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CYP2C9‐mediated warfarin and milk thistle interaction
Author(s) -
Lash David Benjamin,
Ward Shereen
Publication year - 2020
Publication title -
journal of clinical pharmacy and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.622
H-Index - 73
eISSN - 1365-2710
pISSN - 0269-4727
DOI - 10.1111/jcpt.13064
Subject(s) - warfarin , milk thistle , in vivo , medicine , pharmacology , cyp2c9 , biology , microbiology and biotechnology , atrial fibrillation , metabolism , cytochrome p450
What is known and objective In vitro studies suggest a CYP2C9‐mediated interaction between milk thistle and warfarin, but there has been no in vivo case report on this interaction. Case description A White Hispanic man in his 30s was well controlled on warfarin therapy for mitral valve replacement. His INR increased from 2.64 to 4.12, and he denied changes to his medications and diet but noted starting a ‘liver cleanse’ supplement which contained milk thistle (200 mg). After stopping the supplement his INR normalized, and he remains on the same warfarin dose. What is new and conclusion This is the first in vivo report of an interaction between milk thistle and warfarin.