Analysis and evaluation on decrease of anticoagulant effect of warfarin by herbal and dietary supplements based on case report literature
10.3760/cma.j.cn114015-20230630-00485
- VernacularTitle:基于病例报告文献对草药和膳食补充剂降低华法林抗凝作用的分析与评价
- Author:
Lijun WANG
1
;
Bing CHEN
;
Peng ZHANG
;
Yuyong JIANG
;
Haodong CAI
Author Information
1. 首都医科大学附属北京地坛医院药学部，北京 100015
- Publication Type:Journal Article
- Keywords:
Drugs, Chinese herbal;
Dietary supplements;
Warfarin;
Herb-drug interactions;
Anticoagulants
- From:
Adverse Drug Reactions Journal
2023;25(9):556-563
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze and evaluate the decrease of anticoagulant effect of warfarin by herbal and dietary supplements (HDS) based on case report literature.Methods:The case reports on decrease of anticoagulant effect of warfarin by HDS were selected by searching the relevant databases at home and abroad (up to June 24, 2023). The degree of decrease of anticoagulant effect of warfarin by HDS was evaluated according to the reduction degree of international normalized ratio and the occurrence of thrombotic events in patients in the case reports. The reliability scoring criteria of HDS-warfarin interaction was established according to the causality of the interaction between HDS and warfarin, the number of case reports, and the other evidences (warnings issued by relevant national institutions, clinical studies, pharmacokinetic/pharmacodynamic studies, animal studies, etc.). It was evaluated as highly, relatively, possibly, and suspiciously reliable if the total score was ≥9, 6-8, 3-5, and ≤2 points, respectively.Results:A total of 17 case reports were enrolled in the analysis, involving 25 patients and 11 kinds of HDS. Two kinds of HDS reduced the anticoagulant effect of warfarin severely, including ginseng ( Radix Ginseng)[(American ginseng ( Radix Panacis Quinquefolii), red ginseng, etc.] and Myrrh; 5 kinds of HDS reduced the anticoagulant effect of warfarin moderately, including St. John′s wort ( Hypericum perforatum L.), tea [green tea ( Camellia sinensis), black tea], peppermint ( Herba Menthae), coenzyme Q 10, and chitosan; 4 kinds of HDS reduced the anticoagulant effect of warfarin slightly, including milkvetch root ( Radix Astragali seu Hedysari), avocado, seaweed ( Sargassum), and soya ( Glycine max). The reliability of anticoagulant effect reduction of warfarin was evaluated as highly reliable in 1 kind of HDS, namely St. John′s wort (10 points), relatively reliable in 2 kinds of HDS, including ginseng and tea (8 and 6 points, respectively), possibly reliable in 7 kinds of HDS, including Myrrh, peppermint, coenzyme Q 10, chitosan, milkvetch root, avocado, and seaweed (5, 5, 5, 4, 4, 4, and 3 points, respectively), and suspiciously reliable in 1 kind of HDS, namely soya (2 points). Conclusion:The degree and reliability of anticoagulant effect reduction of warfarin by ginseng (American ginseng, red ginseng, etc.), St. John′s wort, and tea (green tea, black tea), are higher, which should be paid attention to by clinicians and clinical pharmacists.
