation. In the U.S., warfarin is sold under the trade name Coumadin.
Natural Supplements,
vitamins, herbs and Coumadin, diet restriction
Certain supplements have blood thinning potential and should be
used with caution by those who are on blood thinning medication such as
Coumadin. These natural supplements include, in alphabetical order:
Bee pollen
Am J Health Syst Pharm. 2010. Probable interaction between Coumadin and bee
pollen. Consumption of bee pollen led to increased INR values in a patient
taking Coumadin.
Chamomile is a
mild relaxation agent and has very mild blood thinning activity.
CoQ10 supplement has been associated with an increased risk of bleeding
with the use of Coumadin medication.
Cranberry juice, sauce or cranberry
supplements thin the blood and increase INR levels in patients who are
taking Coumadin medication.
Dong quai is a
Chinese herbal supplement which has natural coumarin derivatives. Dong quai increases the effect of
Coumadin, increasing the risk of bleeding; therefore, co-administration
of dong quai and Coumadin is contraindicated.
EGCG, the extract from
green tea, may prevent platelet aggregation as potently as aspirin.
Fish oils thin the
blood and their risk in combination with Coumadin depends on the dose of
the fish oils and the dose of Coumadin. Krill oil also also has
long-chained omega-3 fatty acids DHA and EPA and should be used with
caution. Those who take fish oil pills may need to reduce their dose of
prescription anti-coagulants since it is possible that the INR can
increase with supplementation.
Cayenne supplement may increase the risk of bleeding with the use of Coumadin medication.
Garlic is a blood thinner. So are onions.
Ginger may increase bleeding risk in those who are taking Coumadin pills
Ginkgo biloba is an
herb used for mental alertness that has some blood thinning potential.
Bleeding episodes in patients taking Ginkgo biloba
and Coumadin have been documented. Therefore, in vitro and in vivo inhibition
studies were done to ascertain the influence of ginkgo on CYP2C9, the P-450
isozyme responsible for the metabolism of the most potent Coumadin enantiomer,
(S)-Coumadin. Ginkgo extract inhibited human liver microsomal CYP2C9. Two
open-label, crossover pharmacokinetic studies in healthy subjects were performed
using tolbutamide and diclofenac as probe CYP2C9 substrates. In contrast to the
in vitro inhibition of CYP2C9, no interactions between Ginkgo biloba extract and
CYP2C9 probe substrates were observed in vivo as evidenced by the lack of effect
on the steady-state pharmacokinetics of diclofenac or on the urinary metabolic
ratio of tolbutamide.
Indole3Carbinol is a potent anti-thrombotic agent with
anti-platelet activity.
Nattokinase is a potent blood thinner compared to other natural herbs and
supplements. Always consult with your doctor before taking nattokinase
blood thinner, particularly if you are taking Coumadin.
Onion has blood thinning potential
St Johns Wort herb may increase the risk for bleeding when used together with
Coumadin medication.
White willow bark supplement.
Nat Prod Commun. 2014. Warfarin interactions with medicinal herbs. Potential herb-drug interactions are of a major safety concern, especially for drugs with narrow therapeutic indices like Coumadin, which can lead to severe adverse reactions that are sometimes life-threatening. The interactions between Coumadin and medicinal herbs described in the literature have been summarized in this paper relying on Medline database (via PubMed) using the key words: Coumadin, herbal supplements and interactions. The references on the analyzed literature have been investigated in order to collect the existing data. The case reports with severe adverse effects such as spontaneous postoperative bleeding, formation of hematomas, hematemesis, melena, thrombosis, subarachnoid hemorrhage and/or subdural hematomas after concomitant use of warfarin and the medicinal herbs: Panax ginseng, Hypericum perforatum, Salvia milthiorizza, Gingko biloba, Serenoa repens, Angelica sinensis, Vaccinium species, Allium sativum, Zingiber officinale, Tanacetum parthenium, Lucium barbarum, Matricaria chamomilla, Boswellia serrata and Camellia sinensis have been estimated. Some of the interactions between Coumadin and medicinal herbs have been well assessed proving that they are closely-dependent. The interactions between Coumadin and medicinal herbs, not generally reported in previous reviews, are presented in our review.
Q. My father is taking Coumadin due to heart problems and
blood clots in his two legs. He also has gout. I have tried to research natural
herbs to help him with his gout. Could you please let me know if certain herbs
will interact with this blood thinner. He is taking tumeric rootyucca stalk
extract banaba leaf extract acai fruit extract bicarbonate of soda milk thistle
seed celery seed extract artichoke leaf extract.
A. It is difficult to give specific recommendations since thorough
research is not available on these herbs and their interactions.
Q. My husband is on Coumadin. Would vinpocetine
interfere with this?
A. Vinpocetine may have mild blood thinning potential, so it is
difficult to know what the interaction would be. It may be a good idea to avoid
vinpocetine with Coumadin until studies are done.
Q. Are there any contraindications for alpha lipoic acid
being taken with Coumadin? I have DVT and have been on Coumadin for 3 months and
wish to resume taking alpha lipoic acid.
A. We have not come across such interaction between Coumadin and lipoic at this time, but we are not aware of any testing that has
been done with these two together.
Coumadin
bleeding risk
Risk factors significantly associated with increased bleeding included
high target INR (2.5 to 3.5), diarrhea, acetaminophen use, alcohol
consumption, and increased age.
Coumadin side effects,
danger
Hemorrhage (bleeding) is one of the most
common and serious risk associated with coumadin therapy. The bleeding can
occur in practically any tissue or organ. The signs, symptoms and severity
of the bleeding and subsequent complicationsl vary according to the
location and degree of bleeding. Haemorrhagic complications may present as
headache, hypotension, chest, abdomen and muscle pain, red blood in stools
or black stool. Other side effects of coumadin therapy are necrosis of the
skin or skin rashes, priapism, headache, and dark urine.
Osteoporosis
The long-term use of Coumadin appears to
increase the risk of fractures associated with osteoporosis, a
bone-thinning condition that usually increased with age. Coumadin prevents coagulation by blocking
vitamin K,
which is needed to activate certain clotting factors. Because vitamin K is also
used to activate proteins involved in bone formation, drugs like coumadin may
increase the risk of fractures.
To investigate, Dr. Brian F. Gage, from Washington University School of Medicine
in St. Louis, and colleagues assessed the rate of osteoporotic fractures among
12,048 Medicare beneficiaries. The subjects included 4,461 who had been
prescribed Coumadin for at least one year and 7,587 who were not on the drug.
Coumadin users were 25 percent more likely to experience a fracture than
nonusers. However, this relationship was statistically
significant only in men.
Further analysis of data from 1,833 patients who were on Coumadin for less than
one year did not detect a statistically significant increase in fracture risk.
Risk factors for fracture included older age, high risk of falling, overactive
thyroid, neurological or psychiatric disorders, and alcoholism, the report
notes. When prescribing Coumadin to elderly patients at high risk of falling,
healthcare providers can instruct them to wear stable shoes, exercise
regularly, have adequate intake of calcium and vitamin D, use walking
aids, and discontinue unnecessary medications.
Archives of Internal Medicine, 2006.
Coumadin diet interaction, restricitons
The effect of coumadin decreases after initiation of a high-protein,
low-carbohydrate diet.
Coumadin alcohol interaction
It's quite likely that alcohol interferes with its metabolism and
effect. Hence, it is preferable to avoid drinking more than one glass of alcohol
a day. Wine has compounds called flavonoids that thin the blood.
Coumadin drug interaction
Non-selective non-steroidal anti-inflammatory drugs (nNSAIDs) used in
combination with Coumadin are associated with an approximately 3-fold increased
risk of upper gastrointestinal bleeding compared with Coumadin alone.
Questions
Q. Can you tell me if there are any contraindications between Passion Rx
and Coumadin (warfarin)?
A. We have not tested blood coagulation parameters with
Passion Rx so we don't know if the herbs influence blood thinning or coagulation
or have no effect. Most of the time coumadin or warfarin is taken by those who
have a heart condition or atrial fibrillation, and we do not suggest people with
a heart condition take Passion Rx or most of the sex herbs since they have a
tendency to speed heart rate.
Q. i have ordered Prostate Power Rx
caps, can you tell me if the herbs in it interfere with Coumadin / warfirin ?
A. So many factors are involved including the
dose of your Coumadin, how you absorb and process herbs, your overall health
condition, your liver function, etc. We suggest your doctor review the
information on the ingredients in Prostate Power Rx and come to a decision,
perhaps using only one capsule a day.
Q. My husband is interested in taking Inno-Vite
Sytrinol to lower
cholesterol, do you know of any interaction of Sytrinol with any medications,
including Coumadin?
A. This is so difficult to say since I have not seen
studies testing Coumadin in combination with Sytrinol. Plus, much may depend on
dosages and each person's unique absorption and metabolizing processes.
Q. I'm a journalist and read your newsletters which I
really like. Can you tell me if there are natural supplements that can take the
place of coumadin?
A. Many supplements and herbs have blood thinning
potential, but since I am not aware of head to head comparisons between herbs
and Coumadin, and since blood thinning for A Fib or stroke prevention is quite a
serious thing, it is difficult to make any definitive recommendations.
Nattokinase appears to be one of the most potent natural blood thinners.
Q. I have been taking Coumadin for three years. I've
been told that I have an unspecified blood disorder. This diagnosis came after
many test by hematologist and after 3 different episode with DVTs. Is there a
safe, long term natural supplement that I can take as an alternative to Coumadin.
I am otherwise a healthy 47 year old male.
A. Coumadin is a potent blood thinner and we are not aware of any
supplements that are as potent as Coumadin. It is possible that a combination of
several supplements may thin the blood enough to reduce the need for Coumadin or
lower the Coumadin dose requirements, but this is a complicated area and medical
supervision is required since if the supplements fail, a recurrence of deep vein
thrombosis is of major concern.
Q. I am a 74 year old woman interested in natural
supplements that can possibly prevent me from increasing my coumadin dosage and
hopefully allow me to lower the dosage. My doctor has told me that I need to
increase my
pro-time though I am already taking Coumadin 5mg 4 times/week and 2.5mg
3times/week. I have a mechanical heart valve, and have had two bypasses. I eat
very healthfully and currently Coumadin is the only prescription I need. I am
concerned about increasing the Coumadin because of side effects, such as
bleeding and liver area pain, and long term side effects. I understand that this
is a challenging physical condition, but I believe you would be more helpful
than any other professional I have encountered. If I maintain a close to nature,
organic diet, and safe supplements with
assistance to determine the best possible choices of foods, is it possible that
I could lower or even discontinue the coumadin if I keep a close watch on my
pro-time levels. In searching for blood thinners and blood purifiers, I have
found suggestions of the following: (Could you please let me know which of these
you could recommend or discourage.) I would be willing to pay a consultation
fee, if you could please let me know what that charge would
be. Vitamin E, Ginko Biloba, Fish Oils, Nattokinase, Chamomile, Bromelain,
Feverfew, Dong Quai, Garlic,
Ginger, Hawthorne, Others: Sardines, EGCG, onion, pineapple, organic fresh
veggie juice, lecithin, tree ear mushrooms, pomegranet juice, alfalfa, barberry,
brigham tea, chapparral, chlorophyll, dandelion, hyssop, licorice, myrrh, red
clover, sarsaparilla, taheebo, yellow doc, lobelia, burdock, blue cohosh, black
cohosh, couch grass, comfrey, spikenard, strawberry, yucca, yarrow, buckthorn,
cascara sagrada, oregon grape, peach, prickly ash, stillingia. Could you please
let me know if you see patients or if you can give me a referral to someone, a
physician or health care provider, who could help me with natural treatments and
diet? I live in the Brenham Texas area,
halfway between Austin and Houston, TX.
A. We understand fully your concern regarding potential Coumadin
side effects and the urge to find natural solutions. However, Dr. Sahelian does
not take new patients and we don't keep a doctor referral system. Most herbs and
vegetables have blood thinning potential, so does aspirin. We really can't give
any individual advice but can only give general research information on natural
products that help with blood flow as listed above. It is possible that using
these natural supplements may lower the required Coumadin dose, but we can't be
more specific since we can't take over the role of your doctor.
Q. I am a heart patient and have a mechanical aortic
valve replacement. I am currently taking Coumadin to control my Pro Time INR.
Please tell me if their is a problem or conflict by using an andrographis
product with a Coumadin product.
A. We have no research regarding the concurrent use of Coumadin and
andrographis or practically any herb, so we don't know.
Q. My doctor wants to put me on Coumadin to prevent
blood clots, because I have being having episodes of atrial fibrillation. But I
would prefer to go on Wobenzym N, my doctor wants any clinical studies, research
results or scientific information or hard evidence on it. Can you please tell me
where I would be able to find this information or how I can obtain it.
A. See the link for
Wobenzym.
The cardiologist of a friend is keeping her Coumadin
level at 1.2 in the wake of a serious episode of atrial fibrillation as a result
of which she underwent an ablation operation a few months ago. It has been
recommended that she add krill oil to her regimem for keeping herself in good
health now. Is it safe to begin taking krill oil? I have been calling the
various companies who produce a form of this fish oil and the answer so far is
start with one pill but no information specifically about how much of a thinning
effect there is. Can you please tell me a little more about how these substances
interact.
Krill oil has EPA and DHA, fatty acids that do thin the blood.
Caution is advised when combining blood thinners with supplements that thin the
blood. Your friend's cardiologist is the person who needs to make the final
decision regarding the appropriateness of combining Coumadin with fish oil or
krill oil supplements.
My 86 year old aunt has been taking 6 mg of Coumadin for about a year to keep her INR in the correct range (2-3). Last month, her eye began to bleed; she has neovascular glaucoma. She is having a laser treatment for this in a few days. The eye surgeon told her she is either going to lose her eye or have a stroke. In other words, without the Coumadin, a stroke, but with the Coumadin, there will be more intraocular bleeding.
Can nattokinase substitute for Coumadin as a blood thinner?
Nattokinase and Coumadin work in different ways.
Coumadin is a drug with serious positive and negative effects, and hence
changes in your treatment plan should not be done unless you discuss with your
doctor. It is not clear to me how potent nattokinase is compared to the blood
thinning drug.
I'm trying to find out if Hibiscus tea will affect the
Coumadin that a person is on who has 2 factors for having blood clots they are
prothrombin and Lupus anticoagulant.
I have not seen studies regarding the role of hibiscus herb
in interacting with Coumadin.
is it safe to take one of the following if you are
taking this prescription blood thinner: Shilajit, Cabergoline [Dostinex], and
Passion Power for men.
Such studies have not been done so it is not easy to predict.
Any new additions as far as supplements should be done in low dosages and
gradually and one at a time with medical approval.
Is ingesting quercetin contraindicated for Cumodin
patients?
I am not aware of such studies with qurcetin but it is possible it
could have mild blood thinning potential.