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Warfarin Additive effect Ginger: Zingiber officinale: Warfarin Additive effect, causes iris bleeding [3] Ginkgo gingko Ginkgo biloba: Aspirin, warfarin, ticlopidine, clopidogrel, dipyridamole, garlic, vitamin E [15] With aspirin – retards aspirin absorption [3] Ginseng: Panax ginseng: Warfarin [15] Papaya extract Carica papaya: Warfarin
The therapeutic effects of warfarin may be decreased by valerian. Anticoagulants can be affected by chamomile. Dong quai, garlic, ginger, Ginkgo biloba, bilberry and feverfew can increase bleeding time. These same herbal supplements taken with warfarin increased prothrombin time. [24]
In pharmaceutical sciences, drug interactions occur when a drug's mechanism of action is affected by the concomitant administration of substances such as foods, beverages, or other drugs. A popular example of drug–food interaction is the effect of grapefruit on the metabolism of drugs .
Side effects may include bleeding, most commonly from the nose, gastrointestinal tract (GI) or genitourinary system. [2] Compared to the risk of bleeding with warfarin use, direct factor Xa inhibitors have a higher risk of GI bleeding, but lower risk of bleeding in the brain. [2]
Ximelagatran showed good efficacy compared with warfarin in several trials in prevention and treatment of deep vein thrombosis and as thromboprophylaxis in atrial fibrillation. [1] Development was stopped by manufacturer AstraZeneca , however, because of reports of liver enzyme derangements and liver failure .
The drugs are structurally similar to vitamin K and act as competitive inhibitors of the enzyme. The term "vitamin K antagonist" is a misnomer , as the drugs do not directly antagonise the action of vitamin K in the pharmacological sense, but rather the recycling of vitamin K.
Type A: augmented pharmacological effects, which are dose-dependent and predictable [5]; Type A reactions, which constitute approximately 80% of adverse drug reactions, are usually a consequence of the drug's primary pharmacological effect (e.g., bleeding when using the anticoagulant warfarin) or a low therapeutic index of the drug (e.g., nausea from digoxin), and they are therefore predictable.
Dabigatran etexilate is rapidly absorbed, it lacks interaction with cytochrome P450 enzymes and with other food and drugs, there is no need for routine monitoring and it has a broad therapeutic index and a fixed-dose administration, which is excellent safety compared with warfarin. [4]