coumadin and booze?

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Getzfixed

In trying to understand how much coumadin might affect my current lifestyle I asked my doc about drinking-would I still be able to? He told me that I would still be able to enjoy a couple of drinks but I should avoid binging. Now drinking is not as much a part of my life as it was when I was young and stupid. I am curious as to what would constitute a binge. Obviously the St. Paddy's day pub crawl is out. Am I going to have to worry about 4 or 5 beers during an Eagles game? I realize that almost everything about this valve business is subjective. How much is too much and when must I say when?
Getz
 
Hi Getz,

I have to admit... I drink with the best of them, and even though I am on Coumadin, I have not seen any real changes. I Think the doctors tell us not to drink, because we could fall down and really hurt ourselves due to the Coumadin.

The fact is, the American Heart Association and our doctors will tell us that 2 drinks a day is the limit. That is a true statement for healthly people, and those of us with heart conditions or on Coumadin. The guidelines that doctors use is 2 per day for everyone!

My cardiologist told me that the key to stablizing your INR is consistancy.. so... if you are going to drink.. then drink consistantly. hehehe... That is my kind of doctor!!

OK.. so.. here is my routine.. during the week, I may have a beer or two per night, and some nights.. none at all. On the weekends, I do not count or limit what I drink. NOt that I binge drink, but with all my friends on the weekend, and on the boat at the lake in the summer and other activities in the fall and winter. I party with the best of them.

My Coumadin dosage is adjusted to accomodate my lifestyle is my guess. I take my usual 5 mg pill Mon, Tues, Weds, Thurs, Sat Sun.

I take 1/2 pill 2.5 mg on Friday and Monday. I guess that is to adjust for the weekend of having a few drinks. All I know is that it seems to work for me.

By the way, if you did come or plan to come to any of the VR reunions.. you will notice that for the most part.. the 2 drink rule does not apply!

Well,, that is my personal take on your question.

Hope you find a balance,

Rob
 
Rob, I love your theroy:D

At first....for about the first year and a half proceeding my MVR did not have my usual glass or two of wine. As time passed and I became more comfortable.....added the occasional glass or two every other week.

On average now I drink 2 glasses a month. In a social setting I have had, well.....4-5 glasses with no effect. One of these occasions was at our annual VR.com unions.
Usually balance it out with a small salad. Have heard that drinking alcoholic beverages can have an increased or decreased effect on your levels. It's another on of those individualized situations.

The only time I had a concern was while vacationing in Hawaii. I drank consistently 2 tropical drinks per day. Tested at 6.0 upon arriving home. My diet had changed, was eating a lot of fruit and sunbathing. Could have been the juice in the drinks. If grapefruit was added that has been known to raise your INR. I am not really concerned with a higher INR. Would rather it be a little high than risk a clot, stroke or worse.

You will find your range in time.
Good luck
 
The main danger is actually intestinal bleeding. Alcohol is irritating to the lining of your stomach and intestine. If it gets a bleed going, then warfarin will make it very hard to stop. Yes, you will have to find your own limit. I have one patient who starts to bleed after three drinks. For her it is two then O'Douls.
Of course you could give up on the Eagles and settle the whole thing. From a Broncos fan!!
 
Hi Getzfixed,

I remember when I found VR.com this past April that was one of my first questions. I believe it was Rob who told me the same thing and I liked his answer. It's true that any doctor will tell you no more than two drinks a day even if you're healthy. I sometimes have a couple of beers to relax when I get off work and then have maybe four or five on a Friday or Saturday. It really hasn't effected my INR. When my INR is effected it's usually something I ate in excess. I very rarely have mixed drinks anymore though. I believe the last time was at the Nashville reunion when I had two Bloody Marys. I figure I know the alcohol content in a can of beer and how many I can safely drink. When it comes to hard booze, there is different proofs, and unless your making the drink, you don't know if one or two shots are put into the drink so it's harder to keep track of if your still at a safe level. Like everyone has said, consistancy and moderation are the best rules to live by. I know that by staying consistant my INR will stay pretty much the same. Like Gina said. You'll find your range in time. Take care!
 
Does this mean I should not drink my normal 5th of vodka per day?
 
The RN in my coumadin clinic said that drinking and taking coumadin is not good for the liver, as coumadin is processed in the liver?
If I drink now it is only half glass of wine or a small glass out of my husband's beer, and then maybe only once a week, if that.
I already take kind of high warfarin dose, why mess up my internal organ,by ingesting alcohol that doesn't do the liver any good.
And I've already had 2 avr's , so I need to think about being good to my poor body!
Gail
 
Gail,
Your response reminds me of a story I read once. This woman died and her three ex-husbands were at her funeral. All agreed that she was an excellent wife except that she had one serious flaw that not of them could tolerate. The story went on and on about how they did not want to mention her one flaw at her funeral. However, after she was finally buried, they agreed to reveal the truth. Whereas, most women would order a drink and give their husband the other half, she always took half of her husband's drink. Thus, all the other husbands wound up with a drink and a half, but her three ex-husbands just could not stand the fact that she caused them to wind up with only half a drink. So they had all divorced her for the same reason.
 
Ha Ha Mr Pharmacist! I've worked with many pharmacists and they do have an interesting sense of humor. We were always chuckling about something behind the wall separating us from the patients!
Luckily, my husband doesn't mind me taking a bit from his India pale ale, that way he doesn't get the backwash from my leftover bottle!
Now a ? for you. Is it bad for the liver to drink much alcohol?
My surgeon said a glass of wine once in a while is ok, that says to me , don't drink much.
What do you think about this liver issue?
Gail
 
Hi Gail,

I found two sites that may help answer your question.

The first one is a Coumadin information site, and will inform you of the effects of Alcohol and Coumadin, Look at the highly probable list, (note the reference to liver disease). Then scroll down to the No Effect list and see the reference to "No liver disease"

NOTE: You will have to type in the "$1511" when you first try this link it wont work, just type $1511 at the end of the address and it will take you there.

http://www.hsforum.com/stories/storyReader$1511

The next site talks about Fatty Liver Disease, and lists Alcohol and Coumadin, seperately can be possible causes, so combining the two may increase that chance.

However, this should be further pursued with your doctor. If you are in good health, and your triglycerides are in a good range, then you probably are not going to develop fatty liver disease.

The site is;

http://www.emedicine.com/MED/topic775.htm

I think everything in moderation is OK. As long as you are not an out and out alcoholic. Afterall, we still have to enjoy life. The end result is still the same.. so.. Enjoy.

Rob
 
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I have to go along with the everything in moderation school of thought.
I have only seen one patient who drank enough to truly have a long-lasting effect on her liver. A few months ago, she went through treatment and stopped drinking altogether. Evidently the alcohol had a huge influence on shutting down the enzymes in her liver. When she was drinking, she required 20 mg of warfarin per week to keep her INR between 2 and 3. Now after several months with no alcohol, she is requiring about 50 to 55 mg of warfarin per week to maintain her INR between 2 and 3. So her enzymes have evidently started working again and she is metabolizing the warfarin more rapidly. This lad seemed to function fairly well even when drinking. She delivered meals-on-wheels several times per week.
The problem that surfaces sooner than liver disease is the disruptive lifestyle that many heavy drinkers have. As you know, consistency is the key to warfarin management. I classify a heavy drinker a one who probably has their blood alcohol above 0.1 every day.
Heavy drinkers, narcotic addicts and daily marijuana users do not lend themselves well to the warfarin lifestyle.
 
The reason I have so many stories is that I have probably seen over 1,200 people on warfarin. They have made more than
12, 000 visits to my clinic. Plus, I get about 5 e-mails per day from people all over the world about warfarin. I have had hits from 75 different countries on my website. The writers to the website have asked things as diverse as a vegetarian in Israel wanting to know the vitamin K content in foods that I have never heard of, to a woman in Singapore who could choose any hospital in the world and wanted to know which one, to a guy wanting to work warfarin into a death in a play, to a man who was probably poisoning his wife. You keep asking questions and I'll have a story!!!
 
And to think I was concerned about dropping and misplacing a 1mg tab. In horror mind you.... thinking my child or dog would injest it. I wasn't the only one in the house on all fours. As luck would have it.....we found it.
 
Coumadin and alchohol

Coumadin and alchohol

I would not drink on a daily basis being on coumadin or not being on coumadin.........that, to me is not social drinking, but something more serious.

But, that is only my opinion.
 
So many stories...

So many stories...

Allodwick, I love reading your replies! You could write a book (on this subject alone!!).

You have given me the final answer to my beer drinkin' dilemna. I gave up drinking over a yr. ago apparently due to intestinal bleeding. Freaked me out enough to just quit!

I played in a summer golf outing (I was then only 4 months post-op!), the beer cart was everywhere and I think I had 1/2 dozen to 8 cold ones all day. Stupid idiot! What was I thinking? I wasn't as in-tune with my INR's as I am today and found myself peeing blood on Monday morning. Like you said, my intestinal tract just did not appreciate what I was doing to it!

I've since learned to control myself, and now still enjoy a few cold ones a week or a glass of wine now and again. O'Douls is my first choice and I am always available as a designated driver. Moderation is indeed the key!

Cheers to all!!!

How are you, Bob?
 
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