Coumadin + Cranberry Juice?

Nurses General Nursing

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Specializes in Emergency.

Hey everyone. I just got home from the nursing home where we are doing our clinicals, and I have a quick question. Reading through our pt's chart, I noticed that he is taking Coumadin. Our Instructor told us to research all the drugs our Pt's were on before we go back tomorrow. I was looking on drugs.com, and under Coumadin, it says do not drink cranberry juice, or eat cranberries. Does anyone know why this is? The only reason I am asking is because Cranberry juice is about the only thing my pt. drank today.

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Specializes in med-surg.

check the vit. k content of cranberries and cranberry juice....

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Specializes in Emergency.

Yeah like 2 seconds after I posted this I realized that it might have to do with vitamin k

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Specializes in Urgent Care, Step-Down, and ER.

I don't think there is any concrete evidence of cranberry juice affecting coumadin. There have been numerous studies done. One of the studies show that cranberry juice has some levels of Vitamin K in it which affects couagulation. Another study shows that cranberry juice alters that same enzyme that is responsible for metabolizing coumadin. So it could be possible for having higher amounts of coumadin in blood (increased Anticouagulation) while ingesting large amounts of cranberry juice.

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Specializes in Emergency.

Thanks GQRN, do you think I should worry then if my pt. does drink Cranberry juice? He has a very poor appetite and it seems like the only thing he will drink.

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Specializes in Urgent Care, Step-Down, and ER.

Well, if that was my patient, I would keep an eye on his PT/INR. Let the doctor know that the patient is drinking a lot of cranberry juice. I'm sure they do frequent PT/INR if pt. is admitted in the hospital unless pt. has been on coumadin for a while. Also you want to make sure that pt's kidneys are fully functional and hasn't had any sort of kidney stones if consuming large amounts of cranberry juice.

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Specializes in OB, Telephone Triage, Chart Review/Code.

Should not eat cranberries or drink cranberry juice while taking this medicine. Cranberries may affect the way this medicine works and may increase the risk of side effects.

Foods that have moderate to high amounts of vitamin K include brussel sprouts, kale, green tea, asparagus, avocado, broccoli, cabbage, cauliflower, collard greens, liver, soybean oil, soybeans, certain beans, mustard greens, peas (black-eyed peas, split peas, chick peas), turnip greens, parsley, green onions, spinach, and lettuce.

If the patient is drinking cranberry juice, it may affect his PT/INR. Most patients are told to report any changes in diet or taking new medications (antibiotics) to their doctor.

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Interaction Between Warfarin and Cranberry Juice

http://www.medscape.com/viewarticle/545631

you may have to register before having access to article.

leslie

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I don't agree with the patient not being able to have cranberry juice at all.

From my understanding (both personal and professional) a person does not need to decrease their diet of Vitamin K in their diet, just keep it consistant (ie., if you rarely eat's salads, don't gorge on 2 a day for a week).

Ask your patient if he normally has cranberry juice at home (and amounts if you can).

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I don't agree with the patient not being able to have cranberry juice at all.

From my understanding (both personal and professional) a person does not need to decrease their diet of Vitamin K in their diet, just keep it consistant (ie., if you rarely eat's salads, don't gorge on 2 a day for a week).

Ask your patient if he normally has cranberry juice at home (and amounts if you can).

yup, that......the dose of coumadin will be moderated to the diet....

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Specializes in SNF.

I agree....that the patient should still be able to have the cranberry juice. The benefits of cranberry juice....keeping UTI's at bay, are huge. INR's are drawn regularly just for this reason....d/t diet. In fact the MD may have ordered daily cranberry juice.

It would be interesting to go into the chart to research if the patient has a hx of UTI's and put on the cranberry juice prophylactically.

Teresa

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Specializes in ER, ICU, Education.

One quick question -- what is the content of the actual fruit in the drink? So many juices are actually fruit drinks with hardly any actual fruit in them. Especially the inexpensive drinks - it's just water, flavoring, and chemicals I can't pronounce....

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