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KMID : 0869620130300050450
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Journal of Korean Society of Hospital Pharmacists
2013 Volume.30 No. 5 p.450 ~ p.470
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A Review of Herbal Interactions with Warfarin
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Chun Pu-Soon
Kim Jong-Yoon
Kim Jung-Tae
Koo Bon-Ki
Rhew Ki-Yon
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Abstract
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Objectives: Concerns on drug interaction with herbal preparations are increasing as
herbs are becoming more widely used as dietary supplements. Drug-herb interactions can alter therapeutic effects on patients, particularly in medications with narrow therapeutic index (NTI), such as warfarin. However, the potential risks from drug-herb interactions are often ignored or underestimated even when known. As there is limited documented information on potential herb-drug interactions, it is essential to provide clinical practices with the updated information as well as the mechanism on potential herb-drug interactions. The goals of this article are: (1) To review the evidence-based data and biomedical reports on herb-warfarin interactions in humans, and (2) To further provide the documented mechanisms and consequences of drug-herb interactions
Methods: PubMed was used to search the clinical trials and the case reports on herb-warfarin interactions in humans. This article focused on the data conducted in humans as well as the studies in animal models, in vitro, in vivo are cited, where relevant.
Results: There are several mechanisms for the occurrence of herb-drug interactions. Herbs which may affect warfarin therapy include the following: green tea, black tea, chamomile, cranberry, danshen, dong quai, ginseng, lyceum, noni, pomegranate, and St John’s wort. A vast majority of clinically significant PK herb-drug interactions involve cytochrome P450 (CYP) enzymes, UDP-glucuronosyltransferases (UGT), and drug transporters.
Conclusion: The reported effects of herbs on warfarin are contradictory. Clinical effects of herbdrug interactions depend on different factors, such as genotypes of patients, origins and constituents of herbs, and doses of administered drugs. Hence, further controlled clinical studies in humans are needed in order to verify the potential herbal interactions with conventional drugs.
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KEYWORD
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Herb-drug interaction, Warfarin, Herbal medicine
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