Warfarin Institute of America
DEDICATED TO YOUR HEALTH SINCE 2000
DANSHEN INTERACTIONS WITH WARFARIN (Coumadin, Jantoven)
Danshen which is defined as the root of Salvia miltiorrhiza appears to have a very powerful effect on warfarin (Coumadin, Jantoven). I have also read that, due to a mispronunciation of the name in Chinese, there is a possibility that what is being called Danshen is not actually the same plant. If this is the case, there may be some reports of no interaction occurring. This could make this interaction very dangerous because you would never know what you were actually taking.
This herb is not very popular in the United States but there is a danger of it being recommended to someone taking warfarin (Coumadin, Jantoven) because traditional Chinese medicine uses it for heart problems.
A review article by Amy Heck and colleagues highlights three cases of people having elevated INRs (5.5 to greater than 8.4) after consuming danshen for periods varying from three days to several weeks. The man with the INR greater than 8.4 bled into his chest cavity and the area around his heart.
This should be considered a very dangerous interaction and danshen should never be taken by anyone who is taking warfarin (Coumadin, Jantoven).
Reference: Heck AM et al. Potential Interactions Between Alternative Therapies and Warfarin. Am J Health-Syst Pharm. 2000;57:1221-30.
The following was written by one of my students
Dan shen is used in Chinese traditional medicine to improve circulation, coronary vasodilatation and protect against myocardial ischemia 1 It is so popular among some groups it is available in orally as well as in cigarettes 1 However, it may decrease the elimination of warfarin (Coumadin, Jantoven) 2 Additionally, it has been found to inhibit platelet aggregation in vivo, prolong PT in rats, increase the absorption rate constant, AUC, Cmax and elimination t1/2. 3 There are several case reports of interactions with warfarin (Coumadin, Jantoven) in the literature.
Case reports:
48 year-old female with a. fib, required close monitoring of INR, needed 2.5 to 3.5 mg of warfarin (Coumadin, Jantoven)/day to maintain INR between 1.5-3; went to ER complaining of malaise, fever, dyspnea; INR was >5.62; warfarin (Coumadin, Jantoven) and herb both stopped. It took 5 days for her to stabilize. At follow up her INR was stable at 2.5 on 3 mg warfarin (Coumadin, Jantoven)/day; danshen was only interaction found 2
62 year-old man with mech. mitral valve; 6 weeks post-discharge went to ER complaining of chest pain and dyspnea X 2 weeks; INR was >8.4 and large pericardial and right pleural collection of 4.5 L of unclotted blood was drained; pt required 6 units of FFP over 2 days; f/u: stabilized on warfarin (Coumadin, Jantoven) 5 mg QD with INR of 3; temporal relationship for interaction 4
References:
1. Cheng TO. Warfarn danshen interaction. Ann Thorac Surg 1999;67:894.
2. Yu CM, Chan JCN, Sanderson JE. Chinese herbs and warfarin potentiation by "danshen". J Int Med 1997; 241: 337-339.
3. Chan K, Lo AC, Yeung HK, Woo KS. The effects of Danshen (Salvia miltiorrhiza) on warfarin pharmacodynamics and pharmacokinetics of warfarin enantiomenrs in rats. J Pharm Pharmacol 1995; 47: 402-406.
4. Izzat MB, Yim APC, El-Zufari MH. A taste of Chinese medicine!. Ann Thorac Surg 1998; 66: 941-2.
© 2001 Patricia Chuong Used by permission
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