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Warfarin (CoumadinÒ) is known to have many drug interactions as well interactions with vitamin K containing foods. Warfarin is an anticoagulant; it increases the time the blood takes to form a clot (measured with an INR). It is considered a narrow therapeutic index medication. This means the range of the effective dose is small. Therefore, patients on warfarin should be closely monitored, especially when making significant dietary changes and beginning or stopping herbal supplements.
Considering the top 10 natural products, increased clotting time may occur with garlic, ginkgo, and fish oil. Garlic is often used to treat high cholesterol and high blood pressure. There have been reports of clotting problems with high doses of garlic and garlic essential oil, but not with simultaneous use of warfarin and garlic. However, at this time, it is not recommended to use the two together. Normal dietary ingestion of garlic should not pose a problem. Ginkgo has been used for improved cognitive function. As with garlic, there have not been reports of interactions between ginkgo and warfarin, but the potential exists based on bleeding
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problems in patients taking ginkgo alone. Finally, there has been at least one report of increased INR in a patient taking warfarin and fish oil supplements. Two of the components of fish oil may have anti-thrombin properties (thrombin is a protein involved in clot formation.)
Decreased INR may occur with ginseng, one of the top 10 supplements, and CoEnzyme Q10. Unlike the previously mentioned supplements with potential interactions in patients taking warfarin, ginseng and CoEnzyme Q10 have been reported to decreased INR in patients taking warfarin with therapeutic INRs. Ginseng has been used for memory, stress management and increased energy. There are three varieties of ginseng generally available in the United States with corresponding variations in potential interactions. CoEnzyme Q10 is used in therapy for disorders such as heart failure, hypertension and other cardiovascular diseases. CoEnzyme Q10 is structurally related to Vitamin K, the antidote for warfarin, which is also the compound in foods known to interact with warfarin. If a patient is using either of these two supplements, their INRs
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should be monitored closely.
As you can see, there is a lot to consider when choosing to take dietary supplements. Remember to look closely at the ingredients listed on herbal and dietary supplements. It is possible to find some of the herbs known to have interactions in combination products, such as those for "improved memory" and "increased energy." Also, if you are taking warfarin and decide to begin taking dietary supplements, talk to your health care provider so he or she can be sure to monitor your INR more closely during the first weeks of taking the supplement. Also, increased monitoring may be necessary if you have been taking supplements and decide to stop. Your doctor may recommend that you wait to take the supplement until such time as you can stop anti-coagulation therapy.
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