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

Table 2

Reports of INR increase associated with use of natural remedies.

Sex, age (years)	Product, dosage, and indication	Concomitant medications and notes	Adverse drug reaction, time to onset, and Naranjo score	Action taken and outcome
M, 77	Arnica compositum (ARNICA CREAM HEEL, Heel Inc., Albuquerque, NM), dosage not reported; myalgia	Warfarin 35 mg/w	Overanticoagulation INR 10.6; 1 month; Possible [4]	Konakion administration; herbal drug withdrawn; completely recovered
F, 42	Arnica compositum; calendula; Hamamelis; Millefolium; belladonna; Aconitum; mercurius solubilis hanemanni; hepar sulfuris;Bellis perennis; Echinacea; Hypericum (ARNICA CPR HEEL, Heel Inc., Albuquerque, NM), 2 tablets/day; myalgia	Warfarin	Overanticoagulation; Possible [4]	Unknown
F, 73	Boswellia serrata dry extract (D E) 95%, 1500 mg/day; osteoarthritis	Warfarin	Overanticoagulation increase of INR; 10 days; Probable [6]	Herbal drug withdrawn; completely recovered
F, 64	Boswellia serrata DE 95%, 1200 mg/day; osteoarthritis	Warfarin	Overanticoagulation increase of INR; 10 days; Probable [6]	Herbal drug withdrawn; completely recovered
M, 61	Passiflora spp, Foenicum vulgare, Melissa officinalis,Glycyrrhiza glabra (COLISOLVE, Farmacia Legnani, Milano, Italy), dosage not reported; Pimpinella anisum, Glycyrrhiza glabra, Forniculum vulgare, Ocimum basilicum, Matricaria recutita (VITABIOSA, Biosa Danmark, Frederiksværk, Denmark), dosage not reported; Boswellia serrata DE, Ficus carica mother tincture; horse colostrum; Mucosa compositum, dosage not reported; indication not reported	Warfarin (since 2 years)	Overanticoagulation INR 8; Possible [4]	Unknown