Food - Drug Interaction - Warfarin (Coumadin – Marivan)

Food – Drug Interaction - Warfarin (Coumadin – Marivan)

• Dosing of Warfarin (a blood thinner) is based on your dietary intake of vitamin K.
• Vitamin K affects your response to this drug; therefore, do not change your usual intake of food rich in Vitamin K, as in green leafy vegetables (spinach, maloukhia, cabbage, broccoli, avocado, lettuce and green tea), coffee, liver, cheese, green peas, and some oils, and soya oil.
• Avoid nutritional supplement containing high amount of vitamin K during taking warfarin which may reduce the effectiveness of warfarin. Don’t use multivitamins or nutritional supplements without consulting your physician.

General advises for patients on Warfarin

1. Be careful while handling sharp objects, be very careful using knives and scissors, be careful when you trim your toenails.
2. Use a soft toothbrush.
3. Don’t go barefoot.
4. Take medication exactly as prescribed by your doctor at the same time every day.
5. Never take any medication, including over the counter (nonprescription) medications without informing your doctor.
6. Carry a form of identification indicating that you are taking an anti-coagulant.
7. If you miss a warfarin dose, take it within a few hours of your usual time; if you remember the next day, skip it —never double up— then continue your normal schedule.
8. While travelling take an adequate supply of medication.
9. You will need to have your blood tested regularly, because your warfarin dose can change over time. The most common blood test is known as the PT/INR.
10. Avoid activities and sports that might cause serious injuries.
11. Tell your doctor or dentist before any planned procedure or surgery.
12. Intramuscular injection is contraindicated.
13. Make sure your bed sheets and underwear are light-colored.

Contact your doctor right away if you have any signs of unusual bleeding:

• Bleeding that is heavier than usual or takes a long time to stop. This includes nose bleeds, bleeding from your gums, bleeding from cuts & scrapes and heavier than usual menstrual periods.
• Red or dark urine.
• Red or black bowel motions.
• Coughing blood.
• Severe headache or dizziness.
• Pain, swelling or discomfort.

General Instructions For Food Interactions with oral drugs

• Drugs that induce gastrointestinal upset; can be administered with a snack (no need to be a full meal) and with drinking a large amount of water.
• Avoid cola, coffee, citrus fruits (orange, lemon), other acidic foods and beverages.
• All analgesic, anti-inflammatory drugs (Ibuprofen, diclofenac, naproxen, indomethacin, etc.)and all corticosteroids should be administered with a snack or with milk.
• Administration of a drug on an empty stomach means: the drug should be taken ½ -1 hour before meals or 2 hours after meals.
• Avoid co-administration of antacids with other drugs, as they should be administered 2 hours before or after administration of other drugs.
• Adverse effects or even toxicity of a drug may occur if the drug is co-administered with grapefruit; therefore, it is recommended at least 2 hours’ separation in administration times (up to 6 hours after administration of sustained release (SR) formulations).
• Natural licorice increase salt and water retention and increase potassium loss, so it should be avoided with diuretics, corticosteroids, antihypertensive drugs and with drugs that can induce hypokalemia.
• Antihypertensive drugs, antiepileptic drugs, antibiotics, oral hypoglycemic drugs should be administered consistently in relation to time and food as its therapeutic efficacy depends on the maintenance of constant blood level.
• Caffeine intake (cacao, chocolate, Cola, coffee, coffee mate and tea) should be limited in those being treated for arrhythmia, angina and hypertension.