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Turmeric Interacts with Coumadin

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Q. Turmeric increases the anticoagulant effect of Coumadin. I have been on Coumadin for 15 years because of an artificial aortic valve.

I had read that turmeric was effective in lowering cholesterol and began sprinkling it on broccoli. My INR went up dramatically and my pharmacist said, “STOP!” Have there been any studies on the blood-thinning effect of turmeric?

A. You are not the first person to report this interaction between Coumadin (warfarin) and turmeric. Others have reported a spike in their INR lab values (a measure of blood anticoagulation) and we believe this is a dangerous combination. Our fear is that this could lead to a serious bleeding episode.

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re: turmeric and coumadin;please don't throw the baby out with the bathwater; there are lots of foods or supplements that are not supposed to be taken while on coumadin;
I have been taking 1 capsule daily(2 of cheaper brands)of turmeric since 2006; it sure helps to reduce inflammation; ( I am taking it preventatively against fibromyalgia as well as brain inflammation that MIGHT result in Alzheimer's disease or other dementia;)
Maybe Peoples Pharmacy can make a list that contains most of the foods (like Ginger, etc.) or supplements like Omega 3, etc. that interact with coumadin.That would be helpful; Just do not make turmeric take the blame. (I am a faithful reader of this column!)

I read this in the newspaper the other day and was very suprised that you didn't pick up on broccoli as a factor that can raise an individual's INR as it is high in Vitamin K. My husband has been on coumadin for years and has avoided eating too much broccoli because it spikes his INR. I would have thought this individual would have known this about broccoli.

PEOPLE'S PHARMACY RESPONSE: IT IS VERY IMPORTANT NOT TO GO OVERBOARD WITH BROCCOLI OR OTHER GREEN VEGETABLES WHEN TAKING COUMADIN. THEY ARE RICH IN VITAMIN K AND CAN INTERFERE WITH THE EFFECTIVENESS OF COUMADIN, POTENTIALLY LEADING TO A DANGEROUS BLOOD CLOT.

So, turmeric and coumadin are an unwise mix. My question: is turmeric and plavix also a bad mix?

PEOPLE'S PHARMACY RESPONSE: WE DON'T KNOW. COUMADIN IS MUCH MORE LIKELY TO INTERACT WITH MANY OTHER FOODS AND DRUGS, BUT PLAVIX MAY ALSO INTERACT WITH A NUMBER OF BOTANICALS THAT INTERFERE WITH BLOOD CLOTTING. NO ONE HAS REPORTED A PLAVIX-TURMERIC PROBLEM TO US YET, BUT THAT DOESN'T MAKE THE COMBINATION SAFE.

I recently started taking Solaray Turmeric with Boswelian and Bromelain. Is there a chance of kidney problems with this herb? I only have one kidney - lost the other one to stones. Thanks

I take 500 mg turmeric daily while on coumadin. I have noticed a slight increase in INR, but variations can be due to many factors, Vitamin K containing foods, different rates of intestinal absorption. That is why the INR is such an important test to run regularly, especially if unusual bleeding occurs, such as spontaneous nosebleeds, bleeding under the skin, etc.

I have been on coumadin for 4 yrs. due to arrhythmia. Cranberry juice (plain, no sugar or other juices added) is supposed to increase INR and mine is always on the low side. so I agree with the digestion comment. It depends on how you metabolize. My cardiologist doesn't want me taking ANY thing natural ie fish oil. My primary dr.says take it. Fish oil is recommended for arrhythmia!

Since my Pro-time tests for Warafin vary, would it be advisable to take 1/2 Aspirin in the morning and the Warafin before bedtime?

PEOPLE'S PHARMACY RESPONSE: PLEASE CHECK WITH YOUR PHYSICIAN BEFORE STARTING TO TAKE ASPIRIN WHEN YOU ARE ALREADY TAKING WARFARIN.

I just recently started taking Turmeric to help with my psoriasis after reading about the benefits in one of your Q & A's and I was wondering how much should I take a day and how long before I see any results?

This posting was very interesting. I am not on medication for blood thinning; however I experienced post menopausal bleeding after taking certain meds, such as aspirin and Boniva. Then the bleeding began again after eating foods high in phytoestrogen, including tumeric. After taking myself off of those foods (including the tumeric) the bleeding stopped.

Hello,
I have a Coumadin question. I am on Coumadin for life because of the MTHFR clotting factor. (I have had problems with blood clots and pulmonary embolism prior to going on Coumadin.)
My INR has been very stable. It was 2.5 on Jan. 9, but I had it checked yesterday and it was 4.9!! (which is w-a-y too high) I was shocked. I have had no change in my diet or medications.
What would cause this? Does this mean I have some other major problem going on?

Thanks for your help.

Regarding the comment on broccoli and Coumadin from 1/7/09. Broccoli contains vitamin K and will not "spike" the INR but rather will lower it significantly. This is why broccoli can increase the risk for clotting in patients on Coumadin. Patients should be consistent with the amount of broccoli (and other dark greens) in their diet and the INR should not be effected. Changes in the INR will occur if greens are suddenly dropped or if someone goes on a "broccoli binge."

Warfarin info is terrible. Most simply state 'dangerous interactions' w/out indicating +/- actions on warfarin or mechanism of action. And it seems the list is ridiculously long. Have there been any studies done on other blood 'thinners' like cranberry, turmeric, etc? It seems that there must be a better, safer compound out there that doesn't have as many 'dangerous interactions' associated w/ it.

Warfarin is a very complex drug; it contains not one, but 2 active components of different potency and its mechanism of action is by causing a controlled nutritional deficiency state. Warfarin absorption is altered by several minerals (most notably zinc, iron, magnesium, and aluminum), and its metabolism and excretion are altered by the functions of several body systems (TS, many of my patients who experience a sudden rise in INR with no other changes in their life are found to have had a significant change in their thyroid function).

It is important to realize that spices and herbs are mostly plant products, and the potency or concentration of a given mineral or chemical can vary, not only from plant to plant, but from one part of the plant to another part of the same plant. This means that it is difficult to keep your intake of a specific vitamin, mineral, or phytopharmaceutical consistent when you are consuming raw or natural product. And, since vitamins and mineral supplements and herbals are classified as 'food supplements' and not as 'drugs', they are not required to meet the same standards as drugs, and the actual contents may not match the labeled value.

There are several drugs and supplements which, if you are already taking them when the warfarin is stated, and you continue the same dose after you start the warfarin, will not cause a significant problem because the interaction occurs instantly and is factored into the warfarin dosing from the start. (From Dr. Noteboom's experience, I'm guessing that turmeric might be one of these.) Of course, the warfarin will need to be readjusted if you then stop taking the other agent. You can see why it is important that your doctor and pharmacist know any time you add, change, or stop taking a supplement or herbal.

DOK is right, there ought to be something easier to use. Unfortunately, we haven't found it yet!
So, whenever possible, check with your pharmacist or physician (or a reputable site, like this one) before adding or stopping a supplement or changing your diet while on warfarin, confirm the change with your physician at your next appointment and your pharmacist the next time you're at the pharmacy so that it's in the official records, and check your INR regularly!

Is there any information on vitamin K content of water chestnut peels? The USDA data list only has peeled (canned) water chestnuts, not whole fresh ones. I am looking for an explanation of a recent drop in INR that coincided with adding unpeeled water chestnuts to salads. Another candidate was kabucha, eaten whole (with its green skin), but removing the skin had no effect; I have assumed USDA figures for "winter squash, all varieties" applied to kabucha too.

I have been on coumadin for over ten years with an artificial aortic valve. I recently discovered that chocolate and alcohol can also spike coumadin INR. That's in addition to the dark green veggies and their generous helpings of Vitamin K, but Vitamin K reduces the thinning power of coumadin, while many other things increase it.

I was recently looking for a protein supplement bar and found that nearly all of them had a significant amount of Vitamin K in them. Cranberries are another culprit that can thin too much, a seasonal reason for spikes.

Probably more, but this may give you some other places to look.
S. Smith

Is there a potential for osteoporosis with long term use of warfarin?

Can the use of things as turmeric, cranberry juice, clove, cinnamon spices/oils or glyco proteins be used in such a manner as to be able to replace the need/use of warfarin,?????

I take two (2) 5mg warfarin daily.

PEOPLE'S PHARMACY RESPONSE: IT CAN BE DANGEROUS TO MIX THESE NATURAL PRODUCTS WITH WARFARIN. INTERACTIONS MAY BE UNPREDICTABLE, AS THEY DEPEND TO SOME EXTENT ON GENETICALLY DETERMINED ENZYME ACTIVITY.

Is it safe to take Turmeric for leg cramps while taking Warfarin?

I am on coumadin for Protein C Deficiency for life. I also have a progressive disease that might be helped by taking turmeric. Why can't I take turmeric daily and just have my protime tested more frequently while taking turmeric?

I am on Coumadin for life after a pulmonary embolism 6 months ago, as well as after genetic testing revealed (pre-Coumadin) a risk factor for clotting. I had a long hard time reaching a stable INR result. My current level of coumadin is10, 10 12.5 mg daily, in that order. I eat greens regularly, and my INR has been fine for the last 3 months until the last test which was 1.3. I also use turmeric on a lot of food, which should have raised the INR number, I would have thought.

I am working this out with my internist, but so little is known about interactions and coumadin (except for Vit. K, and yes, I do take a multivitamin daily).
I also take 1000 mg of fish oil, 1200 vit D and 1200 calcium. I take Lipitor 20 mg and was taking Metformin 500 (for pre-diabetes pro active approach) until recently when I stopped it because of leg cramps.

Any comments would be appreciated, no matter how far fetched they may seem.

I know that turmeric supplements increase the risk of bleeding when taken with Warfarin, but what about turmeric spice. Is there a safe amount I can take daily?

PEOPLE'S PHARMACY RESPONSE: SOME OF THE PEOPLE WHO REPORTED PROBLEMS TO US WERE USING POWDERED TURMERIC SPICE. AN OCCASIONAL CURRY SHOULD NOT BE A SERIOUS PROBLEM FOR MOST PEOPLE (BE MODERATE!), BUT DAILY USE MAY REQUIRE RE-ADJUSTMENT OF THE WARFARIN DOSE.

I am a 73 yo male, have experienced pulmonary embolism and DVT twice during the past 3 years, am now on warfarin for life. Any new promising and safer meds on the horizon to replace warfarin ??

How much Turmeric should I be taking for psoriasis, should I take it in pill form or the regular spice?

PEOPLE'S PHARMACY RESPONSE: YOU COULD TRY HALF TO A WHOLE TEASPOON AS SPICE, OR 1.5 TO 3 GRAMS DAILY IN CAPSULES. REMEMBER: NO TURMERIC OR CURCUMIN FOR ANYONE ON COUMADIN.

Hi,

I have been taking warfarin since march of 2010. I could not get protein levels stable. I began experimenting with turmeric spice (making my own gravity packed gelcaps) had to experiment with dosage. In a nutshell turmeric stabilized protein levels for me at 2 #60 gravity packed gelcaps/day. Now I am experimenting with how long can I take the turmeric before in becomes ineffective.

PEOPLE'S PHARMACY RESPONSE: WE TRUST YOUR INR IS MONITORED ON A REGULAR BASIS. SO LONG AS YOU STICK WITH THE SAME DOSE OF WARFARIN AND DON'T CHANGE YOUR TURMERIC DOSE, YOU SHOULD BE OK BUT MUST BE MONITORED.

I was so excited to see in this past Mondays paper 3/14/11, about taking turmeric for neuropathy in the feet. I am suffering from lupus, fibromyalgia, osteoarthritis and my feet are killing me. However, since I am on coumadin I am afraid to try the turmeric because of my INR. Any other suggestions as to how to alleviate the pain in my feet?

Re the Turmeric/Coumadin question. My VA pharmacist told me if I wanted to try the Turmeric, begin 4 days ahead (In 4/5 months I've been at INR 1.8/2.2). I began with about 1/4 to 1/2 Turmeric per day on dinner food four days ahead and went from 1.8 to 2.2. I'm going to do 1/2 tsp per day from now until the 17th when I have next blood test.

Seems almost impossible to get a real handle on this stuff. My diet is the same, oatmeal and varied fruit & nuts, and then fruit snacks all day; sandwich with protein for lunch. At dinner it's vegetables (ratatouille type veg or a cup of romaine for salad) Seems to keep me (and now with the addition of the Turmeric) somewhat over 200.

Does anybody (or the Graedons) have an opinion of INR self-test kits?? Thanks, Mrs. Innes

will turmeric interact with plavix? I Also take k

I need to know if anyone takes arthritic meds with 50 mg of turmeric while on plavix if its safe?

I am taking warfarin. I had an elevated INR after having two meals of curry in an Asian restaurant. I discovered the advice not to consume turmeric in a book by the Peoples Pharmmacist concerning food and natural remedies. I think this is what caused the INR elevation. I belong to Kaiser and told their Coumadin Clinic after I had stopped eating curry and had a normal result, but the person there (probably a pharmacist) did not agree and said I could consume curry, since it was probably a small amount.

I will tell my doctor. I believe it is true and do not plan to consume curry, since it will lead to being tested more often. The previous contact at the Coumadin Clinic thought it was due to diarrhea, but that has not been a big problem lately. Unfortunately, I am on a gluten-free diet, and the curry dishes were the majority of the gluten-free dishes in the restaurant.

I am a Pharmacist and a drug discovery chemist. I have been in the health care and Pharmaceutical industry for more than forty years. I read all the comments on the interaction of blood thinners like coumadin and plavix. Of the two drugs all clinical evidence points than plavix is a much more safer drug when people take spices like turmeric, ginger cinnamon and others. Moreover when you take as spices they contain other ingredients which counteract some of the actions of the main ingredient.

In case of turmeric it contains no less than 10 to 15 different closely related substances to curcumin. Taking one to two capsules of turmeric or 1-2 grams of turmeric should not effect the clinical effects of drugs like plavix. In case of coumadin it is a different issue. It is a old drug like heparin and they are strong blood thinners but at the same time they have at times more side effects.

After my DVT and massive saddle PE last year, it took more than a year to find my "go to" list of Vitamin K content in food. It's called the USDA National Nutrient Database for Standard Reference. ALL OF THE FOODS ON THIS LIST *LOWER* YOUR INR - they cause more clotting.

Easy version: chose the 2nd link below, scroll down to Vitamin K, and click the "W" to have the list sorted by level of the vitamin. Then use Ctrl-F or the search feature in your browser to look for "curry powder", for example.

You deserve to have more control over your INR. There's too much ignorance on this topic, and "do not eat curry powder without talking to your doctor" is right up there with not eating the following since 1 tsp. of curry powder contains the same Vitamin K (2 micrograms) as the following foods:

Cookies, oatmeal, commercially prepared, regular, 25 g (one cookie)
Spaghetti with meat sauce, frozen entree, 283 g
Plums - 1 plum
Cream of mushroom soup, canned, prepared with water, 1 cup
LETTUCE, ICEBERG, 8 grams (a small amount; Note: a head has 130 mcg)
Reese's Puffs General Mills cereal, 3/4 cup
Saltines, 4 crackers
...and many, MANY more.

Compare 2 micrograms of Vitamin K in the foods I listed (including curry powder aka source of curcumin) to the levels in kale, spinach, and collard greens: 836-1147 micrograms for one cup.

If you had to talk to your doctor before eating any food on this 22 page PDF list your doctor would lose his or her mind! Concentrate on the high levels and even more importantly, WHICH FOODS YOU EAT A LOT OF. If you are prone to eat 50 saltine crackers at one time, those will have MORE Vitamin K (100 mcg) than a cup of raw broccoli (89 mcg)!

I monitor my INR at home so I also have more control and can test when I choose, which also allows me more flexibility.

Paying it forward... :-)

Links: http://www.ars.usda.gov/Services/docs.htm?docid=8964 and
http://www.ars.usda.gov/Services/docs.htm?docid=22114

In response to the person who mentioned not having seen any Plavix-turmeric connection, I did -- big surprise, as I hadn't yet visited this page. I began bleeding at the slightest scratch, took me a while to figure out what was going on, as I often didn't even feel it. I was taking high-grade capsules -- I wish I could take turmeric instead of Plavix, as I can't use NSAIDs and have arthritis. Hope this provides a clue to someone else . . .

Could using turmeric lead to taking smaller doses of Coumadin ? I know its a balancing act.

People's Pharmacy response: doing the experiment would require very close monitoring!

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