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Category Archives: Blood Clot

Grapefruit and grapefruit juice are an excellent source of many nutrients that contribute to a healthy diet. Grapefruit is a good source of vitamin C, fiber, and the pink and red hues contain the beneficial antioxidant lycopene, thought to have a role in preventing various diseases such as cancer and heart disease. Studies have shown that grapefruit helps lower cholesterol, and there is evidence that the seeds have antioxidant properties.

However, there are compounds in grapefruit called furanocoumarins that can interfere with the way your body metabolizes certain medications. This can lead to dangerously high levels of medication in the body and may increase the risk of rare but serious or life-threatening side effects such as slowed heart rate and muscle deterioration. For a few medications, it can lead to decreased effectiveness because these medications need to be metabolized in order to become active. Don’t take these interactions lightly, as some can cause potentially dangerous health problems.

Both grapefruit juice (either fresh or frozen) and the fruit itself can affect certain medications and the effects have been seen with as little as one 8-ounce (250 mL) glass of grapefruit juice. The effects of grapefruit juice on medications can last up to 3 days, so taking them at different times of day will not help. Naturally sweet orange juice has not been shown to affect medications the way grapefruit juice does, but tangelos (which are related to grapefruit), lime juice, andSeville(sour) oranges may affect medications.

Many medications may be affected by grapefruit juice, including medications for:

Allergies Fexofenadine (Allegra)
Anticoagulation Dabigatran (Pradax)
Anxiety/Sleep Buspirone (BuSpar), Diazepam (Valium), Triazolam (Halcion), Alprazolam (Xanax), Clonazepam (Rivotril)
Arrhythmia Amiodarone (Cordarone)
Blood Pressure Amlodipine (Norvasc), Felodipine (Renedil, Plendil), Nifedipine (Adalat)
Cholesterol Simvastatin (Zocor), lovastatin (Mevacor), atorvastatin (Lipitor)
Depression Sertraline (Zoloft)
HIV Saquinavir (Invirase, Fortovase), indinavir (Crixivan)
Seizures/Epilepsy Carbamazepine (Tegretol, Mazepine), Clonazepam (Rivotril)
Sexual Dysfunction Sildenafil (Viagra), Taldafil (Cialis)
Transplants/Autoimmune Diseases Cyclosporine (Neoral, Sandimmune), tacrolimus (Prograf, Advagraf), sirolimus (Rapamune)

This is not a complete list; grapefruit juice may affect medications for conditions other than those listed here. Also, if you are taking any natural health products, check the labels to see if they contain grapefruit, tangelo, Seville orange, or lime juice. Avoid these fruits and juices until your doctor or pharmacist has told you it’s safe to have them.

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There has been a new drug approved to prevent blood clots in people with atrial fibrillation.  Atrial fibrillation is a condition where the heart beats too quickly.  Sometimes this can result in pooling of blood in one of the chambers of the heart which can lead to a blood clot.  This clot can travel to the brain or the lungs and cause a stroke or other serious medical problems.  Traditionally people have taken warfarin to prevent these clots, another drug Pradax is now available.

There are some distinct benefits of Pradax over warfarin and it may be worthwhile to discuss these with your physician.

Warfarin requires frequent monitoring in the form of a blood test called INR testing.  This is not needed with Pradax.  This makes Pradax a great deal more convenient for patients who have difficulty getting to the lab, and for those patients whose INR is hard to control.  This also cuts down on the frequent change of dosing some patients experience with warfarin.

Pradax may also be better at preventing strokes than warfarin.  It is less likely than warfarin to cause bleeding in the brain, (a rare but serious downside of anticoagulants), and it is less likely to interact with medicines and food.

There are however some drawbacks to consider.  Pradax is more expensive than warfarin.  It costs about $120.00 a month.  Warfarin is much less and is covered by the senior’s drug plan.  As of yet Pradax is not covered by the Ontario Drug Benefit Program, but it may be covered by some private insurers.  It may be worth a call to your insurance company to see if it is covered under your plan.

Pradax is taken twice daily as opposed to once daily for warfarin.  It is more important to not miss a dose as this can increase your risk for stroke.

Pradax is also more likely than warfarin to cause heartburn or a stomachache.  Pradax may also cause bleeding in the stomach more often than warfarin.

Pradax capsules need to be kept in their moisture resistant packaging.  Once they are open the tablets are only good for 30 days.  There are no such storage requirements for warfarin.

Pradax may be a good drug for some people.  If you are having trouble keeping your INR at the right therapeutic range and you need frequent dose changes of your medication, you should talk to your doctor or pharmacist about this medication.