The Complete List Of Foods To Avoid With Clopidogrel

As of 2021, approximately four million Americans take clopidogrel.

Clopidogrel is primarily used with or without aspirin to prevent blood clots in people who have had a stroke, heart attack, or severe chest pain. 

If you or a loved one takes clopidogrel, you can learn about the potential interactions and risks associated with certain foods and how to manage your diet.

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What Is Clopidogrel?

Clopidogrel is an oral antiplatelet medication sold under the brand name Plavix.

It prevents serious or life-threatening problems associated with the heart and blood vessels. 

A large research trial, including over 40,000 patients taking clopidogrel, called the DAPT trial, found that neither long-term nor short-term use of clopidogrel was associated with increased risk for death or cancer. 

There are many types of antiplatelet medications available. Clopidogrel may not work well in some people, which laboratory tests can confirm. 

Your healthcare provider can work with you to determine the best antiplatelet medication for your health conditions. 

How Does Clopidogrel Work?

It works by preventing platelets (a type of blood cell) from collecting and leading to a clot that could cause a heart attack or stroke. 

Since it prevents platelet formation, there is an increased risk of bleeding and bruising.

Patients taking clopidogrel may take longer to stop bleeding as well. 

How Do Foods Interact With Clopidogrel?

Clopidogrel inhibits various receptors and systems within the body to achieve clot reduction. 

Certain medications and foods can also interact with these receptors and systems and alter how your body responds to clopidogrel. 

Your liver helps process and absorb medications. Some foods and drinks can reduce the amount of clopidogrel absorbed in the liver, leading to less medication in the body.

Clopidogrel may not work as well to prevent clots when consuming certain foods. 

What Foods Should Be Avoided With Clopidogrel?

Only a few foods and drinks should be avoided while taking clopidogrel.

Your healthcare provider will often discuss the foods you need to avoid and ensure you can follow the recommendations before choosing a specific antiplatelet medication. 

Clopidogrel should be avoided with grapefruit, its close fruit relatives like pomelos, tangelos, minneolas, limes, and Seville oranges, grapefruit juice, and alcohol. 

1. Grapefruit

Grapefruit and its close fruit relatives, including pomelos, tangelos, minneolas, limes, and Seville oranges, inhibit the absorption of many drugs, including clopidogrel.  

These fruits contain furanocoumarins that prevent the absorption of clopidogrel. One whole piece of fruit is enough to impact your medication absorption. 

Sweet oranges (navel or Valencia) do not contain furanocoumarins and do not alter medication absorption.

2. Grapefruit Juice

Juice from grapefruit and its close fruit relatives contains furanocoumarins.

A serving of six ounces (or 200mL) of juice can impact clopidogrel absorption. 

In a small study, healthy volunteers taking clopidogrel consumed 200 mL three times daily for three days.

After consuming twenty ounces of grapefruit juice for three days, the body's active clopidogrel was reduced to 13%. 

You should avoid juice from grapefruit and its close relatives while taking clopidogrel. 

3. Alcohol

Alcohol can increase clopidogrel effectiveness in mice. No human studies exist to date. 

Your doctor determines the appropriate dose to prevent clots.

Drinking alcohol can change how your body responds to medications. 

Additionally, aspirin is often prescribed with clopidogrel. Drinking alcohol while taking aspirin can increase your risk of stomach bleeding and ulcers.

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4. Spices And Herbs That Enhance Clopidgrel Efficacy

Limited research reveals that curcumin (found in turmeric) may boost clopidogrel efficacy. Further studies are needed to quantify its effect. 

St. John’s wort is a popular herb that seems to increase your body’s responsiveness to clopidogrel, making it more effective. 

If you use turmeric regularly or are interested in St. John’s wort, discuss it with your healthcare provider before starting any new supplements or herbs while taking clopidogrel or other medications. 

Healthy Foods To Eat While Taking Clopidogrel

While it can be disappointing to avoid certain foods or drinks while taking clopidogrel, there are many delicious and heart-healthy foods to eat!

The American Heart Associated recommends an overall healthy eating pattern to manage heart disease that prioritizes:

• All other fruits and all vegetables.
• Whole grains and foods made with whole grains.
• Healthy protein options (fish and seafood, legumes, nuts, seeds, low-fat or nonfat dairy, lean and unprocessed meat and poultry).
• Minimally processed foods (like frozen or canned fruits and vegetables).
• Limited intake of added sugars in foods or beverages. 
• Heart-healthy liquid oils like avocado and olive oil. 
• Food prepared with little to no salt.
• Preferably no alcohol intake.

Following a heart-healthy eating plan can help your heart and overall health. 

Overall, there are a few fruits and juices, and alcohol that need to be avoided while taking clopidogrel to maintain a clot-preventative plan. 

Most every other food is acceptable. Ideally, most meals should be heart-protective, but all foods can be eaten in moderation.

Work with a registered dietitian to learn how to balance all types of foods in your daily diet. 

Other Contraindications While Taking Clopidogrel

Many drug interactions exist while taking clopidogrel.

Other medications can reduce the efficacy of clopidogrel and increase your risk of side effects. 

Consult your healthcare provider if you take any of the following medications and also take clopidogrel:

• Cerivastatin.
• Repaglinide.
• Ferulic Acid.
• Sibutramine.
• Efavirenz.
• Omeprazole.
• EsomeprazolE.
• Morphine.
• Scutellarin.
• Fluoxetine.
• Azole antifungals.
• Calcium channel blockers.
• Sulfonylureas.
• Ritonavir.
• Cyclosporin.
• Rifampicin.
• Angiotensin-converting enzyme inhibitors.
• Aspirin.
• Warfarin (or Coumadin).

It’s important to review all your medications with your healthcare provider each time you start or stop any medication to ensure there are no interactions. 

How To Manage Meals While Taking Clopidogrel

Clopidogrel can be taken with or without food, but it’s recommended that it be taken at the same time each day. 

If you can’t imagine life without grapefruit and closely related fruits or juices, sharing this with your healthcare provider is essential.

Other medications allow you to enjoy your favorite fruits and juices and prevent blood clots. 

Other medications, such as Coumadin, allow grapefruit. Still, you need to monitor and maintain a steady intake of foods high in vitamin K.

These include most green and leafy vegetables and some green fruits. 

Coumadin prevents blood clots, and consuming too many vitamin K foods can make Coumadin less effective. 

Never stop a medication without speaking with your healthcare provider and developing an alternative plan to prevent blood clots. 

Meal Planning

A registered dietitian can help you create a meal plan that includes your food preferences, health conditions, and food-medication interactions. 

You can start independently by following the plate method when planning meals. 

1. Fill one-half of your plate with non-starchy vegetables like mushrooms, cauliflower, lettuce, tomatoes, and green beans (if on Coumadin, maintain a steady intake of vitamin K-rich vegetables)
2. Fill one-quarter of your plate with starchy vegetables and whole grains, such as sweet potatoes, oatmeal, brown rice, or whole-grain bread.
3. Fill the final one-quarter with a lean protein option (animal or plant-based) like beans, salmon, chicken, low-fat dairy, and nuts.

The plate method is a simple visual for ensuring a filling and heart-healthy meal.

The breakdown helps you choose enough protein, fiber, and carbohydrates to stay energized between meals. 

Takeaway

You must avoid grapefruit and close-fruit relatives like pomelos, tangelos, minneolas, limes, Seville oranges, grapefruit juice, and alcohol when taking clopidogrel.

These foods can impact the effectiveness of clopidogrel. 

Focus on all the foods you can enjoy and explore different cuisines and recipes.

To further protect your heart, opt for heart-healthy foods, including all other fruits and vegetables, whole grains, and healthy protein choices like nuts, beans, seeds, fish, and lean poultry.

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How A Dietitian Can Help

If you need individualized expert nutrition guidance while taking clopidogrel or other medications, consider working with a dietitian to optimize your eating and lifestyle. 

At Nourish, every nutrition appointment is dedicated to helping you find creative and realistic solutions that bring you closer to your health goals.

Dietitians are uniquely suited to help you create meal plans and understand how medications work alongside them.

Here are some questions to ask when working with a registered dietitian. 

• How do I learn more about grapefruit and drug interactions?
• Can I read more about heart health and nutrition? 
• I need a grocery shopping list for heart health  – can you help me find one?

Find a dietitian who accepts insurance through Nourish.