Is it safe to take Radix Salvia Miltiorrhiza – Radix Pueraria Lobate product with warfarin and aspirin? A pilot study in healthy human subjects

Zhang, Yufeng; Yang, Mengxue; Ho, Nicolas James; Mok, Rosina Yau; Zhang, Zhen; Ge, Beikang; Leung, Ping Chung; Fung, Kwok Pui; Lau, Clara Bik San; Lee, Vincent Hon Leung; Lin, Zhi‐Xiu; Wong, Raymond Siu Ming; Zuo, Zhong

doi:10.1016/j.jep.2020.113151

Cited by 8 publications

(5 citation statements)

References 21 publications

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“…Co‐administration of the pair of S. miltiorrhiza (Danshen) and Pueraria lobata (Willd.) ohwi or Pueraria thomsonii benth (Gegen) was found to be able to significantly increase maximum concentrations of both aspirin and its metabolite salicylic acid, and significantly decrease the concentration of thromboxane B2, as well as the prothrombin time of aspirin (Zhang et al, 2020; Zhou et al, 2012). Similarly, co‐administration of Radix Pueraria Lobata (Gegen) and Radix Angelica Sinensis (Danggui) was found to be able to significantly alter the pharmacokinetics of aspirin, prolonging its half‐life in blood and total bioavailability (Xiao et al, 2019).…”

Section: Interactions Of Common Otc Painkillers and Herbal Remediesmentioning

confidence: 99%

“…Co-administration of the pair of S. miltiorrhiza (Danshen) and Pueraria lobata (Willd.) ohwi or Pueraria thomsonii benth (Gegen) was found to be able to significantly increase maximum concentrations of both aspirin and its metabolite salicylic acid, and significantly decrease the concentration of thromboxane B2, as well as the prothrombin time of aspirin (Zhang et al, 2020;Zhou et al, 2012).…”

Section: Aspirinmentioning

confidence: 99%

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Pharmacokinetic and pharmacodynamic herb–drug interactions of common over‐the‐counter pain medications

Sun

Tsai

2023

Biomedical Chromatography

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Pain is one of the most common reasons for seeking medical intervention, and self‐medication with over‐the‐counter medications and/or traditional herbal remedies has become increasingly popular. In this review, original articles on understanding possible herb–drug interactions between traditional herbs and four major pain medications—acetaminophen, aspirin, ibuprofen and naproxen—are compiled and analyzed. In terms of analytical methods, high‐performance liquid chromatography using an isocratic eluent system coupled to biological sample clean‐up is the most common, while a wide variety of detectors have been observed, including a photodiode array, variable wavelength detector, electrochemical detector and tandem mass spectrometer. Both synergistic and anti‐synergistic effects were observed for acetaminophen and aspirin, while only synergistic effects have been found for naproxen. Currently, no interactions have been reported for ibuprofen.

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Section: Interactions Of Common Otc Painkillers and Herbal Remediesmentioning

confidence: 99%

Section: Aspirinmentioning

confidence: 99%

Pharmacokinetic and pharmacodynamic herb–drug interactions of common over‐the‐counter pain medications

Sun

Tsai

2023

Biomedical Chromatography

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“…It is a potent antioxidant used in traditional Chinese medicine to treat hyperlipidemia, hyperglycemia, allergies, skin diseases and arthritis. 11 Daidzein prevents neuronal cell death in oxygen–glucose-deprived conditions via activating the gamma receptors. It also prevented cultured neuronal cells from glutamate excitotoxicity.…”

Section: Introductionmentioning

confidence: 99%

Daidzein Ameliorates Cerebral Ischemic-reperfusion Induced Neuroinflammation in Wistar Rats via Inhibiting NF-κB Signaling Pathway

Zhang

Kowsalya

2023

Pharmacognosy Magazine

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Background Cerebral ischemia is a condition of acute brain damage due to the depletion of oxygenated blood supply to cerebral tissues. Daidzein is an isoflavonoid predominantly present in soya, Pueraria species, and red cloves. Traditional Chinese medicine utilizes daidzein to alleviate diseases such as inflammation, hyperglycemia, gastric diseases, allergies and aches. The neuroprotective effect of daidzein on cerebral ischemic conditions and its mechanism of action was not yet elucidated. Materials and Methods 24 healthy male adult Wistar rats were grouped into four and the control rats were sham-operated, cerebral ischemic-reperfusion induced rats subjected to middle cerebral artery occlusion (MCAO). Low- and high-dose daidzein rats were treated with 25 and 50 mg/kg daidzein respectively for 7 consecutive days before the induction of cerebral ischemic reperfusion. On completion of treatment, the rats were assessed for neurological deficit scoring and then euthanized for further analysis. The percentage of brain water content and cerebral infarct was evaluated. The ability of daidzein on preventing oxidative stress-induced damage was assessed by quantifying lipid peroxidation and antioxidant levels. The neuroprotective Daidzein was evaluated by measuring the acetylcholinesterase activity and brain ATP levels. The anti-inflammatory role of Daidzein was measured by quantifying the nitric oxide (NO) and inflammatory cytokines. Further, the anti-ischemic role of Daidzein was confirmed by estimating nuclear factor-kappa B (NF-κB) p65 and Caspase 3 levels. Results Daidzein treatment significantly prevented brain edema and cerebral infarction and neurological deficit in cerebral I/R injured rats. It also scavenged the free radicals and prevented the decline in antioxidant levels of ischemic rats. Daidzein decreased the acetylcholinesterase activity, NO, and inflammatory and significantly increased the brain ATP levels signifying its neuroprotective role in ischemic-induced rats. The reduction in the levels of NF-κB p65 and Caspase 3 confirms daidzein prevents neuroinflammation and neuronal apoptosis in ischemic rats. Conclusion Overall our analysis confirms daidzein is a potent neuroprotective drug which can effectively inhibit postischemic complications.

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“…In clinical practice, warfarin often combines with CDDP, and many scholars have reported on this interaction ( Chu et al, 2011 ; Zhang et al, 2020 ; Zhuang et al, 2021 ; Muyambo et al, 2022 ). However, most reports have focused on animals, healthy volunteers (HVs), or pharmacometrics models to predict this interaction.…”

Section: Introductionmentioning

confidence: 99%

Evaluation and clinical implications of interactions between compound Danshen dropping pill and warfarin associated with the epoxide hydrolase gene

et al. 2023

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Introduction: In clinical practice, warfarin is often combined with Compound Danshen dripping pill (CDDP) for the treatment of cardiovascular diseases. However, warfarin has a narrow therapeutic index, wide interindividual variability (genetic and non-genetic factors), and is susceptible to drug-drug interactions. Our previous study indicated that CDDP might interact with warfarin in individuals with the epoxide hydrolase gene (EPHX1; single-nucleotide polymorphism: rs2292566) A/A subtype. We sought to clarify the interaction between CDDP and warfarin associated with EPHX1 in a comprehensive and accurate manner.Methods: Here, EPHX1 A and EPHX1 G cell lines were established. Expression of microsomal epoxide hydrolase (mEH), vitamin K epoxide reductase (VKOR), and vitamin K-dependent clotting factors (FII, FVII, FIX, FX) was measured by western blotting upon incubation with CDDP and warfarin. mEH activity was evaluated by measuring the transformation of epoxyeicosatrienoic acids into dihydroxyeicosatrienoic acids. Then, healthy volunteers (HVs) with the EPHX1 A/A genotype were recruited and administered warfarin and CDDP to investigate the pharmacokinetics and pharmacodynamics of warfarin.Results: CDDP combined with warfarin could decrease expression of mEH and VKOR, and increase protein expression of FII, FVII, FIX, and FX, in EPHX1 A cells. CDDP could slightly influence the pharmacokinetics/pharmacodynamics of warfarin in HVs with the EPHX1 A/A genotype.Discussion: Rational combination of CDDP and warfarin was safe with no risk of bleeding, but the therapeutic management is also needed. The clinical study is posted in the China Clinical Trial Registry (ChiCTR190002434).

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Is it safe to take Radix Salvia Miltiorrhiza – Radix Pueraria Lobate product with warfarin and aspirin? A pilot study in healthy human subjects

Cited by 8 publications

References 21 publications

Pharmacokinetic and pharmacodynamic herb–drug interactions of common over‐the‐counter pain medications

Pharmacokinetic and pharmacodynamic herb–drug interactions of common over‐the‐counter pain medications

Daidzein Ameliorates Cerebral Ischemic-reperfusion Induced Neuroinflammation in Wistar Rats via Inhibiting NF-κB Signaling Pathway

Evaluation and clinical implications of interactions between compound Danshen dropping pill and warfarin associated with the epoxide hydrolase gene

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