Drug Interactions between chamomile and Farbital

One study has reported that coadministration of caffeine and aspirin lead to a 25% increase in the rate of appearance and 17% increase in maximum concentration of salicylate in the plasma. A significantly higher area under the plasma concentration time curve of salicylate was also reported when both drugs were administered together. The exact mechanism of this interaction has not been specified. Physicians and patients should be aware that coadministration of aspirin and caffeine may lead to higher salicylate levels faster.

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Some herbs such as chamomile and fenugreek have coumarin constituents. Theoretically, ingesting large quantities of these herbs may potentiate the risk of bleeding in patients treated with agents that affect hemostasis such as anticoagulants, platelet inhibitors, thrombin inhibitors, thrombolytic agents, or agents that commonly cause thrombocytopenia. However, their effects on the coagulation system have not been studied, and bleeding complications have not been reported in humans. Moreover, pharmacologic effects may be highly variable due to inconsistencies in formulation and potency of commercial herbal products. In one patient, the addition of boldo and fenugreek to a stabilized regimen of warfarin resulted in an increase in INR. The INR returned to normal 1 week following discontinuation of both products but increased again when the patient resumed usage, which subsequently led to a 15% reduction in the weekly warfarin dosage. It is not certain whether the effects on INR are due to boldo or fenugreek, or a combination of both products. Patients should consult a healthcare provider before taking any herbal or alternative medicine. In patients who have used chamomile or fenugreek extensively prior to receiving anticoagulation, antiplatelet or thrombolytic therapy, the potential for an interaction should be considered. Close clinical and laboratory observation for hematologic complications is recommended. Patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools.

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