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Question:
I am taking the drug coumadin (Warfarin®) and have been told to avoid green leafy vegetables and to stop taking Ginkgo and vitamin E. Should I follow these instructions?
Answer:
Since coumadin works by interfering with vitamin K’s role in promoting blood clots and since green leafy vegetables and green teas contain high levels of vitamin K, you should avoid increasing your intake of these foods while taking coumadin. You can eat the same levels you’re accustomed to—just don’t increase your consumption. The key is consistency: Eat approximately the same sized serving of green leafy vegetables every day. Your physician can determine the specific dose of coumadin according to results of a blood test known as the International Normalized Ratio (INR).
You may need to adjust your use of other natural remedies if you take coumadin. Here are some guidelines:
- Coenzyme Q10 and St. John’s wort (Hypericum perforatum) may reduce coumadin’s efficacy, while proteolytic enzymes and several herbs, including panax ginseng, devil’s claw (Harpagophytum procumbens), and dong quai (Angelica sinensis), can increase its effects. It’s likely that you can continue using these products, but don’t change the dosage from what your body is accustomed to. INR values must be monitored appropriately.
- Garlic (Allium sativum) and ginkgo (Ginkgo biloba) extracts may reduce the ability of platelets to stick together, increasing the likelihood of bleeding. However, neither appears to interact directly with coumadin. I generally tell patients taking coumadin to avoid these products at higher dosages (more than the equivalent of one clove of garlic per day for garlic or more than 120 mg per day of ginkgo extract) but not to worry if they are using these products at the lower dosage level.
- Iron, magnesium, and zinc may bind with coumadin, potentially decreasing its absorption and activity. Take coumadin and iron/magnesium/zinc-containing products at least two hours apart.
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