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      Bleeding due to a probable interaction between warfarin and Gouqizi ( Lycium Barbarum L.)

      case-report
      Author(s): a , * , a , b
      Publication date (Electronic):
      Journal: Toxicology Reports
      Publisher: Elsevier
      Keywords: Warfarin, Gouqizi, Lycium barbarum L., Drug–herb interactions, TCM

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          Abstract

          Unlike what is widely anticipated by the public, herbal medicines are not always safe despite being natural. We describe a 65-year-old Chinese man taking a prolonged maintenance dose of warfarin who experienced an elevated international normalized ratio (INR) with associated bleeding after drinking Gouqizi (goji berry) wine. This report illustrates that large doses (more than 6–12 g) of Gouqizi can significantly enhance the anticoagulant action of warfarin and may cause similar adverse effects in keeping with three previous reports. Therefore, the use of herbal medicines must adhere to pharmacopoeia-recommended guidelines, including dosage regimes. Doctors should advise patients regarding possible interactions between herbs and warfarin when prescribing and should increase the frequency of INR monitoring for those patients concurrently receiving warfarin and medicinal herbs. Further study is needed to do for the mechanism of interaction between Gouqizi and warfarin.

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          Goji (Lycium barbarum and L. chinense): Phytochemistry, pharmacology and safety in the perspective of traditional uses and recent popularity.

          Olivier Potterat (2009)
          Since the beginning of this century, Goji berries and juice are being sold as health food products in western countries and praised in advertisements and in the media for well-being and as an anti-aging remedy. The popularity of Goji products has rapidly grown over the last years thanks to efficient marketing strategies. Goji is a relatively new name given to Lycium barbarum and L. chinense, two close species with a long tradition of use as medicinal and food plants in East Asia, in particular in China. While only L. barbarum is officinal, the fruit (fructus Lycii) and the root bark (cortex Lycii radicis) of both species are used in the folk medicine. We review here the constituents, pharmacology, safety, and uses of L. barbarum and L. chinense with consideration to the different parts of the plant. Investigations of the fruit have focused on proteoglycans, known as " Lycium barbarum polysaccharides", which showed antioxidative properties and some interesting pharmacological activities in the context of age related diseases such as atherosclerosis and diabetes. As to the root bark, several compounds have demonstrated a hepatoprotective action as well as inhibitory effects on the rennin/angiotensin system which may support the traditional use for the treatment of hypertension. While there are no signs of toxicity of this plant, two cases of possible interaction with warfarin point to a potential risk of drug interaction. In view of the available pharmacological data and the long tradition of use in the traditional Chinese medicine, L. barbarum and L. chinense certainly deserve further investigation. However, clinical evidences and rigorous procedures for quality control are indispensable before any recommendation of use can be made for Goji products. Copyright Georg Thieme Verlag KG Stuttgart . New York.
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            Epidemiology, risk factors for stroke, and management of atrial fibrillation in China.

            Yihong Sun, Dayi Hu (2008)
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              Updates on the Clinical Evidenced Herb-Warfarin Interactions

              Beikang Ge, Zhen Zhang, Zhong Zuo (2014)
              Increasing and inadvertent use of herbs makes herb-drug interactions a focus of research. Concomitant use of warfarin, a highly efficacious oral anticoagulant, and herbs causes major safety concerns due to the narrow therapeutic window of warfarin. This paper presents an update overview of clinical findings regarding herb-warfarin interaction, highlighting clinical outcomes, severity of documented interactions, and quality of clinical evidence. Among thirty-eight herbs, Cannabis, Chamomile, Cranberry, Garlic, Ginkgo, Grapefruit, Lycium, Red clover, and St. John's wort were evaluated to have major severity interaction with warfarin. Herbs were also classified on account of the likelihood of their supporting evidences for interaction. Four herbs were considered as highly probable to interact with warfarin (level I), three were estimated as probable (level II), and ten and twenty-one were possible (level III) and doubtful (level IV), respectively. The general mechanism of herb-warfarin interaction almost remains unknown, yet several pharmacokinetic and pharmacodynamic factors were estimated to influence the effectiveness of warfarin. Based on limited literature and information reported, we identified corresponding mechanisms of interactions for a small amount of “interacting herbs.” In summary, herb-warfarin interaction, especially the clinical effects of herbs on warfarin therapy should be further investigated through multicenter studies with larger sample sizes.
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                Author and article information

                Contributors
                Jinhua Zhang
                Journal
                Journal ID (nlm-ta): Toxicol Rep
                Journal ID (iso-abbrev): Toxicol Rep
                Title: Toxicology Reports
                Publisher: Elsevier
                ISSN (Electronic): 2214-7500
                Publication date PMC-release: 29 August 2015
                Publication date Collection: 2015
                Publication date (Electronic): 29 August 2015
                Volume: 2
                Pages: 1209-1212
                Affiliations
                [a ]Department of Pharmacy, Fujian Medical University Union Hospital, 29 XunQuan Road, Fuzhou 350001, PR China
                [b ]Department of nursing, Fujian Medical University Union Hospital, 29 XunQuan Road, Fuzhou 350001, PR China
                Author notes
                [* ]Corresponding author. Fax: +86 591 83357896. pollyzhang2006@ 123456126.com
                Article
                Publisher ID: S2214-7500(15)30052-4
                DOI: 10.1016/j.toxrep.2015.08.011
                PMC ID: 5598317
                SO-VID: b8aafd3a-8413-4408-9fef-10fef5150f43
                Copyright © © 2015 The Authors
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 25 June 2015
                Date revision received : 25 August 2015
                Date accepted : 26 August 2015
                Categories
                Subject: Article

                Keywords: warfarin,gouqizi,lycium barbarum l.,drug–herb interactions,tcm
                Data availability:
                Keywords: warfarin, gouqizi, lycium barbarum l., drug–herb interactions, tcm

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