Drug Interactions between aspirin / pentazocine and ginseng

GENERALLY AVOID: Ginseng may potentiate the effects of anticoagulants, platelet inhibitors and thrombolytic agents, possibly increasing the risk of bleeding. In vitro studies have shown that one or more of the active constituents of ginseng, known as ginsenosides, can decrease platelet aggregation, although it is not known whether these constituents are absorbed or are bioactive in humans. Bleeding complications secondary to antiplatelet activity have not been reported. On the contrary, ginseng use has been associated with a reduction in INR in a patient who had been stabilized on warfarin for nine months. The mechanism for this apparent antagonism of warfarin has not been established, although ginseng has been reported to lower the plasma concentrations of warfarin.

MANAGEMENT: Patients should consult a healthcare provider before taking any herbal or alternative medicine. In general, consumption of ginseng supplements and large amounts of ginseng should preferably be avoided during use of coagulation-modifying agents. In patients who have used this herb 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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