Drug & supplement interaction

Vitamin C + Warfarin Sodium

Warfarin Sodium brand names: Coumadin, Panwarfin, Sofarin.

Moderate Interaction
The bottom line Moderate

Vitamin C has a moderate interaction with Warfarin Sodium. High-dose vitamin C might reduce the levels and effectiveness of warfarin.

Read the full interaction report
SeverityModerate
LikelihoodPossible
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Vitamin C and Warfarin Sodium

Here is the interaction we found between these two, with the evidence behind it.

Moderate

WARFARIN (Coumadin)

High-dose vitamin C might reduce the levels and effectiveness of warfarin.
Vitamin C in high doses may cause diarrhea and possibly reduce warfarin absorption. There are reports of two people who took up to 16 grams daily of vitamin C and had a reduction in prothrombin time. Lower doses of 5-10 grams daily can also reduce warfarin absorption. In many cases, this does not seem to be clinically significant. However, a case of warfarin resistance has been reported for a patient who took vitamin C 500 mg twice daily. Cessation of vitamin C supplementation resulted in a rapid increase in international normalized ratio (INR). Tell patients taking warfarin to avoid taking vitamin C in excessively high doses (greater than 10 grams daily). Lower doses may be safe, but the anticoagulation activity of warfarin should be monitored. Patients who are stabilized on warfarin while taking vitamin C should avoid adjusting vitamin C dosage to prevent the possibility of warfarin resistance.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the gist for warfarin: large amounts of vitamin C may keep your body from absorbing the warfarin as well, which can weaken its blood-thinning effect. If that happens, your INR (the blood test that shows how thin your blood is) can drift down, meaning less protection against clots. The reports behind this are pretty thin, mostly a couple of cases at very high doses (think 5 to 16 grams a day), and one oddball case at just 500 mg twice daily.

Honestly, ordinary diet amounts of vitamin C aren't the concern here. Warfarin is a finicky, narrow-margin drug, so the real rule is consistency: don't suddenly start, stop, or change a vitamin C supplement. If you want to take it, loop in your pharmacist or doctor so they can keep an eye on your INR.

References
  1. Rosenthal G. Interaction of ascorbic acid and warfarin. JAMA 1971;215:1671. DOI
  2. Hume R, Johnstone JM, Weyers E. Interaction of ascorbic acid and warfarin. JAMA 1972;219:1479. DOI
  3. Smith EC, Skalski RJ, Johnson GC, Rossi GV. Interaction of ascorbic acid and warfarin. JAMA 1972;221:1166. DOI
  4. Feetam CL, Leach RH, Meynell MJ. Lack of a clinically important interaction between warfarin and ascorbic acid. Toxicol Appl Pharmacol 1975;31:544-7. PubMed
  5. Weintraub M, Griner PF. Warfarin and ascorbic acid: lack of evidence for a drug interaction. Toxicol Appl Pharmacol 1974;28:53-6. PubMed
  6. Sattar A, Willman JE, Kolluri R. Possible warfarin resistance due to interaction with ascorbic acid: case report and literature review. Am J Health Syst Pharm. 2013;70(9):782-6. PubMed

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Vitamin C Also Interacts With Other Medications

Vitamin C has 100 moderate, 106 minor known drug interactions in our database — the Warfarin Sodium one above is one of them. If you take anything else, check it against the full list below.

Taking anything else?

Check Another of Your Medications Against Vitamin C

Covers the 2,830 medications we’ve checked against Vitamin C. Pick one to open its full report.

From our Q&A

Questions About Vitamin C or Warfarin Sodium

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Vitamin C or Warfarin Sodium, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Warfarin Sodium

This page covers Vitamin C only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Warfarin Sodium page lists 361 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Alfalfa (major), American Ginseng (major), Beer (major) and Cannabis (major).

Open the Warfarin Sodium interaction page

One more smart check

Taking Vitamin C as Part of a Dietary Supplement Product? Check It for Interactions

We hold 36,382 real supplement products containing Vitamin C, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Vitamin C. Your product may carry other ingredients that interact with Warfarin Sodium too, on top of Vitamin C — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Vitamin C and Warfarin Sodium Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Vitamin C
Top 10

#2 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Warfarin Sodium
Top 5%

#30 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About Vitamin C

What is Vitamin C?

  • Common cold and immune support
  • Antioxidant support
  • Skin health and collagen formation
  • Wound healing
  • Preventing or treating scurvy
  • Improving iron absorption

Vitamin C (ascorbic acid) is an essential nutrient your body needs but cannot make, so you must get it from food or supplements. It's important for immune function, collagen, and acts as an antioxidant, but taking large doses doesn't prevent colds for most people and may cause stomach upset. Most people get enough from a balanced diet, so check with your pharmacist or doctor before taking high-dose supplements.

Read the full Vitamin C monograph & all interactions
Medication

About Warfarin

What Is Warfarin Used For?

Brand names: Coumadin, Panwarfin, Sofarin

Warfarin helps prevent and treat harmful blood clots. The label lists these uses for both Warfarin Sodium tablets and Jantoven tablets:

  • Preventing and treating venous thrombosis (clots in the veins) and pulmonary embolism (clots in the lungs).
  • Preventing and treating clot-related complications of atrial fibrillation and/or heart valve replacement.
  • Lowering the risk of death, another heart attack, and clot-related events such as stroke after a heart attack.

Warfarin does not dissolve a clot that has already formed. It helps stop the clot from growing and prevents further clot-related complications.

See full Warfarin drug information
Keep checking

Other Drugs & Vitamin C

Browse every other medication we’ve checked against Vitamin C — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
100Moderate
106Minor
2,623No known interaction
Moderate

100 interactions

Showing 60 of 100 moderate interactions — see all 100 on the Vitamin C page.

Minor

106 interactions

Showing 60 of 106 minor interactions — see all 106 on the Vitamin C page.

No interaction 2,623 drugs checked — show the list
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

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Pharmacist Counseling Corner

Taking Vitamin C and Warfarin Sodium Together: Common Questions

Can you take Vitamin C with Warfarin Sodium?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
How serious is the Vitamin C and Warfarin Sodium interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.