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Some Common But Severe Drug Interactions Involving Coumadin (Warfarin)

Beware Of "G" Herbs and Supplements: Garlic, Ginseng, Ginkgo Biloba, and Ginger

In April 2006 Douglas S. Paauw, M.D., a University of Washington medical investigator, spoke at an American College of Physicians meeting about adverse events associated with Coumadin (warfarin) therapy which are caused by drug interactions.

As explained in an April 9, 2006 MedPage Today article by Peggy Peck:

Adverse events associated with Coumadin therapy continue to be a leading cause of hospitalizations for drug-related adverse events, and many times the problem can be traced to those herbs and supplements, he said. Dr. Paauw ran through those and other hazards during a session titled, "Ten Common Prescribing Errors: Drug Interactions and Side Effects."

Starting with the herbs and supplements, Dr. Paauw had an easy-to-remember bit of advice: be particularly careful with herbs and supplements beginning with the letter "G".  Garlic, ginger, and gingko biloba, all increase the anticoagulation of Coumadin (warfarin).  Meanwhile, ginseng decreases the anticoagulation of Coumadin (warfarin).

According to the April 9, 2006 MedPage Today article, Dr. Paauw told the audience of doctors that "the most severe Coumadin adverse events are often traced to Bactrim aka Septra (TMP/sulfa), a frequently prescribed antibiotic in elderly patients who are also the most likely users of Coumadin."

During his presentation, Dr. Paauw listed several other prescription drugs that are likely to interact with Coumadin, including these:

  • erythromycin,
  • amiodarone,
  • Diflucan (fluconazole),
  • Nizoral (keotoconazole),
  • Sporanox (itraconazole), and
  • mentronidazole.

Dr. Paauw also mentioned that the use of Prilosec (omeprazole) or Tylenol (acetaminophen) while using Coumadin at the same time can affect a patient’s INR.

As pointed out in the MedPage Today article, Dr. Paauw’s presentation emphasized these two lessons concerning drug safety:

  1. Patients need to know that herbs, supplements, and vitamins can react with prescription drugs: and,
  2. Patients should, on a regular basis, tell their doctor(s) about all prescription and non-prescription drugs that they are using in order to reduce the risk of adverse events caused by drug interactions.

(Posted by: Tom Lamb)

15 responses to “Some Common But Severe Drug Interactions Involving Coumadin (Warfarin)”

  1. frank kordewineer Avatar
    frank kordewineer

    Hi – Need your moral … and personal support. Been on Coumadin for 4 years now after having several bloodclots in my lung (Pulmonary embolisms). I am presently having large blotches of black and blue discoloring on upper arm that won’t go away. After reading some comments from readers, I am asking my family doctor to go off the medication. I know he will tell me, with my history with blood clots it is not advisable. Have had symptoms such as diahrea, dry mouth, always sleep and tiredness, sudden sweatings, muscle tightness,ect.
    what advise can you give me – God Bless

    Reply
  2. Tom Lamb Avatar
    Tom Lamb

    I am only an attorney and, as such, cannot give you any medical advice.
    I would suggest that if your present doctor does not agree with your request that the Coumadin be stopped, you seek a second opinion from another doctor. The FDA advises that you should not stop taking any prescription medication on your own. This seems like especially good guidance where there exists the possibility of serious blood clots developing as a consequence of doing otherwise.
    Hopefully, you and your doctor(s) will come up with a satisfactory solution to your predicament.
    Thanks for reading Drug Injury Watch.
    Tom Lamb

    Reply
  3. KathyFowler Avatar
    KathyFowler

    I have been told that I need to take the drug Lupron to reduce the size of my fibroids before surgery. Do you have information about this drug.
    Thanks.
    Kathy Fowler

    Reply
  4. Tom Lamb Avatar
    Tom Lamb

    Unfortunately, I don’t have any information available off-hand concerning this drug. I suggest you check the FDA’s MedWatch site and/or Health Canada’s MedEffect site to learn more about Lupron. Links to both are in the side bar on this page, under the heading “Resources”.
    Thanks for reading Drug Injury Watch.
    Tom Lamb

    Reply
  5. Phyllis Price Avatar
    Phyllis Price

    My husband had a very severe interaction to coumadin and diflucan prescribed by his primary care physician. He continues to suffer from seizures, at first they where just on the right side, now they are taking place on the left side as well. Also prescribed at the time where medrol dose pak and benedryl for a suspected fungal infection. My husband I must add is a closed head injury patient. I am shocked that both the Dr. and Pharmacist missed this potential interaction and am at a lost as to what to do from here. We are on our way to his neurologist because again he is starting to exhibit symptoms. We are considering seeking legal counsel and are looking for advice as to whether or not this is pursuable.

    Reply
  6. Tom Lamb Avatar
    Tom Lamb

    I appreciate you taking the time to share this unfortunate drug interaction experience with us. We hope things get better for your husband going forward.
    As any possible legal case would involve the doctor and/or the pharmacist, you need to contact an attorney in your state if you wish to pursue that course action.
    I cannot tell you based on this limited information whether any such legal case would be successful.
    Thanks for reading Drug Injury Watch.
    Tom Lamb

    Reply
  7. Barbara Trevino Avatar
    Barbara Trevino

    I new to taking this drug….I am also taking amiodaron…I’m confused at why my doctor put me on the warafin…I had a cardioversion done and have not had any more bouts with atrial fib.

    Reply
  8. Tom Lamb Avatar
    Tom Lamb

    As I am only an attorney and not a medical doctor, I cannot respond to the issue you raise.
    As general advice, if you are not satisfied with the explanation given to you by the doctor prescribing this drug combination, you may want to get a second opinion from another doctor.
    Best of luck to you, and thanks for reading Drug Injury Watch.
    Tom Lamb

    Reply
  9. Robert Mathis Avatar
    Robert Mathis

    Thanks for the information on the herbs and foodstuffs that interact with Coumadin. I had a severe reaction to the drug and found that people with American Indian and Asian Pacific blood are much more sensitive. I was also drinking Ginger tea in large quantities at the time. Are physicians liable if they do not know or tell you such things?

    Reply
  10. Tom Lamb Avatar
    Tom Lamb

    Robert:
    I appreciate you sharing your experience with us.
    It is my understanding that the prescribing doctor is suppose to convey to their patient the warnings about drug interactions which are contained in the package insert prepared by the pharmaceutical company as well as any other such information the doctor may have learned independently.
    Thanks for reading Drug Injury Watch.
    Tom Lamb

    Reply
  11. Rich Tompkins Avatar
    Rich Tompkins

    Dear Tom,
    You can add one more Natural Healing Herb to the list of G’s, that can cause a “Fatal Drug Interaction” with warfarin, or Coumadin. “Goji” has also been shown to interact negatively with this “rat poison (but then so do the rats).” The good news is.. Dr. Joseph Bissitt, Founder of the Cardiology Department at UAMS, in Little Rock, Arkansas, is now considering using Goji (Wolfberry)as a replacement for warfarin. Seems it does the same thing as warfarin, without violating the Hippocratic Oath of “Do No Harm.” A novel concept for modern, pharmaceutical medicine.
    Warmest Regards,
    Rich Tompkins
    GojiTrees.com

    Reply
  12. Tom Lamb Avatar
    Tom Lamb

    Rich:
    Thanks for letting us know about this possible new alternative to warfarin.
    I hope you continue to read Drug Injury Watch.
    Tom Lamb

    Reply
  13. Rich Tompkins Avatar
    Rich Tompkins

    Dear Tom,
    “If the whole materia medica (drugs/medicines), as now used, could be sunk to the bottom of the sea, it would be so much the better for mankind – and all the worse for the fishes.” – Dr. Oliver Wendell Holmes –
    In the above quote, Dr. Oliver Windell Holmes was warning us about the toxic chemicals, being concocted, and promoted as “medicine,” by BIG PHARMA, and the American Medical Association. Today, when you consider all the death caused by poison pharmaceuticals, fatal drug interaction, medical mal-nutrition, mal-practice, dirty, staph-infected hospitals, and GREEDY INSURANCE COMPANIES (denying people access to proper medical care),
    THE U.S.”HEALTH CARE SYSTEM” HAS BECOME THE #1 CAUSE OF DEATH IN AMERICA!
    10 years ago, Celebrex® gave me a heart attack. 5 years ago, Coumadin® killed my best friend. Doctor owned, staph-infected, hospitals now kill more people each year than all the accidents on our nations highways, while BIG PHARMA, and the AMA, continue to promote their rat poison, causing violent psychotic reractions, blindness, massive strokes, heart attacks, suicides, and death. Ten’s of thousand’s of people die every year from Fatal Drug Interaction. Just read their DISCLAIMER’S! You will find that one of the SIDE-EFFECTS, of their CHEMICAL CONCOCTION, is nearly always DEATH. INSURANCE COMPANIES now decide who lives, or dies, by how much DEATHCARE they will approve. If Hippocrates knew what American “medicine” has become, he would be rolling over in his grave.
    FYI, I am a 61 year old male, and a diabetic for more than 20 years. Five years ago, consuming a few dry Da Ma Ye Goji berries, on a daily basis, cured my chronic gastritis. Neither the pain, nor the disease, has ever returned! By adding nothing but Goji to my diet, I have lost over 60 pounds. My Cardiologist (Dr. Joe Bissitt) now tells me that my heart condition has “improved remarkably”, and my blood presure has returned to normal (without drugs). My heart is now “strong enough for sex,” and my lovely wife (of 36 years) and I, are acting like newly wed’s again (without drugs). Our research, and personal experience, has convinced us that ‘Da Ma Ye’ Goji is both an astonishing medicine, and “the most nutritious whole food on earth.”
    Warmest Regards,
    Rich
    BTW, I have placed a link to your website at the top of GojiTrees.com

    Reply
  14. Heather Verhoeff Avatar
    Heather Verhoeff

    What a useful mnemonic! Thanks for sharing it, supplements beginning with “G” are ones I’ll watch. My husband’s doctor at Kaiser never gave us that information, and in fact she had him on omeprazole and warfarin simultaneously! Recently, his job forced him into retirement, he lost his Kaiser coverage, and he had no choice but to discontinue Warfarin. I made him start taking Nattokinase and Serrapeptase for the anticoagulation effect, and with the addition of Vitamin K2/MK7, he’s no longer at increased risk of bone loss and fractures. Plus, his arteries aren’t getting all calcified like they were on the Warfarin. Kaiser doctors are completely worthless, they’re always pushing more drugs to alleviate the side effects of the first drugs, and their lack of knowledge is astonishing. Kaiser doctors routinely misdiagnose healthy people as having chronic kidney disease because Kaiser administers the creatinine test incorrectly. Ditto with high blood pressure: My husband’s blood pressure has “miraculously” been normal after he stopped taking Kaiser’s Lisinopril. It was never genuinely high to begin with – I suspect Kaiser doctors deliberately misdiagnose healthy people as having high blood pressure so they can trick them into complying with a lifetime of expensive prescription drugs.

    Reply
  15. Julie A Guillaumin Avatar
    Julie A Guillaumin

    Coumandin/Warfarin is wreaking havoc on my body. I’m 43, and was urged to get a mechanical valve. I was promised by many doctors and surgeons that it had no side effects. I could name at least 10 this instant that I’ve had over the past few months. And now, I just took a 150 mg fluconazole tablet before finding this thread.
    I can’t bear to think of being on this rat poison for the rest of my life. It is with great relief that I read about Goji and that it may be an alternative.
    Thank you

    Reply

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