Download Patient`s instructions Patient`s instructions Warfarin/Coumadin

Patient’s instructions
Warfarin/Coumadin™
What it is?
Warfarin/Coumadin™ is a blood thinner. It helps prevent clots from forming in your
blood vessels and heart.
How to take your blood thinner?
• Take it at the same time, every day!
• Never stop a pill and Do Not take a double dose to make up for a missed dose.
• Be sure to tell your doctor or pharmacist if you missed any doses so they can
better understand how your medication is working.
• Never change your dose with out talking to your doctor.
• Let all your doctors, dentists and pharmacists know you are taking Warfarin.
Blood Tests
You might have to have your blood tested while you are taking Warfarin. The most
common test is the Protime (PT) test which measures your International Normalized
Ratio (INR). The INR/PT measures how fast your blood clots and if your medicine needs
to be changed. Your doctor will let you know if you need this test.
Coumadin™ and Vitamin K
• When taking Warfarin, it is important to keep your Vitamin K intake as consistent
as possible. Eat about the same amount of foods with Vitamin K each week.
• Foods that you eat can effect how well your blood thinner works. Sudden
increases in Vitamin K may decrease the effect of Warfarin. Also greatly
lowering your intake of Vitamin K could increase the effect of Warfarin.
• Your doctor will watch your INR closely. If you have changes in your INR month
to month, aiming to keep your Vitamin K consistent may help stabilize your INR.
• Not getting enough Vitamin K in your diet can increase your risk for osteoporosis,
bone fractures, vascular disease and stroke.
The following is a list of foods and their vitamin K content (notice serving sizes!). These
foods are known as being high in vitamin K. However, some foods on the list are actually
low (i.e. egg yolk, green tea vs. green tea leaves). Use this as a guide to aim for a
consistent intake of foods high in Vitamin K!
Item
Avocado
Asparagus
Beef Liver
Broccoli
Broccoli
Brussels sprouts
Cabbage, red
Cabbage, green
Chinese cabbage
Japanese cabbage (natto)
Cabbage, boiled
Cauliflower
Cauliflower, green, raw
Cauliflower, raw
Chick Peas (garbanzo beans)
Cucumber
Egg Yolk
Green Tea Leaves
Green Tea
Kiwi
Green onions
Onions (white)
Onions
Okra
Peas, green (canned)
Peas, green (raw)
Seaweed, raw
Soybeans
Leafy Greens:
Kale, raw
Kale, frozen
Spinach, raw
Spinach, raw
Spinach, canned
Turnip greens, frozen
Turnip greens, raw
Turnip greens, raw
Collards, raw
Swiss chard, raw
Mustard Greens
Parsley, raw
Green Leaf lettuce
Lettuce, boston and bibb types
Lettuce, romaine
Lettuce, red leaf
Lettuce, iceberg
Serving
Vitamin K (mcg)
1 whole
4 large spears
1 slice (130 kcals)
1 cup raw
½ cup cooked
½ cup cooked
1 cup raw
1 cup raw
½ cup cooked
1/2 cup cooked
½ cup cooked
1 cup cooked
1 cup uncooked
1 cup uncooked
1 cup
½ cup w/ skin
1 whole
100 grams
3.5 ounces
1 whole
1 Tbsp, raw
1 cup
1 cup raw
1 cup boiled
½ cup cooked
1 cup
1 cup
½ cup
1 cup
29 mcg
32 mcg
2.2 mcg
92.5 mcg
110 mcg
109 mcg
34 mcg
68 mcg
33 mcg
95 mcg
81.5 mcg
8.6 mcg
12.9 mcg
16.0 mcg
6.6 mcg
8.5 mcg
0.1 mcg
1428 mcg
0.03 mcg
30 mcg
12.4 mcg
207 mcg
0.6 mcg
1.1 mcg
32 mcg
64 mcg
36 mcg
26 mcg
33 mcg
½ cup cooked
½ cup cooked
1 cup uncooked
½ cup cooked
½ cup cooked
½ cup cooked
½ cup cooked
1 cup uncooked
½ cup cooked
½ cup cooked
1/2 cup cooked
¼ cup
1 cup, shredded
1 cup, shredded
1 cup, shredded
1 cup, shredded
1 cup, shredded
531 mcg
573 mcg
145 mcg
445 mcg
494 mcg
426 mcg
264 mcg
138 mcg
418 mcg
286 mcg
210 mcg
249 mcg (2 Tbsp=125 mcg)
63 mcg
56 mcg
48 mcg
39 mcg
17 mcg
An easy way to aim for a consistent intake of Vitamin K is to use the two food lists
below. Since these foods have moderately high or high amounts of Vitamin K, changes
in your intake of these foods would have the greatest impact on your INR.
•
Foods high in Vitamin K – choose no more than ONE of these foods per
day!
Food
Kale, fresh or frozen, boiled
Spinach (fresh, frozen or canned), boiled
Turnip greens, frozen
Collards, fresh
Turnip greens, fresh, boiled
Swiss chard, fresh, boiled
Parsley, raw
Mustard greens, fresh, boiled
•
Foods moderately high in Vitamin K – choose no more than THREE of
these foods per day!
Food
Spinach, fresh, raw, uncooked
Turnip greens, raw, chopped, uncooked
Broccoli, cooked
Brussels sprouts, boiled
Broccoli, raw, uncooked
Japanese cabbage, boiled
Green cabbage, boiled
•
Serving size
½ cup
½ cup
½ cup
½ cup
½ cup
½ cup
¼ cup
½ cup
Serving size
1 cup
1 cup
½ cup
½ cup
1 cup
½ cup
½ cup
Remember that how you prepare and cook can change the amount of Vitamin K in
foods!
Other Foods and Supplements and Coumadin
•
If you drink Cranberry juice, limit amount to 1 cup per day.
•
Alcohol – Drinking can effect reduce the effectiveness of Warfarin. Avoid drinking
alcohol
•
Herbal/Vitamin Interaction - Avoid herbal supplements until you talk to your
doctor! Herbal supplements can increase your risk of bleeding when taking Warfarin
and may affect of your INR. The following herbal supplements should be avoided:
Herbs and Supplements:
Alfalfa
Anglica (dong quai)
Arnica
Borage
Celery
Clove
Cat’s Claw
Coenzyme Q-10
Cranberry supplementation
Fish oil
Flaxseed oil
Forskolin
Garlic
Gingko Biloba
Ginseng
Ginger extract
Herbal teas:
Chamomile
Tonka beans
Horse chestnut (buckeye, aesulus)
Insositol hexaphosphate
Kelpware
Licorice
Meadow
Onion Extract
Pau d’ arco
Papain
Parsley
Passion flower
Melitot (sweet clover)
Quassia
Quinine
Red clover
Reishi mushroom
Rue
Sweet woodruff
St. John’s Wort
Turmeric
Willow bark
Wheat grass
Avoid separate Vitamin A, E, and C supplements. Vitamin supplements such as Vitamin
E can increase your risk of bleeding. A multivitamin/mineral supplement is allowed, but
it should NOT provide more than 100% of the Recommended Daily Intake (RDI) for
vitamins A, E, C, and K. If you are taking a multivitamin/mineral supplement, be sure to
do so consistently since some may contain vitamin K.
It is important to check with your doctor before taking ANY vitamin supplements or
herbal supplements!
Supplements such as Ensure® and Boost® can contain significant amounts of Vitamin K.
Consider these as a “high Vitamin K food” when you are aiming for a consistent intake of
all foods containing Vitamin K.
Always check with you doctor or pharmacist before taking any prescribed or overthe-counter medications to determine if an adjustment in your Warfarin is
necessary (i.e. antibiotics and Prilosec).
References:
Cleveland Clinic:
http://my.clevelandclinic.org/drugs/Coumadin/hic_Anticoagulant_Medication_Warfarin_Coumadin.aspx
Agency for Healthcare Research & Quality. Blood Thinner Pills: Your Guide to Using Them Safely.
www.ahrq.gov/ Accessed 1/9/2012
National Institutes of Health: http://ods.od.nih.gov/pubs/factsheets/coumadin1.pdf
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