brand logo

Am Fam Physician. 2004;70(7):1231

to the editor: In the article, “Panax ginseng,”1 the authors caution readers about the concomitant use of panax ginseng with warfarin (Coumadin). Besides ginseng, several other herbal medications, such as garlic and danshen (Salvia miltiorrhiza), may interact with warfarin, decreasing or increasing its anticoagulant effect.2 The most recent addition to this list is soy milk, which was reported to cause subtherapeutic international normalized ratio.3 Although soy milk is not a herbal medication, it is widely advocated as a nutritional supplement by practitioners of Western and traditional medicine.

Recently, there has been a surge of interest in soy milk as a health food for its antihypertensive4 and antihyperlipidemic5 properties and for use as a natural alternative to hormone therapy.6 The latter use has attracted special attention in light of the disquieting findings from the Women’s Health Initiative trial, which demonstrated an increased incidence of cardiovascular events and breast cancer in women taking hormone therapy.

The use of warfarin in the management of atrial fibrillation, coronary artery disease, congestive heart failure, and strokes has become widespread. Also, the use of complementary or alternative medicine in the United States has become increasingly popular. For these reasons, every physician should be on the alert for possible interactions where excessive bleeding or unexpected prolongation of the international normalized ratio is encountered in any patient taking warfarin who otherwise has had good anticoagulant control.

Email letter submissions to afplet@aafp.org. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors. Letters submitted for publication in AFP must not be submitted to any other publication. Letters may be edited to meet style and space requirements.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

Continue Reading


More in AFP

More in Pubmed

Copyright © 2004 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See https://www.aafp.org/about/this-site/permissions.html for copyright questions and/or permission requests.