Anticoagulants, herbal remedies and being on your guard, part 2

This is the second in a small series of posts about remedies and medicines I have found out interact badly with anticoagulants yet contain no warnings, or hidden warnings, to that effect on their packaging. The first post, about arnica, is here.

This post is about that pregnancy staple, Pregnacare.

To be fair to Pregnacare, this is slightly different, because Pregnacare is OK with aspirin and heparin, but it is not OK with warfarin or other oral (taken by mouth) anticoagulants.

And that information is, bizarrely, not included in the information leaflet that comes in the box, but is instead in small print on the side of the box under the title 'Food Supplement'.

So I contend that almost no-one reads it. I nearly didn't, except the box just haappened to be on my bedside table, and just happened to have that side facing me, and I just happen to be spending a lot of time on my bed right now, so I just happened to read it.

Believe me, I've taken Pregnacare on and off for four YEARS now, and it's the first time I've read it.

Here's a bad picture of the warning:

In case you can't read it (and I don't know why my camera won't allow me to take a better picture than that, I held the box right next to a lamp for goodness' sake) the second paragraph says:

As pregnacare contains vitamin K, if you are taking oral anticoagulants (e.g. warfarin)do not take Pregnacare except on the advice of a doctor. Vitamin K is not known to specifically interact with the action of aspirin or heparin.

And this is in white text on a quite dark green background, in letters that can only be about one millimetre high.

If you're visually impaired, forget it, you won't be able to read that. And the leaflet inside, which is where you usually expect to find contraindications? Nothing but a big fluff for Pregnacare and it's various products.

I find this very concerning.

Thankfully for me, heparin is OK with Pregnacare, but what if you were on warfarin? I have never heard a midwife or chemist's shop assistant or a doctor or anyone mention that Pregnacare isn't totally safe to take.

And most of us are not clued up on vitamin K and its effects on prescription drugs.

We're back to that notion of informed choice. We can only make one if we are informed. And I believe that manufacturers of vitamins, herbal remedies and, ahem, food supplements, have a duty of care to make sure we are properly informed.

Which means putting the information in at least 12 point font, in black text on a white background, in the main leaflet that goes inside the box because that is where we consumers expect that kind of information to go.

Hiding it on the side of a box in teeny tiny writing, in white on green, under the title *Food Supplement*, for crying out loud, is just not good enough.

You hear me, Pregnacare? We expect and deserve better. Hop to it.

Shake me and I'll rattle

In my last post, I mentioned the amount of painkillers I'm on. Some of you might be wondering why I'm on so many different drugs, and why I'm taking them all at once.

The short answer is: the nurses told me to.

But anyone who knows me, knows I don't take anything the medical profession says to me at face value, and I always ask questions.

So yes, I did ask why I was taking three painkillers.

Specifically, I asked why everyone on the ward was being given paracetamol, as in my experience, paracetamol does absolutely nothing to manage pain at all, not even the slightest headache.

I almost think of it as a placebo, so useless have I found it.

But the nurse explained that it works WITH the other tablets, increasing their effectiveness.

I did try to find some kind of study or article explaining this but was defeated by not really knowing the best keywords to Google. I ended up reading a slightly shocking chatroom discussion on how best to get from various legal drugs, and a few illegal ones, which was illuminating in a number of ways but shed no light on the drugs synergy issue.

Anyway.

I already knew that ibuprofen is an anti-inflammatory, and so it helps to prevent and bring down swelling.

And of course, codeine is a strong painkiller. As well as being, for some people, a bit of a high. Sadly, I'm not opne of those people. There's no buzz for me when I take it, more's the pity, although if I were constantly high at the moment my Christmas cards wouldn't be getting written, so I guess I should be grateful.

And on a serious note, codeine is known to be highly addictive, which I'm assuming is because of that high so many people get from it, so I'm glad that I will be spared the possibility of becoming hooked on it, especially as I have 100 - count 'em! - tablets of it in my bedside table drawer right now.

Apart from the painkillers, I'm also taking heparin, which I inject daily, to thin my blood and prevent DVT, which I am more prone to anyway because of my Factor V Leiden, but which anyone who is bedridden and immobile is at risk of.

In hospital, we injected it around 10pm, but at home I've been finding that a really bad time of day for finding the mental strength to stab myself in the tummy and inject a liquid that stings, so on Saturday I skipped my evening pincushion session and instead injected the next morning, about 45 minutes after taking my meds.

That worked much better. I felt mentally more prepared, and I also seemed to feel the pain a bit less because I wasn't tired like I am at the end of the day.

I don't think I put myself at too much risk by postponing the dose 13 hours, but if they had set the injections at a decent time when I was in hospital, by giving it to me in recovery as I expected rather than late at night when I finally demanded I have it, then I wouldn't have had to do it anyway.

In addition, I'm also taking Pregnacare, which is a vitamin supplement designed to get your body ready for, and keep you healthy during, prenancy, as well as supplement your diet during breastfeeding.

I'm taking it because the Hubby and I plan to TTC (Try To Conceive) soon, and it's recommended that you take it for three months before conception. With our history of miscarriages, even though they are caused by the Factor V Leiden, I'm not taking any chances, so I'm popping a Pregnacare pill each evening to ensure my body is as healthy as possible.

The other medicine I'm taking - I think drug is too strong a word - I began taking yesterday, but if you are going to have this or any other surgery that will mean you having a general anaesthetic, and/or you are going to be on codeine for more than a couple of days, it is one you should get ready in your medicine cupboard.

It is Lactulose.

Look away now if you are squeamish or don't have any desire to know about my bowel habits, because here's the thing - Lactulose is great for constipation.

General anaesthetics give you constipation, and so does codeine.

If you're going to have this surgery, or even any surgery requiring painkillers afterwards, you need to know about this stuff. The hospital weren't very bothered about my constipation because it's not like people die of it, but when it's you, it is very uncomfortable and makes you feel yuck, so my recommendation is to get some Lactulose in.

I recommend Lactulose rather than senna, because Lactulose is much more gentle in the way it acts on the body, and yet is very effective. Considering how much medication I'm putting into my system, I want to try and be as gentle as possible.

This link explains what's different about them and how they each work.

I'll be doing a post soon on what I think you need to get ready in advance of having your bunions done, which will include medicines but also will cover lots of other things you might not have thought of and which your hospital is unlikely to tell you about.


*Your Mileage May Vary, or, your experience may be different to mine.

Anticoagulants, herbal remedies and being on your guard, part 1

As I've mentioned, I have a blood clotting disorder called Factor V Leiden, which gives me sticky blood and requires me to inject an anticoagulant (heparin) daily while I'm bedridden to prevent me getting a DVT.

I only recently discovered that I have this condition (see previous post for more details) and as a result I'm not necessarily as fully clued up on it as I might need to be, although I'm trying to educate myself as much as possible.

There's not a lot of information out there about it, and nothing I had read warned me about things you should or shouldn't do while on anticoagulants.

Before my surgery, I had planned to take arnica. This is a natural herbal rememdy that is believed to prevent bruising. I took it before I went into labour and found that I didn't get much bruising while giving birth, so I wanted to take it before this surgery to minimise the bruising to my feet.

Now, its a homeopathic medicine, and I know that homeopathy is controversial, with many people claiming it has no effect at all. But I still thought I'd take it just in case.

I bought mine from Boots, with a bit of help from an assistant, although she didn't seem to know much about it and mostly just showed me where it was on the shelf.

I started taking it a few days before surgery. Then, the night before I went into hospital, I was Googling various things to do with bunion surgery, and taking arnica, and I spotted something that looked interesting. Something about arnica being a natural anticoagulant.

My first thought was "ooh, is it possible to medicate this naturally?"

So I Googled a bit more.

And this was the page of results that I got.

I'm sorry the picture isn't great quality, but if you click on the link above you'll get the same list of results on your own screen. And then, like for me, some words and phrases might jump out.

Phrases like "if you take anticoagulant medicine, use homeopathic arnica with caution".

And "If arnica were taken internally, in addition to serious side effects, it would possibly interact with the anticoagulant".

Woah! Hold up a moment there!

Am I reading this right? I wondered. Are these links saying it's not a good idea to take arnica if you're going to be taking an anticoagulant?

So I Googled some more.

This time, the words arnica and heparin. And got this list of results.

Which yielded some more serious phrases.

Like "It is NOT SAFE to take Arnica if you are on Heparin".

And "arnica may potentiate the effects of anticoagulant drugs such as heparin".

Ooo-kay. So. I've been taking this stuff, and there is nothing and I mean NOTHING on the bottle of arnica tablets to say it might interact with anything. There are literally no contraindications on this at all.

And yet it's a common thing for people to take for bruising. They sell it in every Boots store in the UK. It is not an obscure herbal remedy I'd tracked down in Guatamala and had shipped to me by camel and yak.

I'm pretty shocked. And I plan to write to Boots about it, because this is potentially serious.

I appreciate that not everything you read on the internet is accurate, but there are enough chatroom warnings about taking arnica with an anticoagulant like coumadin or heparin to persuade me that this is true.

This link has some useful info on arnica's side effects and interactions with other drugs, including with anticoagulants.

Quite frankly this is frightening.

It is common for people to take arnica for bruising if they are having surgery.

The very first result from a Google search of arnica and surgery says "It is an excellent idea to use Arnica both before and after surgery".

Now, because I'm a fair kind of person, I had a click on the link in case they then qualified that by saying it's not always safe, etc.

But it goes on to say "Homeopathic remedies are prepared to an extremely dilute potency and there is no risk of an interaction with anaesthesia or other medications".

NO RISK OF AN INTERACTION.

Really?

This is very scary. Doing the wrong search of the wrong keywords will give you false information.

So I'm telling you now, people, DO NOT TAKE ARNICA WITH ANTICOAGULANTS.

And just so I don't look like I'm down on the herbals, I read through the leaflet that came with my heparin.

It has a section called 'Taking other medicines' which mentions ibuprofen (which I've been prescribed along with the heparin), aspirin, clopidogrel, streptokinase, activated protein C, dextrans and vitamin K antagonists such as warfarin, but there is no mention of arnica.

Now, it may be that the risk is small, but I always prefer to make an INFORMED CHOICE on things that involve my body and my health, and the lack of available information is depriving me of that opportunity.

All I can do is use what sources I have at my disposal, namely the internet, and from what I've seen in my searches, it isn't safe to take them both.

Obviously, you will want to do your own research, and if you read this in advance of seeing your consultant, you can ask them yourself about this.

But in the meantime, I hope I've shed some light on this, and prevented other people from potentially putting themselves at risk, like I did, because there were no warnings on items being sold as medicine.

*This is the first of (so far) two posts on medicines/remedies that potentially interact with anticoagulants yet which have little or no warning on their packaging. Next post: Pregnacare