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Table 4 Potential Drug-Biological Based Therapies Interactions & Management

From: Use of biological based therapy in patients with cardiovascular diseases in a university-hospital in New York City

Medication Alternative Pharmacotherapy Product Potential Interaction and Management Number of Patients Onset28* Level of Severity28
Warfarin Green tea Green tea may antagonize warfarin effects. Monitor INR. 1 Delayed Moderate
Warfarin Coenzyme Q 10 Coenzyme Q 10 may have procoagulant effects and may decrease response to warfarin.
Monitor INR.
2 Delayed Moderate
Warfarin Vitamin E Vitamin E may potentiate warfarin effects. Monitor INR and signs and symptoms of bleeding. 5 Delayed Moderate
Warfarin Garlic Garlic has antiplatelet effects, and risk of bleeding may be increased.
Monitor INR and signs and symptoms of bleeding.
1 Delayed Major
Warfarin Ginkgo biloba Ginkgo inhibits platelet aggregation, risk of bleeding may be increased.
Monitor INR and signs and symptoms of bleeding
2 Delayed Major
Warfarin Fish oils Concomitant use of warfarin and fish oils may increase risk of bleeding.
Monitor INR and signs and symptoms of bleeding.
1 Not specified Not specified
Aspirin Vitamin E Coadministration of vitamin E and aspirin may increase the risk of bleeding. Monitor for signs and symptoms of bleeding 16 Not Specified Not specified
Aspirin Garlic Additive antiplatelet effects may occur with coadministration of garlic and aspirin, risk of bleeding may be increased. Monitor for signs and symptoms of bleeding 1 Delayed Moderate
Aspirin Fish oils Concomitant use of aspirin and fish oils may increase risk of bleeding.
Monitor for signs and symptoms of bleeding
3 Not specified Not specified
Aspirin Ginko biloba Ginkgo inhibits platelet aggregation; risk of bleeding may be increased.
Monitor for signs and symptoms of bleeding.
1 Delayed Major
Clopidogrel Vitamin E Concomitant use of vitamin E and clopidogrel may increase the risk of bleeding. Monitor for signs and symptoms of bleeding 5 Not specified Not specified
Clopidogrel Garlic Additive antiplatelet effects may occur, risk of bleeding may be increased. Monitor for signs and symptoms of bleeding 1 Delayed Major
Clopidogrel Coenzyme Q Coenzyme Q 10 may have procoagulant effects, may partially antagonize antiplatelet effect of clopidogrel. 1 Not specified Not specified
Insulin Insulin leaf Enhanced hypoglycemic effects.
Patient was advised to discontinue insulin leaf while receiving insulin for glycemic control.
1 Delayed Moderate
Paroxetine Saint John's Wort Saint John's Wort induces cytochrome P450 3A4 enzyme and has mechanism of action similar to serotonin reuptake inhibitors.
Administering it concomitantly with paroxetine will enhance the toxicity of paroxetine. Patient was advised to discontinue the use of Saint John's Wort
1 Rapid Severe
  1. INR = International Normalized Ratio
  2. * Delayed onset of interactions occurs after multiple doses of both agents.