Table 4 Potential Drug-Biological Based Therapies Interactions & Management
Medication | Alternative Pharmacotherapy Product | Potential Interaction and Management | Number of Patients | Onset28* | Level of Severity28 |
|---|---|---|---|---|---|
Warfarin | Green tea | Green tea may antagonize warfarin effects. Monitor INR. | 1 | Delayed | Moderate |
Warfarin | Coenzyme Q 10 | Coenzyme Q 10 may have procoagulant effects and may decrease response to warfarin. Monitor INR. | 2 | Delayed | Moderate |
Warfarin | Vitamin E | Vitamin E may potentiate warfarin effects. Monitor INR and signs and symptoms of bleeding. | 5 | Delayed | Moderate |
Warfarin | Garlic | Garlic has antiplatelet effects, and risk of bleeding may be increased. Monitor INR and signs and symptoms of bleeding. | 1 | Delayed | Major |
Warfarin | Ginkgo biloba | Ginkgo inhibits platelet aggregation, risk of bleeding may be increased. Monitor INR and signs and symptoms of bleeding | 2 | Delayed | Major |
Warfarin | Fish oils | Concomitant use of warfarin and fish oils may increase risk of bleeding. Monitor INR and signs and symptoms of bleeding. | 1 | Not specified | Not specified |
Aspirin | Vitamin E | Coadministration of vitamin E and aspirin may increase the risk of bleeding. Monitor for signs and symptoms of bleeding | 16 | Not Specified | Not specified |
Aspirin | Garlic | Additive antiplatelet effects may occur with coadministration of garlic and aspirin, risk of bleeding may be increased. Monitor for signs and symptoms of bleeding | 1 | Delayed | Moderate |
Aspirin | Fish oils | Concomitant use of aspirin and fish oils may increase risk of bleeding. Monitor for signs and symptoms of bleeding | 3 | Not specified | Not specified |
Aspirin | Ginko biloba | Ginkgo inhibits platelet aggregation; risk of bleeding may be increased. Monitor for signs and symptoms of bleeding. | 1 | Delayed | Major |
Clopidogrel | Vitamin E | Concomitant use of vitamin E and clopidogrel may increase the risk of bleeding. Monitor for signs and symptoms of bleeding | 5 | Not specified | Not specified |
Clopidogrel | Garlic | Additive antiplatelet effects may occur, risk of bleeding may be increased. Monitor for signs and symptoms of bleeding | 1 | Delayed | Major |
Clopidogrel | Coenzyme Q | Coenzyme Q 10 may have procoagulant effects, may partially antagonize antiplatelet effect of clopidogrel. | 1 | Not specified | Not specified |
Insulin | Insulin leaf | Enhanced hypoglycemic effects. Patient was advised to discontinue insulin leaf while receiving insulin for glycemic control. | 1 | Delayed | Moderate |
Paroxetine | Saint John's Wort | Saint John's Wort induces cytochrome P450 3A4 enzyme and has mechanism of action similar to serotonin reuptake inhibitors. Administering it concomitantly with paroxetine will enhance the toxicity of paroxetine. Patient was advised to discontinue the use of Saint John's Wort | 1 | Rapid | Severe |