Effects of herbal medicines on warfarin response

[Guest guest]

Hi All,

 

Jiang X, Blair EY, McLachlan AJ. Investigation of the effects of herbal

medicines on warfarin response in healthy subjects: a population

pharmacokinetic-pharmacodynamic modeling approach. J Clin Pharmacol.

2006 Nov;46(11):1370-8. Faculty of Pharmacy, Building A15, the U Sydney,

NSW 2006, Australia; e-mail: andrewm Systematic

evidence regarding herb-drug interactions is lacking. This study investigated

herb-drug interactions with warfarin. S-warfarin concentration and response

(prothrombin complex activity) data from healthy subjects (n = 24) who

received a single warfarin dose (25 mg) and either St John's wort, Asian

ginseng, Ginkgo biloba, or ginger were analyzed using a population

pharmacokinetic-pharmacodynamic modeling approach. The ratio of S-

warfarin apparent clearance (CL/F) compared to control was 1.39 +/- 0.06

and 1.14 +/- 0.04 after St John's wort and Asian ginseng pretreatment,

respectively. Other pharmacokinetic and pharmacodynamic parameters

were unaffected. Coadministration of St John's wort significantly increased

S-warfarin CL/F, whereas treatment with Asian ginseng produced only a

moderate increase in CL/F. Ginkgo and ginger did not affect the

pharmacokinetics of warfarin in healthy subjects. None of the herbs studied

had a direct effect on warfarin pharmacodynamics. Studies in

anticoagulated patients are warranted to assess the clinical significance of

these herb-drug interactions. PMID: 17050802 [PubMed - in process]

 

Best regards,

 

 

 

 

[Guest guest]

While on the subject of warferin

 

Has anyone had any experience in treating patients with DVT and taking

warferin

 

I spoke to a TCM doctor from China recently and they use tao hong si wu tang

for that problem

 

Any thought s on if blood moving medicinals would benefit the dvt or hinder

process

 

Heiko

 

 

 

 

 

 

 

 

 

On Behalf Of

Sunday, October 22, 2006 12:22 PM

vBMA; traditional_Chinese_Medicine

Cc:

Effects of herbal medicines on warfarin response

 

 

 

Hi All,

 

Jiang X, Blair EY, McLachlan AJ. Investigation of the effects of herbal

medicines on warfarin response in healthy subjects: a population

pharmacokinetic-pharmacodynamic modeling approach. J Clin Pharmacol.

2006 Nov;46(11):1370-8. Faculty of Pharmacy, Building A15, the U Sydney,

NSW 2006, Australia; e-mail: andrewm (AT) pharm (DOT)

<andrewm%40pharm.usyd.edu.au> usyd.edu.au Systematic

evidence regarding herb-drug interactions is lacking. This study

investigated

herb-drug interactions with warfarin. S-warfarin concentration and response

(prothrombin complex activity) data from healthy subjects (n = 24) who

received a single warfarin dose (25 mg) and either St John's wort, Asian

ginseng, Ginkgo biloba, or ginger were analyzed using a population

pharmacokinetic-pharmacodynamic modeling approach. The ratio of S-

warfarin apparent clearance (CL/F) compared to control was 1.39 +/- 0.06

and 1.14 +/- 0.04 after St John's wort and Asian ginseng pretreatment,

respectively. Other pharmacokinetic and pharmacodynamic parameters

were unaffected. Coadministration of St John's wort significantly increased

S-warfarin CL/F, whereas treatment with Asian ginseng produced only a

moderate increase in CL/F. Ginkgo and ginger did not affect the

pharmacokinetics of warfarin in healthy subjects. None of the herbs studied

had a direct effect on warfarin pharmacodynamics. Studies in

anticoagulated patients are warranted to assess the clinical significance of

 

these herb-drug interactions. PMID: 17050802 [PubMed - in process]

 

Best regards,

 

 

 

[Guest guest]

Because of its narrow therapeutic index (TI), I've come to the opinion

that we simply should not prescribe Chinese meds to patients on

warfarin (unless we have A LOT of experience doing that). The other

two Western meds I have come to the same conclusion about (through the

research and advice of Dr. Greg Sperber, MD and DOM) are lithium and

phenytoin.

 

For info on the CM treatment of DVT, see Simon Becker et al.'s The

Treatment of Cardiovascular Diseases with available

from Blue Poppy Press.

 

Bob

[Guest guest]

I have experience treating patients with Chinese herbs while they

are using warfarin (coumadin), lithium, and dilatin (phenytoin). I

haven't had any bad experiences as of yet with adverse side effects,

but of course, don't start unless you have a good idea of what you

are doing and you need to communicate well with the patient and PCP

on what your plan of action is. Keeping in mind many Western docs

out there just tell their patients that all Chinese herbs are

poison. When you start cautiously and by using appropriate

monitoring (ie, INR / PT for warfarin in particular), you should be

able to detect gradually when a problem may arise and modify

accordingly. I had beat into me to be very deathly afraid of

interactions for these types of medications, but in practical

experience, I haven't seen any yet that even come close to severity

of interactions amongst various Western meds. After talking with

John Chen and his experiences after one of his interaction classes,

I became less deathly afraid and proceeded cautiously with

treatment. Has anyone had specific actual adverse interactions with

these interactions?

 

Geoff

 

, " Bob Flaws "

<pemachophel2001 wrote:

>

> Because of its narrow therapeutic index (TI), I've come to the

opinion

> that we simply should not prescribe Chinese meds to patients on

> warfarin (unless we have A LOT of experience doing that). The other

> two Western meds I have come to the same conclusion about (through

the

> research and advice of Dr. Greg Sperber, MD and DOM) are lithium

and

> phenytoin.

>

> For info on the CM treatment of DVT, see Simon Becker et al.'s The

> Treatment of Cardiovascular Diseases with

available

> from Blue Poppy Press.

>

> Bob

>

[Guest guest]

Yes, but usually add chong (bugs) to make it more effective.

Geoff

 

, " Heiko Lade "

<heikocha wrote:

>

> While on the subject of warferin

>

> Has anyone had any experience in treating patients with DVT and

taking

> warferin

>

> I spoke to a TCM doctor from China recently and they use tao hong

si wu tang

> for that problem

>

> Any thought s on if blood moving medicinals would benefit the dvt

or hinder

> process

>

> Heiko

>

 

>

> On Behalf Of Phil

Rogers

> Sunday, October 22, 2006 12:22 PM

> vBMA; traditional_Chinese_Medicine

> Cc:

> Effects of herbal medicines on warfarin response

>

>

>

> Hi All,

>

> Jiang X, Blair EY, McLachlan AJ. Investigation of the effects of

herbal

> medicines on warfarin response in healthy subjects: a population

> pharmacokinetic-pharmacodynamic modeling approach. J Clin

Pharmacol.

> 2006 Nov;46(11):1370-8. Faculty of Pharmacy, Building A15, the U

Sydney,

> NSW 2006, Australia; e-mail: andrewm (AT) pharm (DOT)

> <andrewm%40pharm.usyd.edu.au> usyd.edu.au Systematic

> evidence regarding herb-drug interactions is lacking. This study

> investigated

> herb-drug interactions with warfarin. S-warfarin concentration and

response

> (prothrombin complex activity) data from healthy subjects (n = 24)

who

> received a single warfarin dose (25 mg) and either St John's wort,

Asian

> ginseng, Ginkgo biloba, or ginger were analyzed using a population

> pharmacokinetic-pharmacodynamic modeling approach. The ratio of S-

> warfarin apparent clearance (CL/F) compared to control was 1.39 +/-

0.06

> and 1.14 +/- 0.04 after St John's wort and Asian ginseng

pretreatment,

> respectively. Other pharmacokinetic and pharmacodynamic parameters

> were unaffected. Coadministration of St John's wort significantly

increased

> S-warfarin CL/F, whereas treatment with Asian ginseng produced

only a

> moderate increase in CL/F. Ginkgo and ginger did not affect the

> pharmacokinetics of warfarin in healthy subjects. None of the

herbs studied

> had a direct effect on warfarin pharmacodynamics. Studies in

> anticoagulated patients are warranted to assess the clinical

significance of

>

> these herb-drug interactions. PMID: 17050802 [PubMed - in process]

>

> Best regards,

>

>

>

[Guest guest]

I have also been treating and been getting results, his legs no longer

purple, walking better, and tongue deviation has improved, been using di

long as well

 

Heiko

 

 

 

 

 

On Behalf Of G Hudson

Friday, October 27, 2006 7:11 PM

 

Re: Effects of herbal medicines on warfarin response

 

 

 

Yes, but usually add chong (bugs) to make it more effective.

Geoff

 

@ <%40>

, " Heiko Lade "

<heikocha wrote:

>

> While on the subject of warferin

>

> Has anyone had any experience in treating patients with DVT and

taking

> warferin

>

> I spoke to a TCM doctor from China recently and they use tao hong

si wu tang

> for that problem

>

> Any thought s on if blood moving medicinals would benefit the dvt

or hinder

> process

>

> Heiko

>

 

> @ <%40>

 

> [@ <%40>

] On Behalf Of Phil

Rogers

> Sunday, October 22, 2006 12:22 PM

> vBMA; traditional_

<traditional_Chinese_Medicine%40>

Chinese_Medicine

> Cc: @ <%40>

 

> Effects of herbal medicines on warfarin response

>

>

>

> Hi All,

>

> Jiang X, Blair EY, McLachlan AJ. Investigation of the effects of

herbal

> medicines on warfarin response in healthy subjects: a population

> pharmacokinetic-pharmacodynamic modeling approach. J Clin

Pharmacol.

> 2006 Nov;46(11):1370-8. Faculty of Pharmacy, Building A15, the U

Sydney,

> NSW 2006, Australia; e-mail: andrewm (AT) pharm (DOT)

> <andrewm%40pharm.usyd.edu.au> usyd.edu.au Systematic

> evidence regarding herb-drug interactions is lacking. This study

> investigated

> herb-drug interactions with warfarin. S-warfarin concentration and

response

> (prothrombin complex activity) data from healthy subjects (n = 24)

who

> received a single warfarin dose (25 mg) and either St John's wort,

Asian

> ginseng, Ginkgo biloba, or ginger were analyzed using a population

> pharmacokinetic-pharmacodynamic modeling approach. The ratio of S-

> warfarin apparent clearance (CL/F) compared to control was 1.39 +/-

0.06

> and 1.14 +/- 0.04 after St John's wort and Asian ginseng

pretreatment,

> respectively. Other pharmacokinetic and pharmacodynamic parameters

> were unaffected. Coadministration of St John's wort significantly

increased

> S-warfarin CL/F, whereas treatment with Asian ginseng produced

only a

> moderate increase in CL/F. Ginkgo and ginger did not affect the

> pharmacokinetics of warfarin in healthy subjects. None of the

herbs studied

> had a direct effect on warfarin pharmacodynamics. Studies in

> anticoagulated patients are warranted to assess the clinical

significance of

>

> these herb-drug interactions. PMID: 17050802 [PubMed - in process]

>

> Best regards,

>

>

>

[Guest guest]

Great - sounds like you're doing the right thing! I love the

description of 'chong' that the Chinese docs would say 'they crawl

through the channels like a worm through dirt' ;-)

Geoff

 

, " Heiko Lade " <heikocha

wrote:

>

> I have also been treating and been getting results, his legs no longer

> purple, walking better, and tongue deviation has improved, been using

di

> long as well

>

> Heiko