Research Article

Interactions between Natural Health Products and Oral Anticoagulants: Spontaneous Reports in the Italian Surveillance System of Natural Health Products

Table 1

Reports of INR reduction associated with use of natural remedies.

Sex, age (years)Product, dosage, and indicationConcomitant medications and notesAdverse drug reaction, time to onset, and Naranjo scoreAction taken and outcome

F, 45Camellia sinensis, Malva sylvestris, Elettaria cardamomum, Hibiscus sabdariffa (THERMOJETICS, Herbalife International of America, Inc Los Angeles, CA), 3 g/day; weight loss dietAcenocoumarol 14 mg/w (since 10 years)Reduction of anticoagulant therapy efficacy INR 1.4; 16 days; Possible [4]Herbal drugs withdrawn, Acenocoumarol dosage increase (16 mg/w); completely recovered

F, 70Aloe barbadensis, honey, alcohol beverage, herbal liquid home-made preparation, 3 spoons/day; constipationWarfarin 5 mg/w (since 10 years)Reduction of anticoagulant therapy efficacy INR 1.42; 2 weeks; Possible [3]Herbal drug withdrawn, warfarin dosage increase (6.25 mg/w); completely recovered

F, 81Panax Ginseng (Red Ginseng), dosage not reported; tiredness and dizzinessAcenocoumarol 7 mg/wReduction of anticoagulant therapy efficacy INR 0.99; Possible [4]Herbal drugs withdrawn, Acenocoumarol dosage increase (08 mg/w); completely recovered

M, 70Fermented Papaya Preparation (IMMUN'AGE FPP, Osato international, Gifu, Japan), 3 g/day orally; ageing preventionWarfarin 25 mg/w (since 9 years)Reduction of anticoagulant therapy efficacy INR 1.64; 1 month; Probable [8]Herbal drug withdrawn, warfarin dosage increase (27.5 mg/w); completely recovered

F, 80Vaccinium myrtillus (BILBERRY JUICE, Sottobosco Paoli, Civezzano, Italy), 200 ml/day; indication not reportedWarfarin 27.5 mg/w (since 1.5 year)Reduction of anticoagulant therapy efficacy INR 1.6; 4 days; Possible [4]Herbal drug withdrawn, warfarin dosage increase (32.5 mg/w); completely recovered

F, 63Spirea ulmaria, Taraxacum officinale, Sambucus nigra, Betula alba, Urtica dioica, Cynara scolymus, Amarena, Ttriticum repens, Tilia cordata (AFFILINE, Nahrin AG, Saren, Switzerland), 1 spoon/day and Spirulina maxima, Urtica Dioica, Papaya extract (LINPHACELL Nahrin AG, Saren, Switzerland), 4 tablets/day; weight loss dietAcenocoumarol 20 mg/w (since 2 years)Reduction of anticoagulant therapy efficacy INR 1.37; 1 month; Possible [2]Herbal drugs withdrawn, Acenocoumarol dosage increase (22 mg/w); improvement

M, 79vitamins (C,E), fish oil, lutein, zeaxantin, minerals (PRESERVISION 3, Bausch & Lomb incorporated Rochester, NY), 1 capsule/day; macular degenerationAcenocoumarol 11 mg/w (since 15 years)Reduction of anticoagulant therapy efficacy INR 1.50; 6 days; Possible [3]Supplement withdrawn, Acenocoumarol dosage increase (12 mg/w); improvement