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Search Health Information    Warfarin

Topic Contents

Warfarin

Drug Information

Warfarin is an anticoagulant (slows blood clotting) used to prevent and treat people with venous thrombosis (blood clots in the veins) and pulmonary embolism (blood clots in the lungs). Warfarin is also used to treat or prevent dangerous blood clotting in people with atrial fibrillation (an irregularity in heartbeat) and, in some cases, to prevent stroke .

Common brand names:

Coumadin, Jantoven

Summary of Interactions with Vitamins, Herbs, & Foods

Types of interactions: Beneficial Adverse Check

Replenish Depleted Nutrients

  • none

Reduce Side Effects

  • none

Support Medicine

  • none

Reduces Effectiveness

  • Coenzyme Q10

    Coenzyme Q10 (CoQ10) is structurally similar to vitamin K and may affect blood coagulation.1 Four case reports describe possible interference by CoQ10 with warfarin activity.2 , 3 , 4 It remains unknown how common or rare this interaction is. Those taking warfarin should only take CoQ10 with the guidance of their doctor.

  • Glucosamine
    There have been more than 20 case reports in which the use of glucosamine was associated with an apparent decrease in the efficacy of warfarin (as demonstrated by an increase in the International Normalized Ratio [INR]).5 Because INR values can fluctuate randomly, controlled trials are needed to determine whether the increased INR values in these case reports were caused by glucosamine. Nevertheless, people taking warfarin should not take glucosamine without consulting their doctor.
  • Green Tea

    One man taking warfarin and one-half to one gallon of green tea (Camellia sinensis) per day developed signs based on laboratory testing suggesting his blood was too thick because the green tea was blocking the effect of warfarin.6 Removal of the green tea caused normalization of his blood tests. Those taking green tea and warfarin together should have their blood monitored regularly to avert any problems and should consult with a doctor, healthcare practitioner and/or pharmacist before taking any medication.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Iron

    Iron , magnesium , and zinc may bind with warfarin, potentially decreasing their absorption and activity.7 People on warfarin therapy should take warfarin and iron/magnesium/zinc-containing products at least two hours apart.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Magnesium

    Iron , magnesium , and zinc may bind with warfarin, potentially decreasing their absorption and activity.8 People on warfarin therapy should take warfarin and iron/magnesium/zinc-containing products at least two hours apart.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • St. John’s Wort

    According to a preliminary report, volunteers taking 900 mg per day of St. John’s wort were given a single dose of an anticoagulant similar in action to warfarin.9 There was a significant drop in the amount of the drug measured in the blood. Seven case studies reported to the Medical Products Agency in Sweden also found a decrease in the anticoagulant activity of warfarin when St. John’s wort was taken at the same time.10 This may have occurred because certain chemicals found in St. John’s wort activate liver enzymes that are involved in the elimination of some drugs.11 , 12 People taking warfarin should consult with their doctor before taking St. John’s wort.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Zinc

    Iron , magnesium , and zinc may bind with warfarin, potentially decreasing their absorption and activity.13 People on warfarin therapy should take warfarin and iron/magnesium/zinc-containing products at least two hours apart.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Potential Negative Interaction

  • American Ginseng

    In a study of healthy human volunteers, supplementing with American ginseng reduced warfarin's anticoagulant effect, apparently by stimulating the body to accelerate the metabolism of warfarin.14 People taking warfarin should not take American ginseng, unless supervised by a doctor.

  • Cranberry

    There have been at least five case reports suggesting that cranberry juice increases the activity of warfarin, possibly by inhibiting the breakdown of warfarin in the body.15 Because of this potential interaction, people taking warfarin should avoid, or limit the intake of, cranberry juice. The U.K. Medicines Authority has advised people taking warfarin to avoid cranberry juice.

  • Dan Shen

    Dan shen (Salvia miltiorrhiza), a Chinese herb, was associated with increased warfarin activity in several cases.16 , 17 , 18 , 19 Dan shen should only be used under close medical supervision by people taking warfarin. Sage  (Salvia officinalis), a plant relative of dan shen found in the West, is not associated with interactions involving warfarin.

  • Grapefruit Seed Extract

    In case reports, ingestion of grapefruit seed extract interfered with the effect of warfarin.20 This inhibitory effect appeared to be due to benzethonium chloride, a synthetic preservative that is added to most grapefruit seed extract products.

  • Reishi

    As it may increase bleeding time, reishi (Ganoderma lucidum) is not recommended for those taking anticoagulant (blood-thinning) medications.21

  • Asian Ginseng

    Asian ginseng was associated with a decrease in warfarin activity in a case report.22 However, in a clinical trial, no interaction was seen between Asian ginseng and warfarin.23 An animal study also found no significant interaction between warfarin and pure ginseng extract.24 Nevertheless, persons taking warfarin should consult with a physician knowledgeable about botanical medicines if they are considering taking Asian ginseng or eleuthero /Siberian ginseng (Eleutherococcus senticosus). A 1999 animal study did not reveal any significant interaction between warfarin and pure ginseng extract.25

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Devil’s Claw

    Devil’s claw (Harpagophytum procumbens) was associated with purpura (bleeding under the skin) in a patient treated with warfarin.26 However, key details in this case—including other medications taken and the amounts and duration of warfarin and devil’s claw taken—were not reported, making it impossible to evaluate this reported interaction. Until more is known, people taking warfarin should avoid taking devil’s claw.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Dong Quai

    A 46-year-old woman taking warfarin experienced increased strength of the anticoagulant properties of the drug after starting to use dong quai (Angelica sinensis) for menopause.27 The daily amount of dong quai was 1,130–2,260 mg per day. Her bleeding tendency returned to normal after discontinuing the dong quai. While little is known about the potential interaction of dong quai and warfarin, women should discuss the use of the herb with a healthcare professional if they are taking an anticoagulant drug and wish to use dong quai.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Feverfew

    Although there are no documented cases of feverfew (Tanacetum parthenium) interacting with warfarin in humans, feverfew has been shown to interfere with certain aspects of blood clotting in test tube studies.28 , 29 , 30

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Garlic

    Garlic (Allium sativum) has been shown to help prevent atherosclerosis (hardening of the arteries), perhaps by reducing the ability of platelets to stick together.31 This can result in an increase in the tendency toward bleeding.32 Standardized extracts have, on rare occasions, been associated with bleeding in people.33 Garlic extracts have also been associated with two human cases of increased warfarin activity.34 The extracts were not definitively shown to be the cause of the problem. People taking warfarin should consult with a doctor before taking products containing standardized extracts of garlic or eating more than one clove of garlic daily.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Ginger

    Ginger has been shown to reduce platelet stickiness in test tubes. Although there are no reports of interactions with anticoagulant drugs, people should consult a healthcare professional if they are taking an anticoagulant and wish to use ginger.35

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Ginkgo

    Ginkgo extracts may reduce the ability of platelets to stick together, possibly increasing the tendency toward bleeding.36 Standardized extracts of ginkgo have been associated with two cases of spontaneous bleeding, although the ginkgo extracts were not definitively shown to be the cause of the problem.37 , 38 There are two case reports of people taking warfarin in whom bleeding occurred after the addition of ginkgo.39 , 40 People taking warfarin should consult with a physician knowledgeable about botanical medicines if they are considering taking ginkgo.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Goji Berry

    There is one reported case of increased bleeding tendency in a woman taking warfarin who also drank 3 to 4 glasses per day of goji berry tea.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Herbs with Coumarin-Derivatives

    Although there are no specific studies demonstrating interactions with anticoagulants, the following herbs contain coumarin-like substances that may interact with warfarin and may cause bleeding.41 These herbs include angelica root, arnica flower, anise, asafoetida, celery, chamomile , corn silk, fenugreek , horse chestnut , licorice root, lovage root, parsley, passion flower herb, quassia, red clover , rue, sweet clover, and sweet woodruff. Dong quai contains at least six coumarin derivatives, which may account for the interaction noted above. People should consult a healthcare professional if they are taking an anticoagulant and wish to use one of these herbs.

    There is one case report in which ingestion of a Chinese herbal tea made from Lycium barbarum appeared to interfere with the effect of warfarin.42

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Papain

    Papain, an enzyme extract of papaya, was associated with increased warfarin activity in one patient.43 Persons taking warfarin should avoid papain supplements until further information about this potential interaction becomes available.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Quilinggao

    There is one published case report in which the Chinese herbal product quilinggao increased the action of warfarin and apparently contributed to a bleeding episode.44 There are many different brands of quilinggao, and the composition varies between manufacturers. Individuals taking warfarin should not take quilinggao.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Vitamin D

    In 1975, a single letter to the Journal of the American Medical Association suggested that vitamin D increases the activity of anticoagulants and that this interaction could prove dangerous.45 However, there have been no other reports of such an interaction, even though tens of millions of people are taking multivitamins that contain vitamin D. Most doctors typically do not tell patients taking anticoagulant medications to avoid vitamin D.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Explanation Required 

  • Bromelain

    In theory, bromelain might enhance the action of anticoagulants. This theoretical concern has not been substantiated by human research, however.46

  • Eleuthero

    Asian ginseng was associated with a decrease in warfarin activity in a case report.47 However, in a clinical trial, no interaction was seen between Asian ginseng and warfarin.48 An animal study also found no significant interaction between warfarin and pure ginseng extract.49 Nevertheless, persons taking warfarin should consult with a physician knowledgeable about botanical medicines if they are considering taking Asian ginseng or eleuthero /Siberian ginseng (Eleutherococcus senticosus). A 1999 animal study did not reveal any significant interaction between warfarin and pure ginseng extract.50

  • Maitake

    In a case report, ingestion of a maitake extract appeared to enhance the effect of warfarin in an elderly man. Although a cause-effect relation was not demonstrated, people taking warfarin should not take maitake without medical supervision.51

  • Olestra

    The FDA-approved fat substitute, olestra, interferes with fat absorption, including the absorption of fat-soluble vitamins. Vitamin K , a fat-soluble vitamin, is added to olestra to offset this adverse effect.52 Since vitamin K interferes with the activity of warfarin, eating snacks containing olestra may also interfere with the drug’s activity. The impact of eating snacks containing olestra has not been evaluated in people taking warfarin. However, until more is known, it makes sense for people taking warfarin to avoid olestra-containing foods.53

  • Vitamin C

    Although case reports have suggested that vitamin C might increase the activity of anticoagulants in a potentially dangerous way, this interaction has not been confirmed in research studies.54 In fact, a possible interference by vitamin C with the effect of anticoagulants has also been reported.55 A 52-year-old woman maintained on 7.5 mg of warfarin per day had a shortening of the blood clotting time which was not corrected by increasing warfarin up to 20 mg per day. Further questioning revealed she had begun taking an unspecified amount of vitamin C each morning. After stopping vitamin C, the blood clotting time returned to desired levels. Based on this and other case reports, people taking warfarin should consult with their physician before taking vitamin C supplements.

  • Vitamin K

    Warfarin slows blood clotting by interfering with vitamin K activity. Since vitamin K reverses the anticoagulant effects of warfarin,56 people taking warfarin should avoid vitamin K-containing supplements unless specifically directed otherwise by their prescribing doctor. Some vegetables (broccoli, Brussels sprouts, kale, parsley, spinach, and others) are high in vitamin K. Eating large quantities57 or making sudden changes in the amounts eaten of these vegetables can interfere with the effectiveness and safety of warfarin therapy. The greener the plant, the higher the vitamin K content.58 Other significant dietary sources of vitamin K include soybean oil, olive oil, cottonseed oil, and canola oil.59

    Vitamin K supplementation can be used, however, to counteract an overdose of warfarin.60 In addition, controlled and continuous supplementation with vitamin K (100 to 150 mcg per day) has been used effectively to reduce the fluctuations in dosage requirement that occur in some people taking warfarin or related drugs that have the same action as warfarin.61 , 62 , 63 Such treatment requires a doctor's supervision.

  • High-Protein

    Some vegetables (broccoli, Brussels sprouts, kale, parsley, spinach, and others) are high in vitamin K. Eating large quantities64 or making sudden changes in the amounts eaten of these vegetables, interferes with the effectiveness and safety of warfarin therapy. Eating charbroiled food may decrease warfarin activity,65 while eating cooked onions may increase warfarin activity.66Soy foods have been reported both to increase67 and to decrease68 warfarin activity. The significance of these last three interactions remains unclear.

    Preliminary evidence suggests that frequent consumption of mangoes may interfere with the effect of warfarin.69

    There is one preliminary report in which a high-protein, low-carbohydrate diet appeared to interfere with the effect of warfarin in two people.70 While additional research is needed to confirm that observation, people taking warfarin should consult their doctor before making large changes in the amount of protein they eat.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Low-Carbohydrate

    Some vegetables (broccoli, Brussels sprouts, kale, parsley, spinach, and others) are high in vitamin K. Eating large quantities78 or making sudden changes in the amounts eaten of these vegetables, interferes with the effectiveness and safety of warfarin therapy. Eating charbroiled food may decrease warfarin activity,79 while eating cooked onions may increase warfarin activity.80Soy foods have been reported both to increase81 and to decrease82 warfarin activity. The significance of these last three interactions remains unclear.

    Preliminary evidence suggests that frequent consumption of mangoes may interfere with the effect of warfarin.83

    There is one preliminary report in which a high-protein, low-carbohydrate diet appeared to interfere with the effect of warfarin in two people.84 While additional research is needed to confirm that observation, people taking warfarin should consult their doctor before making large changes in the amount of protein they eat.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Mango

    Some vegetables (broccoli, Brussels sprouts, kale, parsley, spinach, and others) are high in vitamin K. Eating large quantities92 or making sudden changes in the amounts eaten of these vegetables, interferes with the effectiveness and safety of warfarin therapy. Eating charbroiled food may decrease warfarin activity,93 while eating cooked onions may increase warfarin activity.94Soy foods have been reported both to increase95 and to decrease96 warfarin activity. The significance of these last three interactions remains unclear.

    Preliminary evidence suggests that frequent consumption of mangoes may interfere with the effect of warfarin.97

    There is one preliminary report in which a high-protein, low-carbohydrate diet appeared to interfere with the effect of warfarin in two people.98 While additional research is needed to confirm that observation, people taking warfarin should consult their doctor before making large changes in the amount of protein they eat.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Onions

    Some vegetables (broccoli, Brussels sprouts, kale, parsley, spinach, and others) are high in vitamin K. Eating large quantities99 or making sudden changes in the amounts eaten of these vegetables, interferes with the effectiveness and safety of warfarin therapy. Eating charbroiled food may decrease warfarin activity,100 while eating cooked onions may increase warfarin activity.101Soy foods have been reported both to increase102 and to decrease103 warfarin activity. The significance of these last three interactions remains unclear.

    Preliminary evidence suggests that frequent consumption of mangoes may interfere with the effect of warfarin.104

    There is one preliminary report in which a high-protein, low-carbohydrate diet appeared to interfere with the effect of warfarin in two people.105 While additional research is needed to confirm that observation, people taking warfarin should consult their doctor before making large changes in the amount of protein they eat.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers’ package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a new supplement with your doctor or pharmacist.

References

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42. Lam AY, Elmer GW, Mohutsky MA. Possible interaction between warfarin and Lycium barbarum L. Ann Pharmacother 2001;35:1199-201.

43. Shaw D et al. Traditional remedies and food supplements: a 5-year toxicological study (1991-1995). Drug Safety 1997;17:342-56.

44. Wong ALN, Chan TYK. Interaction between warfarin and the herbal product quilinggao. Ann Pharmacother 2003;37:836-8.

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47. Janetzky K, Morreale AP. Probable interaction between warfarin and ginseng. Am J Health Syst Pharm 1997;54:692-3.

48. Lee SH, Ahn YM, Ahn SY, et al. Interaction between warfarin and Panax ginseng in ischemic stroke patients. J Altern Complement Med 2008;14:715-21.

49. Zhu M, Chan KW, Ng LS, et al. Possible influences of ginseng on the pharmacokinetics and pharmacodynamics of warfarin in rats. J Pharm Pharmacol 1999;51:175-80.

50. Zhu M, Chan KW, Ng LS, et al. Possible influences of ginseng on the pharmacokinetics and pharmacodynamics of warfarin in rats. J Pharm Pharmacol 1999;51:175-80.

51. Hanselin MR. Vande Griend JP, Linnebur SA. INR elevation with maitake extract in combination with warfarin. Ann Pharmacother 2010;44:223-4.

52. Food additives for direct addition to food for human consumption; olestra; final rule. 21 Federal Register 1996:3118-73.

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55. Rosenthal G. Interaction of ascorbic acid and warfarin. JAMA 1971;215:1671.

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57. Harris JE. Interaction of dietary factors with oral anticoagulants: Review and application. J Am Diet Assoc 1995;95:580-4.

58. Kodaka K, Ujiie T, Ueno T, Saito M. Contents of vitamin K1 and chlorophyll in green vegetables. J Jpn Soc Nutr Food Sci 1986;39:124-6.

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60. Weibert RT, Le DT, Kayser SR, Rapaport SI. Correction of excessive anticoagulation with low-dose oral vitamin K1. Ann Intern Med 1997;125:959-62.

61. Reese AM, Farnett LE, Lyons RM, et al. Low-dose vitamin K to augment anticoagulation control. Pharmacotherapy2005;25:1746-51.

62. Sconce E, Avery P, Wynne H, Kamali F. Vitamin K supplementation can improve stability of anticoagulation for patients with unexplained variability in response to warfarin. Blood 2007;109:2419-23.

63. Rombouts EK, Rosendaal FR, Van Der Meer FJM. Daily vitamin K supplementation improves anticoagulant stability. J Thromb Haemost 2007;5:2043-8.

64. Harris JE. Interaction of dietary factors with oral anticoagulants: Review and application. J Am Diet Assoc 1995;95:580-4.

65. Holt GA. Food & Drug Interactions. Chicago: Precept Press, 1998, 293.

66. Holt GA. Food & Drug Interactions. Chicago, Precept Press, 1998, 284-5.

67. Holt GA. Food & Drug Interactions. Chicago, Precept Press, 1998, 284-5.

68. Cambria-Kiely JA. Effect of soy milk on warfarin efficacy. Ann Pharmacother2002;36:1893-6.

69. Monterrey-Rodriguez J. Interaction between warfarin and mango fruit. Ann Pharmacother 2002;36:940-1.

70. Beatty SJ, Mehta BH, Rodis JL. Decreased warfarin effect after initiation of high-protein, low-carbohydrate diets. Ann Pharmacother 2005;39:744-7.

71. Harris JE. Interaction of dietary factors with oral anticoagulants: Review and application. J Am Diet Assoc 1995;95:580-4.

72. Holt GA. Food & Drug Interactions. Chicago: Precept Press, 1998, 293.

73. Holt GA. Food & Drug Interactions. Chicago, Precept Press, 1998, 284-5.

74. Holt GA. Food & Drug Interactions. Chicago, Precept Press, 1998, 284-5.

75. Cambria-Kiely JA. Effect of soy milk on warfarin efficacy. Ann Pharmacother2002;36:1893-6.

76. Monterrey-Rodriguez J. Interaction between warfarin and mango fruit. Ann Pharmacother 2002;36:940-1.

77. Beatty SJ, Mehta BH, Rodis JL. Decreased warfarin effect after initiation of high-protein, low-carbohydrate diets. Ann Pharmacother 2005;39:744-7.

78. Harris JE. Interaction of dietary factors with oral anticoagulants: Review and application. J Am Diet Assoc 1995;95:580-4.

79. Holt GA. Food & Drug Interactions. Chicago: Precept Press, 1998, 293.

80. Holt GA. Food & Drug Interactions. Chicago, Precept Press, 1998, 284-5.

81. Holt GA. Food & Drug Interactions. Chicago, Precept Press, 1998, 284-5.

82. Cambria-Kiely JA. Effect of soy milk on warfarin efficacy. Ann Pharmacother2002;36:1893-6.

83. Monterrey-Rodriguez J. Interaction between warfarin and mango fruit. Ann Pharmacother 2002;36:940-1.

84. Beatty SJ, Mehta BH, Rodis JL. Decreased warfarin effect after initiation of high-protein, low-carbohydrate diets. Ann Pharmacother 2005;39:744-7.

85. Harris JE. Interaction of dietary factors with oral anticoagulants: Review and application. J Am Diet Assoc 1995;95:580-4.

86. Holt GA. Food & Drug Interactions. Chicago: Precept Press, 1998, 293.

87. Holt GA. Food & Drug Interactions. Chicago, Precept Press, 1998, 284-5.

88. Holt GA. Food & Drug Interactions. Chicago, Precept Press, 1998, 284-5.

89. Cambria-Kiely JA. Effect of soy milk on warfarin efficacy. Ann Pharmacother2002;36:1893-6.

90. Monterrey-Rodriguez J. Interaction between warfarin and mango fruit. Ann Pharmacother 2002;36:940-1.

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95. Holt GA. Food & Drug Interactions. Chicago, Precept Press, 1998, 284-5.

96. Cambria-Kiely JA. Effect of soy milk on warfarin efficacy. Ann Pharmacother2002;36:1893-6.

97. Monterrey-Rodriguez J. Interaction between warfarin and mango fruit. Ann Pharmacother 2002;36:940-1.

98. Beatty SJ, Mehta BH, Rodis JL. Decreased warfarin effect after initiation of high-protein, low-carbohydrate diets. Ann Pharmacother 2005;39:744-7.

99. Harris JE. Interaction of dietary factors with oral anticoagulants: Review and application. J Am Diet Assoc 1995;95:580-4.

100. Holt GA. Food & Drug Interactions. Chicago: Precept Press, 1998, 293.

101. Holt GA. Food & Drug Interactions. Chicago, Precept Press, 1998, 284-5.

102. Holt GA. Food & Drug Interactions. Chicago, Precept Press, 1998, 284-5.

103. Cambria-Kiely JA. Effect of soy milk on warfarin efficacy. Ann Pharmacother2002;36:1893-6.

104. Monterrey-Rodriguez J. Interaction between warfarin and mango fruit. Ann Pharmacother 2002;36:940-1.

105. Beatty SJ, Mehta BH, Rodis JL. Decreased warfarin effect after initiation of high-protein, low-carbohydrate diets. Ann Pharmacother 2005;39:744-7.

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