Western medicine joke

It is best not to eat medlar when taking warfarin.

"When people reach middle age, they have to soak in a thermos cup." A joke reflects the pursuit of health preservation by people who pay attention to health at present. Lycium barbarum is a kind of Chinese herbal medicine with high medicinal value, which has a high nourishing effect and is deeply loved by middle-aged and elderly people. But for patients who need to take warfarin for anticoagulant therapy, eating Lycium barbarum is not only unhealthy, but also may affect the curative effect. Recently, a case report published in the European Heart Journal warned that patients taking warfarin had better not eat Lycium barbarum.

Lycium barbarum can significantly enhance the anticoagulant effect of warfarin.

It is reported that a 75-year-old female patient went to the emergency room due to syncope. The patient underwent mitral valve replacement 3 years ago and took warfarin orally after operation. The international normalized ratio (INR) is 2.5-3.5. Two years ago, he took flucaine to treat atrial premature beats; I felt dizzy, nauseous and extremely tired two days ago. INR was 7. 18 at admission, and the electrocardiogram showed polymorphic ventricular tachycardia.

Upon inquiry, the patient recently drank 1~2 cups of wolfberry tea every day. However, Lycium barbarum has inhibitory effects on drug metabolism enzymes CYP450 (inhibiting more than 75% of enzyme activity) and CYP2C9 (inhibiting 50%~60% of enzyme activity), and the latter is related to the metabolism of warfarin. The author points out that patients taking warfarin should not drink wolfberry tea. The patient's polymorphic ventricular tachycardia may be related to the toxicity of flucaine. Because Lycium barbarum can inhibit CYP2D6, CYP2D6 is closely related to the metabolism of fluorine dogs.

In fact, there are many case reports about the interaction between Lycium barbarum and warfarin. China, a 6 1 year-old woman, received anticoagulation therapy and the INR was stable. Later, after drinking a herbal tea made of Lycium barbarum (3~4 cups a day), INR increased to 4. 1, and other drugs or lifestyle did not change. There is also an 80-year-old woman who has been taking a stable dose of warfarin for a long time, but after drinking herbal tea containing Lycium barbarum, INR has tripled. The author thinks that taking Lycium barbarum in large dose (above 6 ~ 12g) can significantly enhance the anticoagulant effect of warfarin.

Taking warfarin should avoid eating a lot of green leafy vegetables.

Warfarin, as the most widely used oral anticoagulant, can prevent the formation and development of thrombus, but its curative effect will be greatly reduced if some food and drugs are not avoided.

The mechanism of warfarin is to antagonize the anticoagulant effect of vitamin K, which can reverse or weaken the anticoagulant effect of warfarin by promoting the synthesis of the above coagulation factors.

That is to say, before and after taking warfarin, you should avoid eating a lot of green leafy vegetables, including leeks, spinach, asparagus, amaranth, cabbage, green beans, mustard greens, spinach, bean sprouts and so on.

Besides food, warfarin also interacts with many drugs, such as phenobarbital, phenytoin sodium, carbamazepine, chlorthalidone, spironolactone, glimepiride, rifampicin, oral contraceptives, estrogen and so on. Among Chinese herbal medicines, there are Salvia miltiorrhiza, Angelica sinensis, Ginkgo biloba and so on. These will weaken the anticoagulant effect of warfarin, so try not to take them together.

Of course, when taking warfarin, it is not to say that you don't eat a bite of vegetables, but to control the amount and avoid eating a lot at once. At the same time, patients should be monitored regularly and the dose of warfarin should be adjusted in time. If the dose of warfarin is insufficient, embolism cannot be prevented; Taking too much can cause bleeding, so take it carefully in strict accordance with the doctor's advice.