5.4m blood clot patients warned off cranberry juice


James Meikle, health correspondent
Saturday November 6, 2004
The Guardian

Drug watchdogs say patients on the anti-coagulant warfarin should not drink cranberry juice. A second person has died since informal advice to at least limit consumption was issued last year.

Now the Committee on the Safety of Medicines has said "it is not possible to define a safe quantity or brand of cranberry juice" and told doctors that patients on warfarin should be advised to avoid the drink unless the health benefits are thought to outweigh the risks.

Women often drink cranberry juice because of its known benefits in reducing cystitis, but patients who refuse to abandon cranberry, and that includes capsules and concentrates, must now be put under increased medical supervision and undergo coagulation tests.

The warning coincides with separate advice for those on cholesterol-lowering drugs called statins not to drink grapefruit juice. The two alerts could affect millions of people.

The grapefruit warning was particularly related to an over-the-counter product called simvastatin, brand name Zocor, and a prescription-only drug, Lipitor. But the Food Standards Agency and juice manufacturers made clear yesterday there would be no health warnings on the drinks.

The problems are thought to be linked to chemicals in the juices which interfere with the way enzymes metabolise drugs. About 100m litres of cranberry juice are sold each year in Britain, as well as 30m litres of grapefruit.

Neither safety warning has been issued to the public in general but only through the update on current problems in drug safety issued to health professionals. About 5.4m prescriptions were issued for warfarin in England last year. It helps prevent blood clots which can lead to heart attacks and strokes. More than a million people are on statins.

Cathy Rees, medical spokeswoman for the British Heart Foundation, welcomed the guidance . "It is important that agencies producing medications work together to make any side-effects apparent."

She added: "For most of the millions with heart disease who take statins or warfarin, the benefits of medicines far outweigh the risks, but these side effects should not be ignored. We advise anyone concerned to speak to their doctor."

The medicines committee said it had received a total of 12 reports of suspected interactions involving warfarin and cranberry, including two deaths. Some involved bleeding. The committee said there was now "sufficient evidence" for formal advice for patients not to drink cranberry juice to be issued. Product information issued with warfarin would therefore be updated.

The British Soft Drinks Association said people on medication should take advice from their doctors "about what kind of dietary avoidances they should make". Warnings on the juices might cause people "to worry unnecessarily".

The Food Standards Agency said: "We haven't discussed the labelling of fruit juices with the industry. It would be for medical professionals to advise on."

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