Warfarin and food, herbal or dietary supplement interactions: A systematic review

Abstract

Aims To present an updated overview on the safety of concurrent use of food, herbal or dietary supplement and warfarin. Methods A systematic literature review was performed on 5 databases from inception up to 31 December 2019. These interactions were classified depending on the likelihood of interaction and supporting evidences. Results A total of 149 articles describing 78 herbs, food or dietary supplements were reported to interact with warfarin. These reports described potentiation with 45 (57.7%) herbs, food or dietary supplements while 23 (29.5%) reported inhibition and 10 (12.8%) reported limited impact on warfarin pharmacokinetics and pharmacodynamics. Twenty unique herb and dietary supplements also reported to result in minor bleeding events, such as purpura and gum bleeding as well as major events such as intracranial bleeding that led to death. Conclusion While most food, herbs and supplements can be safely taken in moderation, healthcare professionals should be aware of the increased risk of bleeding when taking several food and herbs. These include Chinese wolfberry, chamomile tea, cannabis, cranberry, chitosan, green tea, Ginkgo biloba, ginger, spinach, St. John's Wort, sushi and smoking tobacco. Patients should be counselled to continue to seek advice from their healthcare professionals when starting any new herbs, food or supplement.

A Case of an Increase in Prothrombin Time-International Normalized Ratio by Interaction Between Warfarin and Baloxavir Marboxil in a Patient on Implantable Ventricular Assist Device

“…Warfarin interacts with various drugs and foods and inhibits vitamin K-dependent coagulation factors. It is metabolized by cytochrome P450 (CYP450) isozymes; furthermore, it has a high protein-binding rate [6][7][8][9]. BM is immediately hydrolyzed to its active form, S-033447 [1], which has a high protein-binding rate (93%-94%).…”

“…Their prothrombin time-international normalized ratio (PT-INR), an indicator of warfarin efficacy, is precisely controlled [5]. Warfarin poses a clinical problem because the PT-INR fluctuates due to the drug's interactions with other drugs and vitamin K intake [6][7][8][9]. Here, we report a case of a patient with iVAD whose PT-INR was significantly increased from the target range with the intake of BM.…”

Traditional and complementary medicine use in patients with type 2 diabetes: Findings from a multicenter cross-sectional questionnaire survey in Selangor, Malaysia

“…This study showed T&CM was commonly used among patients with type 2 diabetes in multi-ethnic communities (see Figure 1). Of clinical concern, these patients have a high risk of adverse drug events, principally those of older age and have multiple chronic medical conditions [12] . The risk is further increased in light of the challenges to determine specific ingredients in T&CM products, no tablet size and shape requirements, and lack of postmarketing surveillance [13] .…”

Ginger (Zingiber officinale Roscoe) as a nutraceutical: Focus on the metabolic, analgesic, and antiinflammatory effects

“…Ginger exerts antiplatelet actions in preclinical experiments and thus might theoretically interact with antiplatelet and/or anticoagulant drugs (Izzo, 2012). A recent systematic review of the literature retrieved three cases of interaction between ginger, the anticoagulant warfarin (Tan & Lee, 2020). However, a clinical trial showed that consumption of ginger, at recommended doses, does not significantly affect the pharmacokinetics or pharmacodynamics of warfarin in healthy subjects (Jiang et al, 2005).…”