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Related Experiment Videos

Possible interaction between warfarin and Lycium barbarum L.

A Y Lam1, G W Elmer, M A Mohutsky

  • 1Department of Pharmacy, University of Washington, Seattle 98104-3031, USA. aylam@u.washington.edu

The Annals of Pharmacotherapy
|October 26, 2001
PubMed
Summary

A Chinese herbal tea containing Lycium barbarum L. may interact with warfarin, increasing the international normalized ratio (INR). Patients should avoid this combination due to potential risks, especially when using other herbs with narrow therapeutic index drugs.

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Area of Science:

  • Pharmacology
  • Herbal Medicine
  • Drug Interactions

Background:

  • Warfarin is a common anticoagulant medication requiring careful monitoring of the international normalized ratio (INR).
  • Lycium barbarum L. (Goji berry) is a traditional Chinese herb with various purported health benefits.
  • CYP2C9 is the primary enzyme responsible for metabolizing S-warfarin, the active enantiomer of warfarin.

Observation:

  • A patient stabilized on warfarin experienced an elevated INR (4.1) after consuming concentrated Lycium barbarum L. tea.
  • The patient had no other changes in medication or lifestyle, suggesting the tea as the cause.
  • Warfarin dosage was adjusted, and upon discontinuation of the tea, the INR returned to the therapeutic range (2.0-2.5).

Findings:

  • In vitro studies indicated that Lycium barbarum L. tea weakly inhibits CYP2C9, the enzyme that metabolizes S-warfarin.

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  • The observed inhibition suggests a potential herbal-drug interaction, although other factors might also contribute.
  • The dissociation constant (Ki) for CYP2C9 inhibition by the tea was 3.4 mg/mL.

    • Implications:

    • Concurrent use of Lycium barbarum L. and warfarin may lead to potentially dangerous elevations in INR.
    • Healthcare providers should exercise caution and monitor patients closely when warfarin is used with herbal products.
    • Vigilance is recommended for other herbal-drug interactions, particularly with medications having narrow therapeutic indices.