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Hawaiian Punch "Don't do it"!

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  • Hawaiian Punch "Don't do it"!

    Some of you may get a chuckle out of this.

    Just wanted to let you know that drinking Hawaiian punch can be potentially dangerous to those of us taking Coumadin. I ran out of my OJ and was craving figured I would just drink the punch that was in the fridge. Had maybe 3-4 glasses over a 2 day period. Went to test my INR and it was 5.8. What prompted me to test early was and extremely heavy cycle.

    Two of the main ingredients in that particular juice are pineapple and papaya...have been know to raise INR's. In my case it did a good job. Thought it was just a sugar flavored drink.

    Thinking back to my summer vacation in Hawaii...had the same exact concern after consuming a few tropical drinks. My occasional glass of wine never effects me in this way. My bet is on the Pineapple juice.

    Moral of the story.....stay out of the kids stuff. :D.
    All the best,
    LuvMyBirman :)
    MVR, 3/99

  • #2
    How about a nice Hawaiian Pucnh?

    More like a kick in the teeth, huh, Gina!

    Way to go you crazy kid! At least you test on your own so you knew right away what caused your spike-a-roo (that's not a new cereal!).

    What about grapefruit? Is it in the same culprit category as pineapple and papaya?

    I'll be chillin' in Ft. Lauderdale next week and it looks like I'll have to pass on my sister-in-law's incredible homemade pina coladas. She even brings her blender to our room...but, I don't suppose it would even matter if it were a virgin pina colada?! They have their own grapefruit tree in the backyard!

    Oh, well! Pass me a cold O'Doul's!

    Y'all have a very Merry Christmas and a Happy New Year.


    • #3
      Hi GIna,

      hehehehe.... Your story made me laugh!! Well, that and remembering the old Hawaiian Punch TC commercials!

      Hmmm.... I think you have discovered why your INR levels get out of wack everytime you go someplace tropical! Doesn't have to be the alcohol drinks... just the juices... then combine that with a few tropical drinks.. hehehhee... " To the Moon Alice!"

      Happy Holidays,


      ps.. How is everything going with the relo? Have ya thought about a new name? LOL

      (personally, I 'm still partial to "Baltimore Babe")
      3/23/00 Ascending Aortic Dissection-St. Judes mech valve+graft, Vanderbilt, Nashville, TN
      9/16/10 ON-X Aortic Valve/Root Replacment, Cleveland Clinic,OH, Dr Pettersson
      9/16/10 Aortic Stent and Frozen Elephant Trunk Procedure, Cleveland Clinic,OH, Dr. Roselli


      • #4
        Hi Gina,

        Thanks for posting that. I would never have thought Hawaiian Punch would do that! I had my INR taken last Saturday and when my cardios office called me Monday, my reading was 5.56INR. I couldn't even imagined what spiked it so much. I have been busy with exams, working late and not my normal routine. The nurse aske dme if I had changed meds etc. COuldn't think of anything I had different. Just maybe eating on a different schedule. Anyway, I have togo back the day after Christmas to be tested again. I guess I'll have to forego the Mai Tais my sister makes on Christmas day. Boo Hoo! I use to make a mean Pina Colada too, Perry. Oh well. Have A merry Christmas Gina, Perry and Rob. Take care!
        AVR & MVR and Tricuspid Repair
        St. Judes Mechanical
        March 8, 2001
        Chicago University Hospital


        • #5
          Hawaian Punched !

          Help, Al Lodwick! do you have a scientific explanation for this?
          Mitral valve replacement
          September 17, 1998
          Mechanical St. Jude
          Inova Fairfax, Falls Church VA
          Dr. Ed Lefrak


          • #6
            Yep Perry, a kick in the......

            My guess is that it is in the Pineapple juice. Not the first time this has happened to me. My diet remained the same, only change was the juice. Pineapple, Papaya, Grapefruit.

            Just because it had this effect on myself....does not mean it would do the same to the next. As with Coumadin and anything. Another thing I have discovred....antibiotics decrease my INR. Others are effected reversely. Individualized for sure.
            All the best,
            LuvMyBirman :)
            MVR, 3/99


            • #7
              Spiked Punch


              I sure agree with your comment about "individualization." I got tested late yesterday and finally came out with a decent 2.9 INR! (Clinic nurse is so cool, she calls me long distance from home after checking my results). I have not had any antibiotics in a few weeks and didn't do anything dietarily strange. Coumadin sure is a funky, finicky drug.

              I've been spiked with readings like [3.4, 3.8, 4.0] since mid November and I guess it's primarily due to antibiotics (dental deals). My INR goes up, yours goes down, go figure?! I've backed off the dentist until January (just so I can play this stupid game again!).

              I'd like to call a huddle then with Allodwick and see what I can do to stay level when I start the second half. Like eat some greens the day of dental work? Perhaps I should have a nice Hawaiian Punch or a glass of Florida grapefruit juice, or better yet...a double Pina Colada! nyuk nyuk, nyuk, woo, woo, woo, woo!

              Cheers everyone and Happy Holidaze!
              Last edited by Perrster; December 20th, 2001, 04:39 AM.


              • #8

                My pharmicist at one time asked me when my INR jumped what I had changed. Tropical drinks! Who knew! Fruit, right? Well he said it was probably the papaya or grapefruit. Darn! MaiTai's are my favorite soul soother!


                • #9
                  Grapefruit juice does not affect warfarin in any appreciable amount. We have researched this very thoroughly. Warfarin occurs in two forms which are mirror images of each other. Think of your hands as representing the two forms. The hands have to fit into receptors (gloves) in order to work. In every person except maybe one or two who took warfarin in the past 50 years, the left glove is the predominant one in the body. And guess what, warfarin occurs as almost all left-handed type. Grapefruit juice contains an enzyme that breaks down only right-handed warfarin. Therefore, its effect on warfarin is minimal. The one person in the history of the world who had no left handed receptors required a dose of 660 mg of warfarin daily to get enough right handed warfarin to fill the receptors and maintain a therapeutic level. That is not a misprint - he took sixty-six 10 mg tablets daily.
                  I have seen one person who had a problem with grapefruit juice and warfarin. But he had ascites (ruined liver from alcohol), took Lipitor (which is not the best choice with liver disease) and drank two gallons (256 ounces) of pink grapefruit juice in three days. His INR went up to around 7 and stayed there for a week. He also was so sick to his stomach that he could not eat for days. He had some rectal bleeding which I cured by giving him an oral dose of vitamin K and he was able to go back to work two days later.
                  Papaya and pineapple juice may play some role, but when you go to Hawaii you have two much more important factors. The first is that travel breaks up your routine. Routine is the key to good warfarin management. The second is the time change. It is 6 hours (if DST in effect) from the east coast. My guess is that these two are much more important than a few ounces of juice. If you doubt that the time change is important, consider that football games start at 6AM on Sunday morning and finish around noon. The 5 o'clock news gives the score of the Monday night game before it is shown. One other thing to consider is the POG juice they serve. The G stands for guava which has been shown to increase the INR.
                  The next two weeks will have the lowest percentage of INRs in range of any two weeks of the year. The biggest factor is that over the holidays, people get out of their routine. They travel or have company and this upsets things. Drinking also plays some role. But I still do not think that two drinks of anything is going to cause blood to gush out of any body opening.
                  AND I'll still stand by my statement that menstrual flow is not actual bleeding and therefore, is very little influenced by warfarin.
                  Well, some of you asked for my opinion!!!
                  If we don't communicate again before the big days -Happy Holidays.


                  • #10
                    I want to correct something that I wrote last night. It is not guava but papaya that has some reports of increasing the INR.

                    I checked the National Library of medicine and no medical journal has ever published a report of pineapple juice or papaya juice affecting the INR. So if you have one, you can be the first in the over 50 year history of warfarin to get yours in a medical journal.

                    When you are assessing whether or not a drug caused a certain thing to happen, the first thing that you have to ask is did the event happen in a timely manner after the drug was administered. If the answer is yes, then you can proceed to the next question. Could the same thing have happened to this person if they did not take the drug in question? If the answer is yes, then you can only ascribe probable or possible cause to the event being related to the drug. You can never assign 100% certainty if the answer to the second question is yes.

                    When you assess the answer the doctor gives you to a question, remember this. The doctor is not getting paid for the length of the visit. If it seems easier to agree with you than to try to convince you of something else, you are usually going to get the answer that lets the doctor get on to the next patient. This is especially true if you can only ascribe probable or possible cause to an event being related to a drug.


                    • #11
                      If I have learned one thing out my experience.....NOBODY, including doctors and medical professionals have all of the answers. If it is not medically documented... it must be in your head. Yeah right. Just like all of the visual disturbances some of us post valvers experience.

                      Guess what....maybe I/we are the first to document these occurrences as a side effects to the medication, consumables and surgery. That is what this site is about. To support, compare and sympathize with each other. Not to blow others in the head for an opinion or experience. Man!

                      It is real, believe me. My doctors do listen to me with an open mind and treat me accordingly. I don't know how one can pass judgment without all of the facts.

                      PS. Tell me where to sign up for the "50 year" journal documentation. Would be happy to document. And I am willing to bet my only born child that I am not the first.
                      Last edited by LUVMyBirman; December 21st, 2001, 08:53 PM.
                      All the best,
                      LuvMyBirman :)
                      MVR, 3/99


                      • #12
                        Just for argument's sake- Here's the ingredients from a Hawaiian Punch site. Lots of other things besides fruit juices, maybe they're the culprits.

                        Hawaiian Punch


                        Contains: Water, High Fructose Corn Syrup and 2% or less of each of the following: Concentrated Juices (Pineapple, Orange, Passionfruit, and Apple), Purees (Apricot, Papaya and Guava), Citric Acid, Natural and Artificial Flavors, Pectin, Gum Acacia, Gum Ghatti, Glycerol, Ester of Wood Rosin, Sodium Hexametaphosphate, Red #40, Blue #1, Sodium Benzoate, and Potassium Sorbate (Preservatives) and Ascorbic Acid (Vitamin C).


                        • #13
                          Sorry, Gina,
                          I didn't mean to bash you. I guess I switched over too far into my student training mode. I train senior pharmacy students for the University of Colorado. One of the things that I make them do is to look rationally at drug problems. But in doing so here, I forgot one of the main principles - if it happens to the individual that you are talking too - they consider it 100% significant.
                          You are right too about the forum being a place to record what happens to you.
                          I'm not one with a valve, I'll stick to just answering questions.

                          Happy Holidays Everyone.


                          • #14
                            And, sorry I posted this experiance. There is first and last for everything.

                            Better go 'brush my teeth' real good, :D
                            All the best,
                            LuvMyBirman :)
                            MVR, 3/99


                            • #15
                              Hi Janie-

                              Well, Hawaiian Punch did add Vitamin C and ester of wood rosin (yuck, whatever THAT is), maybe that forgives all the naughty things. LOL