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.
[Show abstract][Hide abstract] ABSTRACT: Background
The objective of this systematic review was to examine the benefits, harms and pharmacokinetic interactions arising from the co-administration of commonly used dietary supplements with cardiovascular drugs. Many patients on cardiovascular drugs take dietary supplements for presumed benefits and may be at risk for adverse supplement-drug interactions.
The Allied and Complementary Medicine Database, the Cochrane Library, EMBASE, International Bibliographic Information on Dietary Supplements and MEDLINE were searched from the inception of the review to October 2011. Grey literature was also reviewed.
Two reviewers independently screened records to identify studies comparing a supplement plus cardiovascular drug(s) with the drug(s) alone. Reviewers extracted data using standardized forms, assessed the study risk of bias, graded the strength of evidence and reported applicability.
Evidence was obtained from 65 randomized clinical trials, 2 controlled clinical trials and 1 observational study. With only a few small studies available per supplement, evidence was insufficient for all predefined gradable clinical efficacy and harms outcomes, such as mortality and serious adverse events. One long-term pragmatic trial showed no benefit from co-administering vitamin E with aspirin on a composite cardiovascular outcome. Evidence for most intermediate outcomes was insufficient or of low strength, suggesting no effect. Incremental benefits were noted for triglyceridemia with omega-3 fatty acid added to statins; and there was an improvement in levels of high-density lipoprotein cholesterol with garlic supplementation when people also consumed nitrates
Evidence of low-strength indicates benefits of omega-3 fatty acids (plus statin, or calcium channel blockers and antiplatelets) and garlic (plus nitrates or warfarin) on triglycerides and HDL-C, respectively. Safety concerns, however, persist.
"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. "
[Show abstract][Hide abstract] ABSTRACT: A 71-year-old man was stable on warfarin (2.25 mg daily) therapy with an international normalized ratio (INR) of 1.8-2.2 after a heart valve replacement surgery. Recently, he consumed the liquid-like herbal product called shengmai-yin (10 mL daily) against medical advice. Seven days after the daily consumption of shengmai-yin, he was admitted to the intensive care unit because of consciousness disturbance [Glasgow Coma Scale (GCS) score 7] with an INR of 5.08. Head computed topography revealed intracerebral hematoma in the left temporoparietal region. Both warfarin therapy and the herbal product were withdrawn. At the same time, therapy with intravenous vitamin K1 40 mg was started. On the second day of admission, craniectomy was performed to remove the intacerebral hematoma under general anesthesia. He remained confused and restless for 2 days, but then showed progressive recovery in the consciousness level as well as motor and verbal functions. Shengmai-yin contains herbal ingredients that can interact with warfarin. The Drug Interaction Probability Scale (DIPS) indicated that warfarin and shengmai-yin were highly probable causes of intracerebral hematoma. Patients on warfarin therapy should be discouraged from taking herbal medicines, especially preparations that are already known to have antiplatelet and antithrombotic effects.
Yonsei medical journal 09/2010; 51(5):793-6. DOI:10.3349/ymj.2010.51.5.793 · 1.29 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: There are certain comments derived from observational clinical research and television commercials that are almost beginning
to sound cliché in the urologic world and this is remarkable if one looks back just a few years on the educational progress
that has occurred in the area of sexual health. For example, the relationship between erectile dysfunction (ED) and the potential
for a first cardiovascular disease (CVD) event is now well known that I do not even need to really provide a medical reference
after stating this fairly obvious relationship pick a study-Prostate Cancer Prevention Trial (PCPT) l… . However, these
correlative findings seem to promote more intervention compared to education and prevention in my opinion. Health care professionals
need to sell the concept of lifestyle changes and dietary supplement additions and deletions to promote sexual health first
as much as pharmacologic intervention in my opinion. I often tell patients that it has become an adage that they can reiterate
over and over to say that “when diet and exercise do not work there is …!” However, this should be true of every aspect of
preventive medicine and not just heart disease. For example, when diet and exercise does not work there is …. This is the
simple goal of this chapter.
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