Missed a dose. What do you do?

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jlcsn2015

Liborio
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Sep 21, 2015
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Or a glass of cranberry or grapefruit juice? Cranberry sends my INR up.
Grapefruit has the property of interfering with Many prescription medicines, not only Warfarin,
one of those "curiosities" good to know. The 2 things i avoid are Grapefruit and Tummeric ( i miss it )
 

jlcsn2015

Liborio
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Sep 21, 2015
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That helps alot, and i guess doing it the way that I do, and I admit I am an old timer. using CELL is a very good idea, and perhaps I should and need to at least consider it? and that is good, "paper calendar", lol! ya just made me feel much older........heeehehehehehe. And yes to that, incase anyones even cares, i usta also own one of those SHARP devices.
Yes, I have 2 alarms on my phone, 2 hours between them, just in case do not follow the first one, and that works, but, over the past 6 years, at least 3 times, i forgot to take it one day, nothing changed for missing 1 day.
 

almost_hectic

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I was also so advised, but I did some digging and found that it was life changing when I badly hurt my back (in Feb this year). I monitored INR and monitored my stools and found that all it did was take away the pain.

By pain I mean confined to the floor, bed or using crutches type back pain for 2 months.

I mentioned to my surgeon that I don’t take any NSAIDs and that I used to need ibuprofen for occasional back pain. He said so long as it was occasional he didn’t think it would be a problem so long as I used it sparingly and watched my INR
 

tom in MO

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I drink cranberry juice 2-3 times a week, no problem with my INR. I wasn't told by anyone who prescribed or trained me on warfarin therapy to avoid it.
 
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drleng

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I drink cranberry juice 2-3 times a week, no problem with my INR. I wasn't told by anyone who prescribed or trained me on warfarin therapy to avoid it.
The cranberry-warfarin interaction is debatable. But perhaps your warfarin does has "factored in" your regular cranberry juice consumption.
 
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RAS

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The cranberry-warfarin interaction is debatable.
Agree. Very debatable. I've been drinking cranberry juice all of the 15+ years while I've been on warfarin. I make no attempt to be consistent in how much I drink per week though. No impact to INR one way or the other.

Shortly after I started home testing in 2007, but before I started managing my own dosing, I had a 4.1 INR test. The nurse called and asked if I drank cranberry juice that week. I said I did. She seemed rather alarmed and advised I should discontinue. I told her it was nothing new, since I had been drinking it for decades including the entire time I had been on warfarin which at that point was about a year. I asked her why the concern and she told me there was a patient somewhere who had a significant interaction with cranberry juice. I told her one patient's experience was no reason for me to discontinue cranberry juice considering I had been drinking it all along with no issues.

After that call, I searched the web and found a report of a patient on warfarin who died with cause attributed to interaction of warfarin and cranberry juice. I can't find the report now and my memory of it is rather vague, but as I recall he had started a diet which included drinking something like 6 to 12 glasses of cranberry juice daily! This continued for a number of weeks. He started bleeding internally and was taken to the ER where an INR test came back extremely high. At the time I didn't find any formal studies or other reports of significant interaction between warfarin and cranberry juice. If cranberry juice was the cause for that patient, it was probably the extreme amount and sudden change in diet along with apparently no INR testing until it was too late.
 

pellicle

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I told her one patient's experience was no reason for me to discontinue cranberry juice considering I had been drinking it all along with no issues.
I love your approach. I bet that didn't go down well :)

If cranberry juice was the cause for that patient, it was probably the extreme amount and sudden change in diet along with apparently no INR testing until it was too late.
couldn't agree more.

BTW, how much do you typically drink?
 

RAS

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much do you typically drink?
1 glass per day. It takes about a week to finish a bottle of juice, but the particular juice variety is whatever happens to be next in the cupboard. So one week could be cranberry every day and the next week or even several weeks, none.
 

pellicle

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1 glass per day
I agree, won't be a problem. I can't find the thread of the guy not long back who posted he was drinking a gallon because he bought a couple of bottles at Costco on special.

Anyway, from these links

There have been conflicting reports about the effect of grapefruit juice on warfarin.
Mr. Lodwick did see the following patient. A middle-aged man with liver disease was taking warfarin and atorvastatin (Lipitor). He consumed approximately two gallons of pink grapefruit juice over three days. He developed severe muscle pain and cramps to the point that he was unable to eat. His INR increased into the 6 to 7 range and he developed bloody diarrhea. About three days after he finished the grapefruit juice, he was given a dose of vitamin K by mouth. The next day the bloody diarrhea stopped and he began to return to normal.
and

Cranberry juice is fine also, just don't sit down with a few gallons and start chugging.
 

Superman

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I agree, won't be a problem. I can't find the thread of the guy not long back who posted he was drinking a gallon because he bought a couple of bottles at Costco on special.

Anyway, from these links



and
All I know is the one time I had an INR out of control, cranberry juice was the variable. I was on a salad kick for dinner with a glass ir two of cranberry juice over ice. There weren’t any other variables in the diet that would increase INR. Ended up at urgent care with very dark urine. Test confirmed it was blood. INR over 8. I cut cranberry juice out (as that was the only thing I could think of that changed) of my diet and it’s never happened again.

Now maybe that’s confirmation bias or post hoc ergo propter hoc, but it was an awfully weird coincidence if not true. We all metabolize things differently so who knows. Outside of that incident, my INR has been pretty rock solid for over 30 years now.
 

Superman

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good to know ... so I should revise that to "one glass probably shouldn't be a problem"

I never drink that stuff anyway
Like anything. It’s moderation. Don’t eat a whole bag of spinach every day for a week after avoiding greens for a month. That’s not to say you can’t have it. Just don’t be weird about it.

I’m sure if I had morning cranberry instead of morning orange juice, I’d dose the diet and be fine. But there’s something about the sweetness and the dryness of it and over ice - I just don’t stop at a small glass. That’s where things go off the rails.
 

pellicle

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But there’s something about the sweetness and the dryness of it and over ice
I forgot to ask, you didn't feel inclined to test again (... given that you like it and all ... I might buy some and do a test this end)

and was it pure cranberry (not mixed with something like grapefruit or spanish mandarins?
.
 

caro

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I remember at CC I was told to avoid grapefruit juice. My first thought was “oh nooo” and then I remembered I didn’t drink grapefruit juice 😂. I was worried it meant I couldn’t have grapefruit anything. I don’t drink them regularly but when I crave the taste, I haven’t had any issues on inr with grapefruit soda (about 15% grapefruit juice) and grapefruit sparkling water. Luckily, I can still have a Paloma 🍹
 

Superman

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I forgot to ask, you didn't feel inclined to test again (... given that you like it and all ... I might buy some and do a test this end)

and was it pure cranberry (not mixed with something like grapefruit or spanish mandarins?
.
Just Ocean Spray cranberry. About the only mixes I’ve seen are Cran-Grape or other fruits. I’ve never seen Cran-Citrus anything.

It’s not that I’ve never had it again. I’ll have cranberries with Thanksgiving Dinner (traditional), or if I’m traveling and the hotel has it, I’ll have a small glass. I just don’t buy a big jug anymore.
 

tom in MO

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Grapefruit OTOH is often consumed in greater volumes and is worth monitoring
Please provide your customary hard evidence for a warfarin - grapefruit abstinence. Do you have any studies?
 

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