Botanical Products and Warfarin

CHINESE BOTANICAL PRODUCTS AND WARFARIN Angelica sinensis (Chinese Angelica, Dong Quai) 

Dong quai (dang gui, tang kuei) is the extract from the dried root of Radix Angelicae sinensis (Fig. 1), which belongs to the family Umbelliferae. It has been used for many years as a Chinese botanical remedy for management of menstrual cramps, irregular menses, and menopausal symptoms, and the 

Danshen, the dried root and rhizome of S. miltiorrhizae (Fig. 2), is another Chinese botanical product used for its ability to alleviate menstrual irregularities, as well as for its vasodilative and hypotensive functions in a variety of cardiovascular conditions (8). The botanical product had also been shown to inhibit platelet aggregation in vitro (9). Danshen is widely available in different preparations for oral consumption, with usual dose range of 9 to 15 g per decoction. In addition, its increasing popularity is reflected by its availability even in Chinese cigarettes (10). 

Clinicians from Hong Kong reported a case of potential danshen-warfarin interaction in a 48-year-old female with a history of rheumatic heart disease, atrial fibrillation, and mitral stenosis (11). The patient underwent successful transvenous mitral valvuloplasty for management of her medical conditions, and was discharged with 1 mg warfarin, as well as 

Another case involved a 66-year-old male patient who was stabilized on 2 to 2.5 mg of warfarin per day with INR of about 2. About nine days 

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