![]() ![]() Cigarette smoking significantly reduced melatonin plasma exposure (AUC) as compared to melatonin levels after 7 days of smoking abstinence (7.34 +/- 1.85 versus 21.07 +/- 7.28 nmol/L*h, respectively). They had smoked prior to the first measurement but had not smoked for 7 days prior to the second. In a small clinical trial (n=8), habitual smokers had their melatonin plasma levels measured two times, each after a single oral dose of 25 mg of melatonin. In addition, CYP450 1A2 inducers like cigarette smoking may reduce exogenous melatonin plasma levels. The mechanism of this interaction is not fully understood. The clinical significance of this interaction is unknown.Īccording to some authorities, alcohol may reduce the effect of melatonin on sleep. The half-life did not change significantly. The greatest effect was seen in subjects with the *1F/*1F genotype (n=7), whose melatonin Cmax increased by 202%. The metabolic inhibition was greater in nonsmokers (n=6) than in smokers (n=6). After administration of melatonin 6 mg and caffeine 200 mg orally (approximately equivalent to 1 large cup of coffee) to 12 healthy subjects, the mean peak plasma concentration (Cmax) of melatonin increased by 137% and the area under the concentration-time curve (AUC) increased by 120%. The proposed mechanism is inhibition of CYP450 1A2 first-pass metabolism. MONITOR: Oral caffeine may significantly increase the bioavailability of melatonin. Feeding formulas containing soy protein should be avoided.Ĭonsumer information for this interaction is not currently available. When warfarin is given with enteral (tube) feedings, you may interrupt the feeding for one hour before and one hour after the warfarin dose to minimize potential for interaction. Do not stop using any medications without first talking to your doctor. It is important to tell your doctor about all medications you use, including vitamins and herbs. ![]() Talk to a healthcare provider if you are uncertain about what foods or medications you take that may interact with warfarin. ![]() Again, you do not need to avoid these foods completely, but it may be preferable to limit their consumption, or at least maintain the same level of use while you are receiving warfarin. There have been reports of patients who experienced bleeding complications and increased INR or bleeding times after consuming large quantities of cranberry juice, mangos, grapefruit, grapefruit juice, grapefruit seed extract, or pomegranate juice. However, even foods that do not contain much vitamin K may occasionally affect the action of warfarin. Moderate to high levels of vitamin K are also found in other foods such as asparagus, avocados, dill pickles, green peas, green tea, canola oil, margarine, mayonnaise, olive oil, and soybean oil. Foods rich in vitamin K include beef liver, broccoli, Brussels sprouts, cabbage, collard greens, endive, kale, lettuce, mustard greens, parsley, soy beans, spinach, Swiss chard, turnip greens, watercress, and other green leafy vegetables. While there is no need to avoid products that contain vitamin K, you should maintain a consistent level of consumption of these products. For example, increasing vitamin K levels in the body can promote clotting and reduce the effectiveness of warfarin. Therefore, it is important to keep your vitamin supplement and food intake steady throughout treatment. Nutrition and diet can affect your treatment with warfarin. ![]()
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