Possible Interaction: Warfarin and Ginseng

“A widely cited case report showed a substantial decrease in the anticoagulant effect of warfarin after ginseng consumption in a patient who was previously maintained with stable warfarin therapy (7).”

“Cautions Patients and physicians should be aware that ginseng is among many substances that can interfere with warfarin's anticoagulant effect.”

“Context Consuming ginseng , a commonly used herbal dietary supplement, has been associated with a decrease in warfarin's anticoagulant effect in at least 1 case report.”

“Herbs such as ginseng may interact with medications that have a narrow therapeutic index, such as warfarin , a commonly used oral anticoagulant (5, 6).”

“In our healthy patients, however, ginseng reduced the anticoagulant effect of warfarin.”

“The results of both in vitro and in vivo study demonstrated that there is a serious interaction between warfarin and ginseng , which may deteriorate atherosclerosis and thrombosis after combined use of warfarin and GS.”

“Therefore, it is very essential to probe the interaction between warfarin and ginseng.”

“In addition, cranberry, danshen, dong quai, Ginkgo, ginseng , green tea, and St John's wort were found to have potential interactions with warfarin.”

“The case reports with severe adverse effects such as spontaneous postoperative …, thrombosis, subarachnoid hemorrhage and/or subdural hematomas after concomitant use of warfarin …: Panax ginseng , Hypericum perforatum, Salvia milthiorizza, Gingko biloba, Serenoa repens, Angelica sinensis, Vaccinium species, …, Lucium barbarum, Matricaria chamomilla, Boswellia serrata and Camellia sinensis have been estimated.”

“We also briefly stated recent case reports on potential interaction between warfarin and ginseng products.”

“Similarly, case reports have demonstrated that ginkgo may potentiate bleeding when combined with warfarin or aspirin, increases blood pressure when combined with thiazide diuretics, and has even led to a coma when combined with trazodone, a serotonin antagonist and reuptake inhibitor used to treat depression.”

“ Panax ginseng (ginseng) reduced the blood concentrations of alcohol (ethanol) and warfarin , and induced mania when used concomitantly with phenelzine, but ginseng increased the efficacy of influenza vaccination.”

“A systematic review of data from 9 RCT with warfarin and herbal products8 suggested that St John’s wort and Echinacea alter pharmacokinetic parameters and American ginseng might interfere the pharmacodynamics of warfarin , without any severe adverse effects being reported after the interactions as reported in those studies.”

“ American ginseng altered the PD parameters of warfarin.”

“Potential risks of bleeding due to the use of Ginkgo biloba, garlic or ginseng with aspirin or warfarin was the most reported herb–drug interaction.”