Interaction between warfarin and selected superfoods: a comprehensive review of potential mechanisms and their clinical significance
DOI:
https://doi.org/10.56782/pps.199Keywords:
Warfarin, Herb-drug interaction, Linum usitatissimum, Moringa oleifera, Nigella sativaAbstract
Warfarin is one of the oldest and still widely used anticoagulant agents. Interactions between warfarin and herbs have been intensively studied in recent years. However, due to the growing worldwide interest and consumption of herbal products this area requires further investigations. Patients on warfarin should receive special attention from their physicians, especially concerning the concomitant use of herbal products. In this study, we provide a comprehensive review of the mechanisms and clinical significance of interactions between warfarin and selected plants, also frequently referred to as superfoods: Linum usitatissimum, Moringa oleifera, Lindera aggregata, and Nigella sativa. We carried out a non-systematic review of the literature using PubMed using the key terms: warfarin, interaction, Linum usitatissimum, Moringa oleifera, Lindera aggregata, Nigella sativa, CYP2C9, CYP3A4, serum albumin, blood coagulation, antiplatelet. We analyzed articles published up to 2024. The wealth of phytoconstituents contained in reviewed plants favor the occurrence of potential interactions with warfarin. Possible mechanisms involved in these interactions include plasma and platelet hemostasis processes and warfarin pharmacokinetics, i.e. distribution and hepatic metabolism. Critical evaluation of the risk of warfarin-herb interaction is challenging and still inconclusive because most of the sources of evidence are in vitro and animal studies. Therefore we expect human clinical studies evaluating the risk of combined use of warfarin and discussed plants in the near future. To summarize, we hope that the results of our study will help healthcare professionals in their daily practice and improve the safety and effectiveness of warfarin pharmacotherapy.
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