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Investigation of the Effects of Herbal Medicines on Warfarin Response in Healthy Subjects: A Population Pharmacokinetic‐Pharmacodynamic Modeling Approach
Author(s) -
Jiang Xuemin,
Blair Elaine Y. L.,
McLachlan Andrew J.
Publication year - 2006
Publication title -
the journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.92
H-Index - 116
eISSN - 1552-4604
pISSN - 0091-2700
DOI - 10.1177/0091270006292124
Subject(s) - warfarin , pharmacodynamics , pharmacokinetics , medicine , pharmacology , ginseng , drug interaction , prothrombin time , population , ginkgo biloba , herb , drug , traditional medicine , medicinal herbs , atrial fibrillation , alternative medicine , environmental health , pathology
Systematic evidence regarding herb‐drug interactions is lacking. This study investigated herb‐drug interactions with warfarin. S‐warfarin concentration and response (prothrombin complex activity) data from healthy subjects (n = 24) who received a single warfarin dose (25 mg) and either St John's wort, Asian ginseng, Ginkgo biloba, or ginger were analyzed using a population pharmacokinetic‐pharmacodynamic modeling approach. The ratio of S‐warfarin apparent clearance (CL/F) compared to control was 1.39 ± 0.06 and 1.14 ± 0.04 after St John's wort and Asian ginseng pretreatment, respectively. Other pharmacokinetic and pharmacodynamic parameters were unaffected. Coadministration of St John's wort significantly increased S‐warfarin CL/F, whereas treatment with Asian ginseng produced only a moderate increase in CL/F. Ginkgo and ginger did not affect the pharmacokinetics of warfarin in healthy subjects. None of the herbs studied had a direct effect on warfarin pharmacodynamics. Studies in anticoagulated patients are warranted to assess the clinical significance of these herb‐drug interactions.