Warfarin Institute of America
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GINGER INTERACTIONS WITH WARFARIN
I have seen one possible interaction between ginger and warfarin. This was a very young woman with lupus who had a serious, debilitating stroke. This left her with poor balance and the only thing which would relieve her nausea without oversedation was ginger. At one point her platelets (a blood clotting factor) dropped to an alarmingly low level. Her INR also increased dramatically. It was impossible to determine how much of the effect was due to a lupus flare-up, how much was due to ginger, and how much may have been attributed to other interacting medications. She continues to take ginger and warfarin and her INR has stabilized. Because of her precarious situation, she is monitored frequently.
The amount of ginger in various foods should not be enough to affect the INR.
Heck et al. says, "Patients taking warfarin and ginger supplements concurrently should have their INR checked regularly and be advised to watch for symptoms of bleeding."
Reference:
Heck AM, DeWitt BA, Lukes 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
Ginger is used as an antiemetic (3) in seasickness, pregnancy and following gynecological surgery. (2) It is proposed to interact with warfarin via thromboxane synthetase inhibition. (3) There are some studies available in the literature that suggest consumption of ginger while taking warfarin is fine. Therefore, it is advisable to monitor closely for any signs of bleeding if these two are taken concurrently.
Studies:
A randomized placebo controlled study of 18 healthy volunteers given 15 g of ginger root or 40 g of stem ginger. (1) The conclusion of this study is that anticoagulation activity unlikely to be affected by daily consumption of ginger (raw or cooked).
A randomized, double-blind study in 8 healthy volunteers (2) given up to 2 g of dried ginger. No effect on platelet function was noted. This study suggests fresh ginger may contain an essential oil that evaporates, and central aromatic components may undergo chemical changes in storage, explaining why the expected thromboxane synthetase inhibition did not occur. A problem with this study is its small study size of healthy volunteers.
References:
1: Janssen PLTMK, Meyboom S, van Straveren WA, de Vegt F, Katan MB. Consumption of ginger (Zingiber Officinale Roscoe) does not affect ex vivo platelet thromboxane production in humans. European J Clin Nutr 1996; 50: 772-4.
2: Lumb AB. Effect of dried ginger on human platelet function. Thromb Haemost 1994; 71: 110-1.
3: Backon J. Ginger as an antiemetic: possible side effects due to its thromboxane synthetase activity. Anaesthesia 1991; 46: 705-6.
4: Miller LG. Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med 1998; 158: 2200-9.
©2001 Patricia Chuong Used by Permission
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Last updated November 13, 2004