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pellicle

Professional Dingbat, Guru and Merkintologist
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Nov 4, 2012
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A discussion started tonight about Mango and its potential to influence INR ... as this was "new to me" (eating a bit of fresh mango during summer, typically no more than one per day) I thoght this was interesting as I'd never found any effect ...

A quick google revealed this study:

https://journals.sagepub.com/doi/10.1177/0897190014544823

A Comprehensive Review of Potential Warfarin-Fruit Interactions​

Daryl A. Norwood, PharmD [email protected], Crystal K. Parke, PharmD, and Leonard R. Rappa, PharmD, BCPPView all authors and affiliations
Volume 28, Issue 6

Purpose:​

The aim of this review is to discuss possible interactions that may occur between warfarin and fruit products.​

Methods:​

A literature search was conducted using the search terms: “warfarin (Coumadin®) and fruit interactions, warfarin and fruit, warfarin and fruit juice, case reports and clinical trials”.​

Results:​

A total of 23 citations (15 case reports and 7 controlled clinical trials) were reviewed. The majority of cases involved cranberry products, while pomegranate juice, avocado, grapefruit juice, mango, and papain were also implicated in reports of suspected warfarin-fruit interactions. Cranberry juice was also the most frequently studied fruit product. Other fruit products evaluated with warfarin in controlled clinical trials were cranberry concentrate and grapefruit juice.​

Conclusion:​

Although a number of case reports have been published that suggest warfarin has the potential to interact with several fruit products, it is difficult to determine their relevance, as scientific evidence is scarce. Until further information is available, clinicians may want to encourage patients to consume cranberry products and grapefruit juice in small to moderate quantities and to inquire about the recent consumption of mangos, pomegranate juice, and avocados when taking a dietary history or when assessing possible causes for international normalized ratio (INR) instability.​

I can't read the body, but according to Googles citation of that study:

Mangos contain varying amounts of vitamin A which may inhibit CYP2C19, an enzyme involved in the metabolism of warfarin's R-isomer. It has been suggested that large doses of vitamin A can increase the anticoagulant effect of warfarin

Seems a bit stringy to me ... the study has in its citations (presumably about mango and Vitamin A points here (but is unavailable to me).

The "aware" reader will know already of the dangers of Grapefruit and the suggestions also of Cranberry.

HTH
 
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