What food should be avoided with Lovenox? (+3 effects)

In this article, we will discuss different foods that you should avoid while taking Lovenox. Lovenox (enoxaparin) is an anticoagulant drug that is used in the prophylaxis of deep vein thrombosis.

What food should be avoided with Lovenox?

You should avoid taking foods that are rich in Omega-3, Vitamin E, and salicylic acids with Levenox. These components are natural blood thinners. Eating food high in these components while taking Lovenox may increase the risk of bleeding.

Omega-3 is known to interfere with platelets and prevent the formation of blood clots. However, Omega-3 does not cause thinning of the blood, rather it makes the blood less sticky by enhancing the production of prostacyclin (1).

The fruits in the berry family (cranberries, strawberries, and blueberries) are known to possess blood-thinning activity due to the presence of salicylic acid in them. Taking berries with Lovenox may cause drug-food interaction in rare cases.

It is important to understand that all foods rich in Vitamin E may not necessarily cause drug-food interaction. As an example, spinach and broccoli are rich sources of Vitamin E, however, they also Vitamin K. Vitamin K helps in clotting of the blood.

What food might interact with Lovenox?

Fish, some fruits, and nuts that might cause drug-food interaction with Lovenox include:

• Fish: Salmon, tuna and sardines contain high content of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and Vitamin E.

EPA and DHA are a type of Omega-3 fat. Omega-3 is known to increase the anticoagulant activity of Lovenox (2). Therefore, eating fish rich in Omega-3 fat can increase the risk of bleeding.

• Cranberry: According to a phase IV clinical trial, female patients taking Lovenox and cranberry together reported drug-food interaction.

However, such side effects were not seen in males. The common side effects included headache, convulsion, cold sweats, excessive sweating, nausea, shortness of breath, and swallowing difficulties.

• Strawberries: The strawberries are known to induce an antithrombotic effect due to the presence of antioxidant polyphenols present in the fruit.

According to a study, strawberries were found to possess antiplatelet activity in both in vitro and in vivo studies. Thus, eating excess strawberries while taking Lovenox may increase the chances of side effects (3).

• Nuts: Nuts like peanuts, almonds and walnuts may increase the risk of the anticoagulant activity of Lovenox.

Nuts are a rich source of Vitamin E. Vitamin E is also found in leafy vegetables, cereals, and wheat, however, no side effects have been reported with Lovenox with these food items.

What spices and herbs might interact with Lovenox?

Certain spices and herbs might interact with Lovenox if consumed daily, including:

• Ginger: Administering Lovenox with ginger may increase the incidence of haemorrhage and other side effects.

In one of the toxicity studies, ginger had the least protective activity against the Lovenox-induced toxic effects. The animals had an increased incidence of vacuolar degeneration in the duodenum and lymphocyte degeneration (4).

• Flax seed: It is known to contain a higher content of alpha-linolenic acid (ALA). It is the most common form of Omega-3 fats.

As stated previously, Omega-3 can potentially increase the anticoagulant activity of Lovenox and the risk of bleeding. The mechanism of action of Omega-3 is assumed to inhibit the formation of vascular thrombus (5).

• Gingko Biloba: It is known to possess platelet-activating factor (PAF) receptor antagonist activity.

However, an excess amount of Gingko Biloba may increase the anticoagulant activity of Lovenox. Using the standardized dose of Gingko extract at the recommended dose carries a minimal risk of side effects (6).

• Rosemary: It is known to slow down the blood clotting process and may interfere with the antiplatelet activity of Lovenox.

Carnosic acid, a phenolic diterpene derivative present in rosemary, has been established to cause antiplatelet activity. Therefore, consuming rosemary daily or in excessive quantities while taking Lovenox might increase the risk of bleeding (7).

What drinks might interact with Lovenox?

Certain drinks can interfere with the effect of Lovenox. However, the frequency of drinking is the decisive factor. If the patient stops or lessens the consumption of these drinks then the chances of interactions are reduced.

• Alcohol: It increases the blood-thinning effect of Lovenox and might lead to an increased risk of bleeding.

Taking alcohol with Lovenox can also cause gastric bleeding. It is recommended not to drink alcohol, but if the patient still insists then men should not drink more than 2 drinks/day while females should only consume 1 drink/day.

• Red wine: It is known to have an antithrombotic effect and might interfere with Lovenox.
• Green tea: Green tea is a widely consumed beverage that is made from dried leaves of Camellia sinensis.

The green tea catechins are known to possess antiplatelet activity. Green tea may slow down the blood clotting process, hence increasing the blood-thinning property of Lovenox (8).

Green tea has also been reported to cause an increased risk of bleeding with other medications including some antidepressants like Zoloft (sertraline).

• Soybean oil: It may decrease the therapeutic efficacy of Lovenox as it is rich in Omega-6 and Omega-3 fatty acids.
• Fish oil: It is known to possess anticoagulant activity and has been used in clinical studies for venous thromboembolism prophylaxis.

Using fish oil with Lovenox can increase the risk of bleeding. Also, fish oil is known to lower the haemoglobin level after the surgery when given concomitantly with Lovenox (9).

What are the side effects of taking Lovenox with certain foods?

Lovenox-food interaction might lead to the following side effects:

• Increased chances of bleeding,
• Delayed blood clotting,
• Increased risk of bruising,
• Complications during menstruation and pregnancy, and
• Nausea and headache.

I always consult my doctor for possible drug-food interactions while taking blood thining agents for pulmonary embolism. It is important to make a proper diet plan with your nutritionist while taking Lovenox.

References