An 85-year-old male patient with a history of hypertension, old anterior wall myocardial infarction and atrial fibrillation was placed on warfarin one year previously. However, he did not comply with regular international normalized ratio (INR) measurements, but kept taking warfarin (5 mg) on a daily basis for almost a year without any problems. After watching a television program about herbal remedies, he decided to take St John's wort on his own initiative. One month later, he reported to the emergency service of our hospital with upper gastrointestinal bleeding. Initial blood work revealed hemoglobin (Hb): 7.9 g/dl, hematocrit (htc): 23%, and INR: 6.2. With supportive treatment of fresh frozen plasma and blood transfusions, the bleeding ceased. Later, an esophagogastroduodenoscopy showed no significant pathology. The patient was instructed not to use herbal remedies with prescription medications on discharge.Herbal remedies are frequently used worldwide without medical or government control. Many toxic effects due to herbal remedies have been reported in the medical literature, especially when they are used in combination with prescribed medications. Some have life-threatening side effects, as seen in our patient (1).It is interesting to note that the combined use of St John's wort and warfarin usually causes neutralization of the effect of warfarin by increasing its metabolism via the P450 enzyme system (2). However, in our patient, reverse events occurred: the INR was increased and the patient developed a severe bleeding diathesis, which manifested itself with hematemesis and melena. This is a rare event (3).It is thought that since St John's wort contains many active ingredients, namely hyperforin, flavonols, flavonol glycosides, biflavones, naphthodianthrones, acylphloroglucinols, and phenylpropanes, one or more combinations of these active ingredients might affect the drug metabolism of warfarin in sensitive individuals by potentiating its effect on the clotting cascade (4).Herbal remedies should be considered as toxic as any other drug, and the public should be warned and informed about these effects via accumulation of such reports in the medical literature.

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SUMMARY:The purpose of this study, ischemia reperfusion injury in rats, Potentilla fulgens is to investigate the protective effects. Wistar albino rats (n= 30) weighing 180-220 g were used in the experiment. Group 1 animals underwent sham laparotomy without ischemiareperfusion injury. Group 2 animals underwent laparotomy and occlusion of superior mesenteric arteries for 30 min followed by 20 min of reperfusion without pretreatment. The Potentilla fulgens group received 400 mg/kg/day Potentilla fulgens intraperitoneally 5 days before Ischemia-reperfusion injury. There was a significant difference between the group with ischemia-reperfusion group Potentilla fulgens (p<0.0001). In statistical analysis of the MDA level, data were obtained after a respective measurement in all groups. Potentilla fulgens group with ischemia-reperfusion group was a significant decrease in MDA (p<0.001). In the period after ischemia-reperfusion, marked PCNA immunoreactivities were observed in the nuclei of crypt and villus cell. In ischemia reperfusion group, the number of PCNA immunoreactivity is quite advanced and they extended throughout the middle part of the intestine folds. The number of TUNEL-positive nuclei were also developed. In ischemia-reperfusion plus P. fulgens group, the intestinal epithelium with only a few PCNA immunoreactive nuclei. TUNEL positive nuclei were noted in the gut lumen and mucosal close differentiated goblet cells. We showed that Potentilla fulgens extract significantly prevented mucosal lesions caused by intestinal ıschemia-reperfusion.