Does Mango interact with Warfarin (anticoagulant)?

Warfarin and Mango Interaction

Mango can potentiate warfarin's anticoagulant effect and increase bleeding risk, so clinicians should inquire about mango consumption in patients on warfarin and advise limiting intake to less than one whole fruit per day. 1, 2

Evidence Quality and Clinical Significance

The evidence for mango-warfarin interaction comes primarily from case reports rather than controlled trials, which limits definitive conclusions about the magnitude and consistency of this interaction. 1, 3 However, the 2022 Circulation guidelines specifically identify mango among several fruits (including pomegranate, avocado, grapefruit, and papaya) that have been reported to interact with warfarin. 1

The most recent systematic review (2024) provides the clearest guidance: mango consumption of more than one fruit can potentiate warfarin effects. 2 This represents the best available evidence-based threshold for clinical practice.

Mechanism of Interaction

While the exact mechanism remains incompletely understood, mango likely interacts with warfarin through:

• Pharmacokinetic effects: Potential inhibition of CYP2C9 or CYP3A4 enzymes that metabolize warfarin 1
• Pharmacodynamic effects: Possible direct antiplatelet or anticoagulant properties of mango compounds 2

The challenge in defining these interactions stems from lack of standardization in fruit content and quantity consumed across case reports. 1, 3

Clinical Management Algorithm

When taking a medication history:

• Specifically ask about mango consumption frequency and quantity 1, 3
• Document mango intake patterns in patients with unexplained INR fluctuations 3

For patients currently consuming mango:

• Advise limiting intake to less than one whole fruit per day 2
• Increase INR monitoring frequency if patient regularly consumes mango 3
• Consider checking INR 3-5 days after any significant change in mango consumption patterns 2

For patients with INR instability:

• Include recent mango consumption in your differential diagnosis for elevated INR 1, 3
• Assess dietary history for other interacting fruits (pomegranate, avocado, grapefruit, papaya) 1

Important Caveats

The evidence base has significant limitations:

• Most data comes from isolated case reports with poor quality evidence 3, 4
• Lack of standardization in fruit quantity and preparation makes dose-response relationships unclear 1, 3
• Individual patient factors (genetic polymorphisms in CYP2C9, baseline INR stability, concurrent medications) may modify interaction risk 5

However, the consistency of case reports across multiple fruit products suggests these interactions are clinically relevant enough to warrant caution. 1, 3 The potential for serious bleeding complications with warfarin justifies a conservative approach even with limited evidence. 4

Practical Recommendations

• Do not prohibit mango consumption entirely, as moderate intake (less than one fruit daily) appears safe based on available evidence 2
• Emphasize consistency in dietary habits rather than complete avoidance, similar to vitamin K-containing foods 6, 5
• Maintain heightened vigilance during periods when patients may increase fruit consumption (summer months, holidays, travel to tropical regions) 3