Drug & Food Interactions
- Drug Interactions
- Food Interactions
Several food ingredients may interact with acenocoumarol and affect its anticoagulant property. Changing diet suddenly can affect patient’s international normalized ratio, especially if one begins to eat more vegetables and salads than before. Weight-reducing diet without discussing with physician should not be initiated. A major change in diet means a need for closer monitoring as subsequently acenocoumarol dose may need to be adjusted.
Food products having a high content of vitamin K are known to have adverse interactions with acenocoumarol. The constituents of this group include; egg yolk, liver of chicken, mutton, beef and pork, green leafy vegetables, vegetable oil, pickles, broccoli, and cabbage. The anticoagulant effects of acenocoumarol may be decreased if taken along with foods rich in vitamin K.
As acenocoumarol works by inhibiting the action of vitamin K, changes in dietary intake of vitamin K can alter its effects. Due to this, sudden major changes in diet need to be avoided. Consumption of green tea, salad and green vegetables (e.g. broccoli, brussels sprouts, or spinach), which contain large amounts of vitamin K need to be particularly avoided. Large amounts of green vegetables (more than 500g daily) can reduce the effect of acenocoumarol and hence should be avoided. Changes in consumption of fats and oils can also alter the effect of acenocoumarol, as vitamin K is a fat soluble vitamin.
Content of Vitamin K in various foods
Food products | Low content (20-40% daily value) | Moderate content (40-100% daily value) | High content (>100% daily value) |
---|---|---|---|
Fats and Oils | Corn oil, Sunflower oil, Safflower oil, Peanut oil, Sesame oil | Margarine, Olive oil | Mayonnaise, Soyabean, Canola oil |
Cereals | Bread, Oatmeal, Wheat flour, Rice | ||
Vegetables | Greenbeans, Celery, Corn, Cauliflower, Brinjal, Alfalfa, Cucumber, Potato, Carrots, Mushrooms, Pepper, Pumpkin | Tomato, Asparagus, Avocado, Red cabbage, Green peas, Lettuce (iceberg), Lady finger, Fenugreek (methi), Kelp | Broccoli, Dandelion greens, Sprouts, Collard greens, Kale (raw leaf), Swiss chard, Watercress (raw), Mustard greens (raw), Turnip greens (raw), Lettuce, Brussels, Cabbage, Parsley, Spinach, Spring onion |
Fruits | Apple, Blueberries, Cantaloupe, Grapefruit, Peach | Banana, Grapes, Lemon, Orange | |
Meats | Beef, Ham, Mackerel, Tuna, Chicken, Pork Shrimp, Turkey | ||
Dairy Products | Butter, Sour cream, Cheese-cheddar, Eggs, Yogurt/curd | Egg yolk | Green tea |
Beverages | Coffee, Fruit, juices, Tea (black), Cola, Milk | ||
Pulses | All dals | Cowpea, Soyabean | |
Miscellaneous | Honey, Jelly, Peanut butter, Sugar |
Effects of anticoagulants may be increased with concurrent use of high doses of vitamin E. Hence products rich in vitamin E need to be avoided when on anticoagulant therapy.40
Content of Vitamin E in various foods
Food products41 | Low content (5-10% daily value) | Moderate content (10-30% daily value) | High content (>3% daily value) |
---|---|---|---|
Food Products41
Vegetables |
Pumpkin, Bell peppers, Asparagus Collard greens, Mustard greens | Swiss chard Turnip greens |
Tomato Spinach |
Food Products41
Fruits |
Kiwis, Avocados, Papaya | ||
Food Products41
Fats and Oils |
Olive oil, Sunflower oil | Soyabean oil, Cod liver oil | |
Food Products41
Fish and Meat |
Shell fish, Crab | Prawns | Cod, Tuna |
Food Products41
Miscellaneous |
Sunflower seeds, Almonds, Peanuts, Pine nuts |
Risk of interaction of Acenocoumarol with other food products
Food products41 | Low risk | Moderate risk | High risk |
---|---|---|---|
Food Products41
Alcohol |
Alcohol in moderation | Binge drinking | Chronic daily intake |
Food Products41
Fruit juices |
Grapefruit juice | Cranberry juice | |
Food Products41
Herbs and nutraceuticals |
St John’s wort, Garlic, Ginkgo, Ginseng, Red clover | ||
Food Products41
Miscellaneous |
Coenzyme Q10 | Devils’s claw, Horse chest nut, Kava |
Acenocoumarol’s effect can also be altered by sudden increases or decreases in patient’s body weight. Due to this, sudden major changes in diet during treatment with acenocoumarol should be avoided.
Increased anticoagulant effect may occur in a previously stabilized patient if prolonged malnutrition or vitamin C deficiency develops, or if diarrhea, other illness, or changes in diet resulting in decreased intake or absorption of vitamin K occur during therapy.
Owing to the severe interaction of acenocoumarol with vitamin K containing food products, a vitamin K regulated diet plan is often advised to control increased effectiveness of anticoagulants and severe bleeding episodes.
Sample menu
Breakfast | Lunch | Dinner | Snack |
---|---|---|---|
Orange juice 1/2 cup, Oatmeal 1 cup, Whole wheat toast 2 slices, Butter 1 tsp, Sugar 1 tsp, Skim milk 1 cup, Banana 1 med | Spaghetti with marinara, Sauce 1 1/2 cups, Jello salad 1/2 cup, Italian bread1 slice, Butter 1 tsp, Apple 1 med, Grape juice 1/2 cup, Skim milk 1 cup | Broiled chicken breast 3 oz, Pasta salad 3 oz, Green peas 1/2 cup, Whole wheat roll 1, Pumpernickel bread 1 slice, Butter 1 tsp, Peach cobbler 1/2 cup, Skim milk 1/2 cup | Apple 1 med |
Nutritional content of the sample diet
Calories | 1964 |
Protein | 84 gm |
Carbohydrates | 324 gm |
Fat | 41 gm |
Sodium | 66 mg |
Fiber | 27 gm |