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Updates on the clinical evidenced herb-warfarin interactions.

Beikang Ge1, Zhen Zhang1, Zhong Zuo1

  • 1School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.

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Herbal supplements can dangerously interact with warfarin, a common blood thinner. Nine herbs, including St. John's wort and garlic, show major interaction risks, necessitating further research into herb-warfarin interactions.

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Area of Science:

  • Pharmacology
  • Herbal Medicine
  • Drug Interactions

Background:

  • The increasing use of herbal products raises concerns about potential herb-drug interactions.
  • Warfarin, a widely used oral anticoagulant, has a narrow therapeutic window, making its interactions with herbs a significant safety issue.

Purpose of the Study:

  • To provide an updated overview of clinical findings on herb-warfarin interactions.
  • To highlight clinical outcomes, interaction severity, and the quality of evidence for these interactions.

Main Methods:

  • Review of clinical findings on herb-warfarin interactions.
  • Classification of 38 herbs based on interaction severity and evidence likelihood.
  • Identification of potential pharmacokinetic and pharmacodynamic mechanisms.

Main Results:

  • Nine herbs (Cannabis, Chamomile, Cranberry, Garlic, Ginkgo, Grapefruit, Lycium, Red clover, St. John's wort) demonstrated major severity interactions with warfarin.
  • Herbs were categorized into four levels of interaction probability (Level I to IV).
  • Mechanisms underlying herb-warfarin interactions remain largely unknown, though pharmacokinetic and pharmacodynamic factors are implicated.

Conclusions:

  • Herb-warfarin interactions pose significant clinical safety concerns.
  • Further multicenter studies with larger sample sizes are crucial to investigate the clinical effects of herbs on warfarin therapy.