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Treatment with Marcumar® is in tablet form. They should be taken with as much liquid as possible and not chewed. If possible, they should not be taken with food, as this can lead to a weakening of the effect.

It should always be taken at about the same time of day, simply in the evening. If you are eating via a stomach tube, you must keep at least 2 hours between meals, otherwise the effect of Marcumar® may be weakened or even completely lost. Since Marcumar® is an antagonist of vitamin K, you should make sure that you do not take in too much vitamin K in your diet.

Certain foods contain particularly high levels of vitamin K. Although these should not be avoided, you should take care not to consume large quantities (e.g. Brussels sprouts, broccoli, asparagus, etc.). When ingesting/dosing Marcumar®, it should also be noted that it usually has to be discontinued before an operation. This should be discussed in advance with the treating physician or surgeon.

Marcumar® must then be replaced by heparin injections accordingly. It usually takes 7-10 days until coagulation normalizes after Marcumar® is discontinued.If there is a risk of massive bleeding, for example during an emergency procedure, vitamin K or coagulation concentrates can be added to “buffer” the blood. Marcumar® must not be taken during pregnancy as it can damage the unborn child.

Nutrition

The drug Marcumar®, whose active ingredient is called phenprocoumon, is an anticoagulant. It therefore intervenes in the blood clotting process to inhibit it. During coagulation, a long chain of activation processes takes place in the body.

The individual clotting factors activate each other. The vitamin K-dependent factors II, VII, IX, X are indispensable in this process. The coagulation modulators Protein C and Protein S, which are also vitamin K-dependent, also play an important role.

With Marcumar®, these factors cannot be activated or can only be activated to a very small extent and clotting is therefore suppressed. For some diseases, such as deep vein thrombosis in the leg, atrial fibrillation or an artificial heart valve, taking Marcumar® is indispensable. In simple terms, one can say that Marcumar® is the antagonist to vitamin K. The Vitamin K is urgently needed, in order to be able to manufacture the above-mentioned clotting factors.

Humans take up Vitamin K with the food. It is contained above all in green vegetables such as spinach. Besides body-own intestine bacteria are able to manufacture Vitamin K. The vitamin K is taken up with the help of bile acids, since it is a fat-soluble vitamin.

The daily requirement of vitamin K is about 65 micrograms for women and 80 micrograms for men. A deficiency or excess of vitamin K is very rarely observed in healthy people. However, patients in whom a strictly controlled INR range is aimed for with Marcumar® must be very precisely informed about the influence of food containing vitamin K, the interactions with other medicines and the effect of alcohol on Marcumar®.

As Marcumar® is the antagonist to vitamin K, as already mentioned, it is important to pay attention to foods that contain a lot of vitamin K when eating under Marcumar® therapy. These foods can weaken or even cancel out the effect of Marcumar®. The tablets should not be taken with food, as this can already reduce the effect.

The Marcumar® tablets should always be taken at the same time of day and not chewed, so that they are not forgotten on the one hand and on the other hand to ensure a constant level of medication. It is recommended to take the tablets in the evening. It is neither necessary nor sensible to completely change your diet when taking Marcumar® by avoiding all products containing vitamin K. Nevertheless, you should not eat many foods containing a high amount of vitamin K several times a day.

In addition, foods containing large quantities of vitamin K should be consumed as evenly distributed as possible throughout the day to prevent fluctuations in the vitamin K level. Foods that contain a particularly high amount of vitamin K include various vegetables such as broccoli, some types of cabbage or even asparagus. For example, 100 grams of broccoli contain about 154 micrograms of vitamin K and 100 grams of asparagus contain about 40 micrograms of vitamin K. Kale has a peak value among foods containing vitamin K with about 250 micrograms of vitamin K per 100 grams.

Care should be taken with meat, especially with offal, pork or very fatty beef. Eggs and dairy products also contain higher amounts of vitamin K. Among animal products, meatloaf proves to be very rich in vitamin K with 70 micrograms per 100 grams of meat. As you can see from these examples alone, it is very difficult to do without these foods in everyday life.

A complete renouncement is not necessary and also not advisable. What is important is a varied and versatile diet, which is recommended for everyone and therefore also for Marcumar® patients. Foods with a lower vitamin K content are, for example For the nutrition with Marcumar®, there is a series of tables in which you can see the respective vitamin K content.

In everyday life, it may be necessary to change the daily dosage of the medication by taking more Marcumar®.During the asparagus season, for example, when some patients eat more asparagus, a dose increase of Marcumar® may be necessary to compensate for an increased vitamin K level. A conversion from normal to low-fat food, which possibly takes place in the context of a Diät, can reduce the Vitamin K admission over the intestine. Since vitamin K is a fat-soluble vitamin, it requires parallel fat absorption for utilization by the body.

It is important here to have the Quick/INR value determined by regular checks and to adjust the quantity of tablets to the values. It is also not allowed to take fruit or vegetable raw food days for dietary purposes, as these can have a strong influence on the effect of Marcumar®. If you still want to lose weight, you should try to do so by increasing physical activity or by avoiding foods with high calorie content such as sweets or similar.

Food supplements and dietary powder are also important to mention here. Vitamin powders and diet powders can also contain increased amounts of vitamin K. Therefore one should always pay attention to the respective contents materials of the individual powders.

Apples
Pineapple
Bread roll
Barley
Or even trout.

Dangerous interactions can occur not only through food but also through medication, so that the effect of Marcumar® can be both intensified and weakened by taking certain drugs.

Painkillers such as Ibuprofen, Aspirin or Diclofenac, which are also known as “non-steroidal anti-inflammatory drugs/antirheumatic drugs”, can be the cause of an increased Marcumar effect. Similarly, certain antibiotics such as erythromycin and clarithromycin can enhance the effect of Marcumar® by inhibiting a liver enzyme (cytochrome P450 3A4), which slows down the breakdown of Marcumar® and thus leads to an increased risk of bleeding. Numerous other drugs can also enhance the effect of Marcumar®.

For example, some local anesthetics, allopurinol, cimentidine, amiodarone or so-called platelet aggregation inhibitors such as heparin can increase the effect. Therefore, the interaction of these drugs with the active substance phenprocoumon should always be taken into account and a careful INR control should be carried out whenever the medication is changed. This can cause dangerous bleeding, especially in the gastrointestinal tract.

Some sleeping pills (barbiturates) or antiepileptic drugs, for example, have a weakening effect in which the INR value can drop. Numerous other drugs such as digitalis, steroids or some dehydrating agents can also cause a reduction in effectiveness. It is therefore always important, especially in the case of over-the-counter medicines, to consult your doctor or pharmacist and inform them that they should take Marcumar®.

The consumption of alcohol during a therapy with Marcumar® also poses a risk. In particular, excessive and above all regular consumption of alcohol should not be avoided, not only because of the addictive potential that alcohol brings with it. After all, alcohol has a very strong, very toxic effect on the cells of the liver.

The liver cells break down the alcohol, numerous other drugs and Marcumar and metabolize these foreign substances. Through chronic alcohol consumption, Marcumar® is now broken down more quickly, so that the effect is reduced, the ability to clot increases again and the risk of thrombus formation increases. The effect of alcohol in Marcumar® patients can, as just mentioned, lead to the formation of thrombi, but also the opposite, to massive bleeding due to falls or accidents while under the influence of alcohol.

The same applies to the consumption of illegal drugs. Here, too, intoxication can lead to an increased risk of injury. Dangers may not be assessed correctly, so that a doctor may be consulted too late in the event of a threatening injury.

Smoking also has an influence on coagulation. The consumption of tobacco leads to an increased coagulability of the blood. Since Marcumar® contains lactose, it is important to talk to the doctor before taking it for the first time if you suffer from lactose intolerance.If you notice an increased bleeding tendency (increased bleeding of the gums or increased bleeding after cuts) beyond your “normal level”, it is advisable to consult your doctor and have the INR/Quick value determined out of sequence. Since Marcumar® contains lactose, it is important to talk to your doctor before taking it for the first time if you suffer from lactose intolerance. If you notice an increased tendency to bleed (increased bleeding of the gums or increased bleeding after cuts) beyond your “normal level”, it is advisable to consult your doctor and have the INR/Quick value determined outside of the normal range.