Acerola & Warfarin

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Friday, April 1, 2005

PTINR.com Staff

Natural Medicines are rapidly filling up grocery store shelves. See how a Caribbean fruit might influence your INR.

Acerola (Malpighia glabra). Locals refer to it as Barbados Cherry, Puerto Rican Cherry or the West Indian Cherry. People consume this product orally to treat or prevent scurvy, colds, heart disease, cancer, pressure sores, retinal hemorrhages, tooth decay, bum infections, atherosclerosis, depression, hay fever, prevention of blood clots, collagen disorders, and to enhance physical endurance. Acerola contains high quantities of vitamin C so its role in preventing or treating colds hold the most promise for this use. There are no studies to support the use of acerola for other medicinal areas.

Acerola contains between 1000-2300 milligrams per 100 grams making it a potent source of vitamin C. The acerola fruit also contains vitamin A, thiamine, riboflavin and niacin.
_{W. Kluwer Co. 1999}

The vitamin C in acerola has been linked to nausea, abdominal cramps, fatigue, insomnia, and sleepiness. Doses exceeding 1 gram might cause diarrhea.
_{American Society of Health-System Pharmacists, 1998}

The Natural Medicines Comprehensive Database references concomitant use of acerola and warfarin can reduce the anticoagulant activity of warfarin (Coumadin ®) mainly due to its vitamin C content.

Patients on warfarin traveling to the Caribbean should be advised of this product and not to consume it in excess. Consumption of these cherries in addition to any vitamin supplements or multiple vitamins would exceed the FDA's recommendation for daily intake of vitamin C of 60 milligrams per day for the average adult.

Theoretically, concomitant use with large amounts of vitamin C might impair response to warfarin. Doses of vitamin C up to 10 grams per day don't seem to affect coagulation time in patients taking warfarin. Higher doses of vitamin C might affect warfarin absorption or antagonize the anticoagulant effect of warfarin by an unknown mechanism.
_{Drug Interactions Analysis and Management, 1997}