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Is Cranberry Juice Risky With Blood Thinner?

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Q. Is it true that you should not drink cranberry juice if you are on Coumadin to thin the blood?

A. Several years ago British regulatory authorities issued a warning to patients taking warfarin (Coumadin) not to drink cranberry juice. This combination was associated with excessive bleeding and one man died. An article in the British Medical Journal (BMJ) suggested that patients taking warfarin would be prudent to limit their cranberry juice consumption.

Since that initial publication, there have been other reports of interactions and contradictions. This interaction remains somewhat controversial. One study showed that two cups of cranberry juice a day did not lead to bleeding worries. But there is a case of a man who died after drinking a substantial amount of cranberry juice daily after two weeks. The cause was internal hemorrhage linked to an interaction with his blood thinner warfarin.

The most recent reference is another case report in which a person twice experienced elevated INR (a measure of blood thinning) after drinking cranberry juice cocktail.

Our standard reference for drug interactions, Drug Interaction Facts, recommends that people should avoid drinking large amounts of cranberry juice if they are on warfarin.

You can access our free Guide to Coumadin (Warfarin) Interactions here.

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12 Comments

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I think that anyone should not take medication with any kind of juice, only with water and wait a couple hours after taking medication to drink any juice, milk or sodas & also herbs/supplements/spices etc...Dr.'s still don't know many things about medications side effects/reactions/interactions etc...

What about other blood thinners, like Plavix and Effient?

People's Pharmacy response: They aren't expected to interact with cranberry juice.

I have been on coumadin (warfarin) for 21 years now due to Factor 5 Leiden and will remain on it for the duration of my life. I don't drink sodas and find other fruit juices too sweet but drink at least one 8-ounce glass of cranberry juice cocktail each day. My INR is fairly stable (it reacts more to the leafy green vegetables) and have not had any problems with my protimes or INR numbers being excessively high. I think the key is moderation.

People's Pharmacy response: Moderation is the first key, and the second is consistency. You have embraced both.

Does this include cranberry pills? I've been taking these for years to avoid bladder infections.

In the case of Coumadin....my husband had a
Serious internal bleeding because he was on
THREE THINNERS AT THE SAME TIME.
He was taking Coumadin--Aspirin--& Plavix.
He was hospitalized with serious internal
Bleeding. People MUST be aware of excess
Blood thinners.

I am glad to see the new posts coming in about cranberry juice and blood thinners. In my initial post I should have made it clear that my primary care doctor was (is) aware that I drink cranberry juice regularly, and she has gone over the caveats with me. I never drink any kind of juice when taking my medications and follow the doctor's instructions as to with/without food as well.

I have never been on any blood thinner other than coumadin. For anyone who takes the cranberry supplements or drinks it while using other kinds of blood thinners I would strongly suggest you have a discussion about it with your doctor. I was only speaking in regards to my own experiences.

Really - the Cranberry Concentrate Pills changed my life. I would get extremely painful UTIs at least once every couple of months. That meant doctor's visits and urine cultures, and antibiotics. Nobody wants to take that many antibiotics!!

I tried Cranberry pills rather than go on prophylaxis and they work! I don't know how, but they do. I take one in the morning and one in the afternoon and stay as hydrated as possible, and I have been UTI free! Definitely worth the money.

I have Multiple Bilateral Pulmonary embolisms....and I would like to share the episode I had when I drank just a 12 oz serving of cranberry grape juice. It was horrid and sent my INR level to a 16.4...the previous day check was only like 6.5, not theraputic, but not a deadly 16 either.

I am on Coumadin (warfarin) as most of you are. PLEASE speak to your physician before venturing on any new endeavor regardless of how "successfull" you've heard it to be for others. We all are different, hence, some are adversly affected while others are not.

The best advice is not to give advice about what is good for you and suggest it to another. Safety please...this is nothing we should toy with.

Speedy recoveries to us all!!

My INR bounces between 3 and 1.8 for no apparent reason. I've taken other people's word for it about spinach and broccoli. I'm reasonably sure I shouldn't eat cabbage, but other than that, nothing I eat seems to have much correlation with any change in INR. I had been avoiding cranberry juice. Since the evidence of likely harm doesn't look all that convincing, I think I'll stop worrying about that and see what happens.

I have been taking warfarin for a long time and am just now finding out that cranberry juice can control the effects of the drug. I have taken a lot of prednisone during this time and was blaming it for all of the high readings. Now, come to think of it I do believe cranberry juice may have been the problem. I will tell my coumadin nurse and see what she has to say about the problem. Maybe we can get the darn stuff regulated. I did have all of the warfarin side affects.

I was diagnosed with Antiphospholipid syndrome in 1999, and frequently have DVTs in my lower extremities. I have been taking coumadin (warfarin) ever since. PT/INR blood levels are drawn weekly, and my INR consistently runs between 1.5-2 on a steady dose of 12mg daily. I am susceptible to repetitive UTIs. Whenever UTI symptoms begin to manifest I drink large amounts of cranberry juice, and when I do my INR increases to 6.7 - 11.2.

Despite the lack of official research findings to substantiate interactions between cranberries/cranberry juice and coumadin (warfarin), and its effect on plasma levels of the drug, I am thoroughly convinced that there is indeed an interaction. The high level of antioxidants called flavonoids contained in cranberry juice may inhibit the function of the enzymes that break down warfarin in the body, causing the drug to remain longer than usual. This theory would support the fact that the only time my INR levels reach dangerous levels is when I drink cranberry or cran-grape juice.

Therefore, I would encourage patients taking coumadin (warfarin) to carefully weigh the potential risks of anticoagulation therapy against its potential benefits.

The interaction happens no matter when you drink the cranberry juice it still interacts with the warfarin. Not drinking juice while taking medication.

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