1.2m people in UK told never have two drinks – all those affected

Hundreds of thousands of people across the UK have been advised never to drink two fruit juices. Many people regularly enjoy the juices when they are trying to increase the amount of vitamins they consume. However, for some people, including them in their diet could actually make them very unwell, and, according to the NHS, they should avoid them at all times.

It is understood that 1.2 million people across the UK take the anticoagulant warfarin. The medication makes your blood flow more easily through your veins and decreases the likelihood of a blood clot which can be life-threatening.

People prescribed the drug usually take it daily, every evening. They will usually need to have a blood test at least every 12 weeks to ensure they are taking the correct dose and to allow any adjustments to be made.

They will also have to carry a card to alert doctors, dentists or other professionals that they are taking an anticoagulant. This must be shown ahead of any medical or dental procedures, such as vaccinations and routine appointments with the dental hygienist.

According to the NHS most adults and children are able to take the drug. However some people might not be suitable for the medication including those who:

• have ever had an allergic reaction to warfarin or any other medicine
• are trying to get pregnant or you’re already pregnant
• have liver or kidney problems
• have had an infection of the lining of your heart, known as endocarditis
• have a health problem that causes bleeding (such as a stomach ulcer ) or makes you bruise easily
• have high blood pressure (hypertension)

The NHS warns there are some side-effects including increased bleeding if you cut yourself. You might also have occasional nosebleeds, bruise more easily and your gums may bleed when brushing your teeth.

Other common side effects include hair loss and a mild rash. If you develop these side-effects you should talk to your doctor or pharmacist if they bother you or do not go away.

There are some serious side effects which include bleeding suddenly without a cut or injury or if it will not stop. The NHS advises: “This can be dangerous and needs urgent medical attention.” It says you should call 111 for advice if you have:

• any bleeding that’s not heavy but will not stop, or stops then starts again
• pink, red or brown pee, or black poo
• bruises for no reason, they’re larger than you’d expect or they keep growing in size
• sudden, severe back pain
• increased bleeding from your vagina during a period or bleeding between periods
• bleeding from your vagina after the menopause

It is advised that you should go to A&E if:

• you have a nosebleed you cannot stop and that last longer than 10 minutes
• there’s blood in your vomit or you’re coughing up blood

The NHS says: “These are symptoms of serious bleeding. If you have any serious bleeding, stop taking warfarin.”

And it adds that on very rarel occasions the medication can lead to bleeding in the brain. It says call 999 now if you get any of these symptoms:

• a sudden and severe headache
• a seizure or fit
• sudden loss of vision or blurred vision
• numbness or tingling in your arms or legs
• slurred speech
• cannot be woken up (lose consciousness)
• difficulty breathing, breathing faster than usual, or chest pain
• any heavy bleeding where blood is spraying, pouring or enough to make a puddle

You may also feel tired, weak or sick. For full details visit the NHS website here.

And the NHS has listed set out some guidelines over what people taking warfarin can eat and drink. This includes avoiding two fruits and juices made using them.

It says: “It’s very important to keep your diet stable while taking warfarin. This means your dose of warfarin is more likely to stay the same. Any big changes in what you eat or drink can change how your body responds to warfarin.”

The NHS says foods containing a lot of vitamin K can affect how warfarin works. These include:

• green leafy vegetables, including broccoli, spinach and lettuce
• chickpeas
• liver
• egg yolks
• mature cheese and blue cheese
• avocado
• olive oil

The NHS advises: “It’s important that you eat foods containing vitamin K, so rather than leaving them out of your diet, make sure you eat similar amounts of them regularly. This will mean the level of vitamin K in your blood stays fairly constant and makes it more likely that your INR level stays stable.”

But it also warns that there are other foods which should be avoided completely if you are taking warfarin. Both Cranberry and grapefruit juice increase the blood-thinning effects of the medication by inhibiting the liver enzymes responsible for breaking down the medication, causing higher levels of warfarin to remain in the bloodstream which significantly increases the risk of dangerous bleeding and bruising.

The NHS adds: “Do not drink cranberry or grapefruit juice while you’re taking warfarin. It can increase the effect of your medicine and put you at higher risk of bleeding.”