Health
October 10, 2008 01:43 PM
beingwell magazine Fall 2008
I have recently started taking Warfarin (Coumadin). I read on the Internet that I have to avo_id alcohol as well as certain foods, especially green leafy vegetables. Is that right? Also, what is the average dose of Warfarin? I am taking 17 mg, is that too much?
Green leafy vegetables are often high in vitamin K. Because Warfarin works by decreasing the activity of vitamin K (a vitamin that is important in the formation of blood clots), it was previously thought that patients on Warfarin should avoid foods rich in vitamin K.
Studies now show that it is not necessary to avoid these foods. In fact, eating green leafy vegetables regularly can help keep Warfarin effect stable. What you need to do is avoid significant changes in your diet, unless approved by a qualified health care provider.
Alcohol can increase Warfarin effect and also the risk of falls. That is why it is advisable to limit your alcohol intake to less than two drinks (two ounces) per day. Most importantly, do not suddenly drink a large amount of alcohol as this will definitely affect how the Warfarin works in your body.
In general, to keep Warfarin effect stable, ask your doctor or pharmacist before taking any prescription drug, multivitamin, antibiotic or any other herbal or OTC medication.
There is no such thing as an average dose of Warfarin. The dose that keeps your INR (the measurement done by the laboratory) in the therapeutic range, between two and three for most patients, is an appropriate dose. There is a very large range in Warfarin dosing. Some patients require as little as 0.5 mg to keep their INR therapeutic, some require more than 20 mg.
You are a pharmacist in the hospital? Do you work in the drugstore there?
If you have not been a patient in the hospital, you may not have met a “hospital pharmacist” before. Southlake Regional Health Centre has a pharmacy services department of more than 50 people.
A pharmacist reviews every medication order for accuracy and safety. The doses are then sent from the pharmacy to the nursing unit, and the nurse will administer the medication to the patient.
For every patient in the hospital there is a specific labelled drawer containing only that patient’s medications. Every tablet or capsule is individually packaged and labelled and all liquids are provided in the exact patient dose by the pharmacy. The pharmacy technicians are responsible for this service.
You may meet the pharmacist when you are being admitted to the hospital through the emergency department to review your medication history, we may come see you in your room to talk about your home medications or to introduce new medications, or you may see us at your discharge to review the changes in your prescriptions before you leave the hospital.
At Southlake we have a new, progressive role for one of our pharmacists in the cardiovascular surgery preoperative clinic. She works under a medical directive with the physicians to prescribe or adjust certain medications to properly prepare patients for their cardiac surgery.
I was started on a cholesterol lowering medication (a statin). While on vacation in Florida I saw a commercial on television stating that these medications can cause serious muscle cramping. Should I be worried? What do these muscle aches feel like?
It is important to look at the risk of any side effect compared with the benefits of avoiding cardiovascular complications. These drugs have proven efficacy in reducing cardiovascular events (cardiovascular death, heart attacks, heart failure) by more than 20 per cent and are well tolerated by most patients. Muscle cramping occurs in about 10 per cent of patient taking statins. Most of these are harmless.
Some patients may experience more serious muscle cramping that may lead to muscle break down. (This is extremely rare, 0.01 per cent.) Speak to your family doctor if you have concerns. There is a lab test that can distinguish the type of muscle cramping you are having.
Factors that increase risk of muscle cramps include: age (especially older than 80 years, women more than men), small body frame and frailty, multiple medications, use of certain other medications and poor health.
Symptoms of statin-induced muscle aches include any combination of muscle pain, tenderness or weakness. Patients describe an aching or cramping sensation in their muscles, particularly the thighs and trunk. Tendon pain and nighttime leg cramps may happen. Muscle symptoms are usually worse with exercise. Some patients describe difficulty opening jars and snapping their fingers. In the elderly, muscle aches may seem like increasing weakness rather than pain. The muscle aches usually occur within one to six months of starting the medication but can present at any time.
As in all treatment decisions, the potential benefits of therapy must outweigh the risks. In the case of statin therapy the benefit/risk ratio is overwhelmingly positive.
Your questions answered by the Inpatient Pharmacy Team, Southlake Regional Health Centre
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