Topic Title: Coumadin and SJW
| |  "Coumadin and SJW"
, Tue 2 Apr 11:20
I have read that coumadin may be affected by the use of St. John's Wort. Does anyone know what the effect would be, and has anyone taken SJW while on coumadin?
HLS
Posts: 0 | | Registered: Tue 2 Apr 2002 11:9 |
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| | "Re(1):Coumadin and SJW" , Tue 2 Apr 14:56
Hi there:
I checked for information on interactions between SJW and Coumadin on the Walgreens drug interaction checker and it produced the following information:
quote:
Interaction Type: Drug/Drug
Severity: MAJOR
Description: COUMADIN with ST JOHNS WORT
Onset: Delayed Severity: Major Documentation: Suspected
Pharmacologic effects of COUMADIN 5MG TABLET may be decreased by ST JOHNS WORT 300MG TABLETS N/M. Reduced therapeutic effects of COUMADIN 5MG TABLET, characterized by increased coagulability, may occur.
Details: Effect: ST JOHNS WORT 300MG TABLETS N/M may decrease the pharmacologic effects of COUMADIN 5MG TABLET. Reduced therapeutic effects of COUMADIN 5MG TABLET, characterized by increased coagulability, may occur.
Mechanism: Unknown. Induction of cytochrome P450 2C9 isoenzymes by ST JOHNS WORT 300MG TABLETS N/M may increase the metabolic elimination of COUMADIN 5MG TABLET.
Management: Close clinical and laboratory monitoring are indicated. Larger dosages of COUMADIN 5MG TABLET may be needed during concomitant administration with ST JOHNS WORT 300MG TABLETS N/M. It is suggested to avoid use of ST JOHNS WORT 300MG TABLETS N/M with COUMADIN 5MG TABLET.
Discussion: Since 1998, the Swedish Medical Products Agency has received data on 7 patients who were receiving stable warfarin regimens and experienced a reduction in International Normalized Ratio when St. John's wort was added (1). Although none of the patients experienced thromboembolic complications, the decreases in INR were thought to be clinically important by the reporting physicians. The patients ranged in age from 56 to 85 years old and INRs were in the target range of 2.1 to 4.1. Upon addition of St. John's wort, INRs decreased to a range of 1.1 to 2.1. The INR of 2.1 was in a patient whose target INR was maintained at 2.4 to 3.6. Warfarin dose increases were performed in 4 of 7 patients and the St. John's wort was stopped in the other 3 patients with a return to baseline INR. The authors postulated that the reduced warfarin effect seen in these 7 cases was the result of induction of cytochrome P450 2C9. Further studies are needed to define the mechanism and determine the clinical impact of this interaction. At this time, it is suggested that patients avoid concomitant use of St. John's wort with warfarin.
You didn't specify your dosages so I just took the regular SJW dosage and the median dosage of Coumadin which was mentioned on the drug checker - hope this helps at all!!
David
Posts: 210 | | Registered: Sat 13 Oct 2001 17:39 |
| | | "Re(2):Coumadin and SJW" , Tue 2 Apr 16:21
David,
Thanks so much for your reply and the information. I take 3 mg. coumadin for atrial fibrillation. In my depressed and muddled state, I'm not sure if the possible problem with interaction is serious enough that I shouldn't take SJW. For instance, 7 reported cases doesn't seem like very many. Also, do you know what N/M means?
I was on Paxil for 7 years and stopped taking that 5 months ago. The depression and anxiety have returned full force. I have been taking SAMe for 3 months, but that is not working for me. I'm afraid I may have to go back on an antidepressant drug, but first I really want to see if SJW helps. I want to start feeling better and I don't know what to do.
HLS
Posts: 1 | | Registered: Tue 2 Apr 2002 11:9 |
| | | "Re(3):Coumadin and SJW" , Wed 3 Apr 00:33
Hi again:
I would say that it sounds like it may well be serious enough to cause a problem and I should certainly speak to your doctor before making any decisions about this.
You're right that 7 reported cases doesn't sound like many, but then there's always the possibility that there was only 7 experiments and 100% of patients had problems?!?! Unfortunately I'm not sure what N/M means - again check with your doctor.
I would have thought that if it was going to work, after 3 months Sam-e would have 'kicked in' - maybe check that you are taking the dosage required?! - If you wanted to try SJW I would wait a couple of weeks after stopping Sam-e (just to be on the safe side) and then have a go at it...although remember that it does take about 6 weeks to really start working.
David
Posts: 212 | | Registered: Sat 13 Oct 2001 17:39 |
| | | "Re(3):Coumadin and SJW" , Wed 3 Apr 00:29:
The "N/M" just refers to a brand name, probably Nature Made. It's an idiosynchrosy of the Walgreen site.
The contraindication for warfarin (Coumadin) is probably overstated here, but it can't just be ignored. A better advice I've seen in other countries like Canada is "evaluate risk/reward ratio". The authorities are concerned that SJW probably competes with warfarin, thus requiring higher dosage of warfarin. Then if you discontinue SJW without adjusting your warfarin, you can end up with elevated levels.
For an informed patient, the ideal situation is that your doctor monitors your INR periodically during SJW usage and discontinuation. That's what gets me ... I thought doctors monitor INR periodically anyway during warfarin treatment?
It's interesting how yet again a single letter to a medical journal casts a cloud over a herbal with an enviable safety record. This link contains some of the correspondence that appeared in Lancet, including the Yue/Bergquist letter that mentions the 7 reported cases. It makes for interesting reading.
Epyx
[this message was edited by Epyx on Wed 3 Apr 18:39]
Posts: 132 | | Registered: Mon 3 Dec 2001 22:11 |
| | | "Re(4):Coumadin and SJW" , Wed 3 Apr 20:57
Epyx and David,
Thanks so much for the additional helpful information. I was taking the maximum recommended dosage of SAM-e, and at first I thought it was working. Likely it was a placebo-type effect.
I do get my INR checked every 1 - 2 weeks because it has never been stable. The problem is that my GP is out of the country for a couple of weeks, and I cannot get her immediately involved in my SJW trial. So if I go it alone, I wanted to know what the ramifications might be.
It might be wise to wait a couple of weeks between stopping the SAM-e and starting the SJW, and by that time my GP will be back and I could consult with her. The problem is that the depression and anxiety (does SJW help with anxiety?) have become so overwhelming that I can barely wait another day before at least starting SJW, never mind waiting the 2 weeks, and then another 6 weeks to see if it works. I am having trouble enough just getting through another day.
Thanks again,
HLS
Posts: 2 | | Registered: Tue 2 Apr 2002 11:9 |
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