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Interaction between warfarin and the herbal product quilinggao.
Anna L N Wong1, Thomas Y K Chan
1Accident and Emergency Department, Alice Ho Miu Ling Nethersole Hospital, Tai Po, New Territories, Hong Kong.
The Annals of Pharmacotherapy
|May 30, 2003
Summary
Consumption of the herbal product quilinggao, particularly certain brands, can lead to dangerous warfarin (an anticoagulant) interactions. Patients on warfarin should avoid herbal medicines due to potential bleeding risks.
Area of Science:
- Pharmacology
- Herbal Medicine Interactions
- Clinical Toxicology
Background:
- Warfarin is a commonly prescribed anticoagulant.
- Quilinggao is a popular Chinese herbal product with variable composition.
- Herbal products can pose risks due to unknown or interacting ingredients.
Observation:
- A patient on stable warfarin therapy experienced loss of anticoagulation control and bleeding events.
- These events occurred after consuming different brands of quilinggao.
- International Normalized Ratio (INR) levels significantly elevated, indicating excessive anticoagulation.
Findings:
- Specific brands of quilinggao contain herbs with antiplatelet and antithrombotic effects (e.g., Fritillaria spp., Paeoniae rubra, Lonicera japonica, Poncirus trifoliata).
- The interaction between quilinggao ingredients and warfarin likely caused the loss of anticoagulation control.
- A high probability of causality was established between quilinggao ingestion and the adverse events.
Implications:
- Quilinggao and similar multi-ingredient herbal products can interact with warfarin, increasing bleeding risk.
- Patients using warfarin should exercise extreme caution with herbal medicines.
- Healthcare providers should counsel patients on potential herb-drug interactions, especially with anticoagulants.