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Drug Interactions between ginseng and P-A-C Analgesic

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

aspirin ginseng

Applies to: P-A-C Analgesic (aspirin / caffeine) 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.

References

  1. Janetzky K, Morreale AP "Probable interaction between warfarin and ginseng." Am J Health Syst Pharm 54 (1997): 692-3
  2. Miller LG "Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions." Arch Intern Med 158 (1998): 2200-11
  3. Fugh-Berman A "Herb-drug interactions." Lancet 355 (2000): 134-8
  4. Heck AM, DeWitt BA, Lukes AL "Potential interactions between alternative therapies and warfarin." Am J Health Syst Pharm 57 (2000): 1221-7; quiz 1228-30
  5. Vaes LP, Chyka PA "Interactions of warfarin with garlic, ginger, or ginseng: nature of evidence." Ann Pharmacother 34 (2000): 1478-82
  6. Izzo AA, Ernst E "Interactions between herbal medicines and prescribed drugs: a systematic review." Drugs 61 (2001): 2163-75
  7. Hodges PJ, Kam PC "The peri-operative implications of herbal medicines." Anaesthesia 57 (2002): 889-99
  8. Ang-Lee MK, Moss J, Yuan CS "Herbal medicines and perioperative care." JAMA 286 (2001): 208-16
  9. Yuan CS, Wei G, Dey L, et al. "Brief communication: American ginseng reduces warfarin's effect in healthy patients: a randomized, controlled Trial." Ann Intern Med 141 (2004): 23-7
View all 9 references

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Minor

aspirin caffeine

Applies to: P-A-C Analgesic (aspirin / caffeine) and P-A-C Analgesic (aspirin / caffeine)

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.

References

  1. Yoovathaworn KC, Sriwatanakul K, Thithapandha A "Influence of caffeine on aspirin pharmacokinetics." Eur J Drug Metab Pharmacokinet 11 (1986): 71-6

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Drug and food interactions

Moderate

aspirin food

Applies to: P-A-C Analgesic (aspirin / caffeine)

GENERALLY AVOID: The concurrent use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) and ethanol may lead to gastrointestinal (GI) blood loss. The mechanism may be due to a combined local effect as well as inhibition of prostaglandins leading to decreased integrity of the GI lining.

MANAGEMENT: Patients should be counseled on this potential interaction and advised to refrain from alcohol consumption while taking aspirin or NSAIDs.

References

  1. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn PROD (2002):

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Minor

caffeine food

Applies to: P-A-C Analgesic (aspirin / caffeine)

The effect of grapefruit juice on the pharmacologic activity of caffeine is controversial. One report suggests that grapefruit juice increases the effect of caffeine. The proposed mechanism is inhibition of cytochrome P-450 metabolism of caffeine. However, a well-conducted pharmacokinetic/pharmacodynamic study did not demonstrate this effect. The clinical significance of this potential interaction is unknown.

References

  1. "Grapefruit juice interactions with drugs." Med Lett Drugs Ther 37 (1995): 73-4
  2. Maish WA, Hampton EM, Whitsett TL, Shepard JD, Lovallo WR "Influence of grapefruit juice on caffeine pharmacokinetics and pharmacodynamics." Pharmacotherapy 16 (1996): 1046-52

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Minor

aspirin food

Applies to: P-A-C Analgesic (aspirin / caffeine)

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.

References

  1. Yoovathaworn KC, Sriwatanakul K, Thithapandha A "Influence of caffeine on aspirin pharmacokinetics." Eur J Drug Metab Pharmacokinet 11 (1986): 71-6

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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