Interaction Between Warfarin and Panax ginseng in Ischemic Stroke Patients

Department of Internal Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea.
Journal of alternative and complementary medicine (New York, N.Y.) (Impact Factor: 1.59). 07/2008; 14(6):715-21. DOI: 10.1089/acm.2007.0799
Source: PubMed


Today, the combined use of Oriental herbal medicines and Western biomedical medicines has been a prevalent yet controversial practice. Case reports and healthy volunteer trials have had conflicting results on the effect Panax ginseng has on warfarin's pharmacologic action, some reporting a reductive and others a potentiating influence.
This study investigated the interaction between warfarin and P. ginseng by observing the prothrombin time (PT) and the international normalized ratio (INR) in ischemic stroke patients who did not have a history of taking warfarin.
Randomized, open-label, controlled study.
Twenty-five (25) patients newly diagnosed with ischemic stroke by brain computed tomography or magnetic resonance imaging in the Korean Medical Hospital, Kyung Hee University (Seoul, Republic of Korea).
Ischemic stroke patients were randomized into 2 groups: the ginseng group (n = 12), given both P. ginseng and warfarin, and the control group (n = 13), given only warfarin, both for 2 weeks. The warfarin dose was restricted to 2 mg in the first week and 5 mg in the second week.
The peak values and the international normalized ratio (INR) and prothrombin time (PT) areas under the curve (AUC) in both groups significantly increased compared to those at baseline. However, there was no statistically significant difference in peak values and INR and PT AUC between groups in both the first and second weeks.
This study suggests that coadministration of P. ginseng and warfarin in ischemic stroke patients does not influence the pharmacologic action of warfarin.

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    • "Evidence from three RCTs for co-administration of ginseng and warfarin was inconclusive (grade: insufficient) [68-70]. "
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    • "In contrast, Jiang et al.15 showed that co-administration of warfarin with ginseng did not affect the pharmacokinetics or pharmacodynamics of either S-warfarin or R-warfarin in healthy subjects in 2004. Recently, Lee, et al.16 also found that co-administration of panax ginseng and warfarin in ischemic stroke patients does not influence the pharmacologic action of warfarin. Later study by Jiang, et al.17 demonstrated that Asian ginseng could actually modestly increase the clearance of warfarin and decrease its effectiveness. "
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