Warfarin Institute of America
DEDICATED TO YOUR HEALTH SINCE 2000
ALCOHOL INTERACTIONS WITH WARFARIN (Coumadin, Jantoven)
The best advice is to not drink alcohol while you are taking warfarin (Coumadin, Jantoven). Since this is not practical for everyone, this discussion will let you know what your risks are. The easiest warfarin (Coumadin, Jantoven) patients to manage are those whose lives follow routines.
Intermittent, occasional or binge drinking tends to raise the INR. This means that your body is acting as if you are taking more warfarin (Coumadin, Jantoven) than you really are. This increases your risk of having a rectal bleeding episode. Saving up all of the drinks you would have had for the week and having them all at a special occasion is one of the worst things you can do. A study of the use of alcohol in medications offers some insight as to how this works. The most common protein in the blood is albumin. Most of the warfarin that a person takes in a dose physically binds to albumin. The warfarin that is bound is then inactive. Alcohol appears to lower the amount of warfarin that is bound to albumin. The unbound warfarin is the part that has an effect on the clotting factors. Therefore, the INR will increase because there is more warfarin working in the body.
Daily moderate alcohol use (1 or 2 drinks - no more) has little effect on the INR. Whether or not it raises the risk of gastrointestinal bleeding is an unanswered question. Some people's attitude is, "If I cannot have a glass of wine with dinner, then I won't take warfarin." Taking warfarin (Coumadin, Jantoven) in this case is probably better for you than not taking it. However, the important word is "probably". Whether or not this is true is not proven.
Daily alcohol use of greater than three or more drinks will result in the possibility of several thing happening. First, the enzymes that metabolize the warfarin (Coumadin, Jantoven) can become more active. This means that the INR test will show that you are not taking enough warfarin (Coumadin, Jantoven). Then your warfarin (Coumadin, Jantoven) dose will be increased. Should you suddenly stop drinking, the INR will shoot upward and increase your risk of bleeding. The other thing that might happen is that the alcohol will irritate the lining of your gastrointestinal tract. If this get some bleeding started, it can be very difficult to stop.
Reference: Tatsumi A. et al. Effect of ethanol on the binding of warfarin enantiomers to human serum albumin.Biol Pharm Bull 2007; 30: 826-9.
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Last updated May 2, 2007
