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Potential interaction between warfarin and boldo-fenugreek.

J P Lambert¹, J Cormier

¹Pharmacy Department, CHAUQ, St-Sacrement Hospital, Québec City, Canada.

Pharmacotherapy

|April 20, 2001

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Boldo and fenugreek may increase bleeding risk in patients taking warfarin. Discontinuing these herbs normalized international normalized ratio (INR) levels, suggesting a significant herb-drug interaction.

Area of Science:

Pharmacology
Natural Products Research
Clinical Medicine

Background:

Warfarin is a common anticoagulant medication used to prevent blood clots in conditions like atrial fibrillation.
Patients often use herbal products alongside conventional medications, leading to potential interactions.
Understanding herb-drug interactions is crucial for patient safety and effective treatment.

Observation:

A patient on warfarin therapy experienced elevated international normalized ratio (INR) levels.
The patient reported concurrent use of boldo and fenugreek herbal supplements.
INR levels normalized upon discontinuation of boldo and fenugreek, and the interaction recurred upon reintroduction.

Findings:

The Naranjo algorithm indicated a probable association between boldo-fenugreek use and increased warfarin effect (elevated INR).

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This suggests a significant herb-drug interaction potentiating the anticoagulant activity of warfarin.

No adverse events were reported by the patient during the observation period.

Implications:

Clinicians should exercise vigilance regarding potential interactions between warfarin and herbal agents like boldo and fenugreek.
Patients on anticoagulant therapy should disclose all herbal product use to their healthcare providers.
Further research into the specific mechanisms of boldo-fenugreek interaction with warfarin is warranted.