Ginseng Digoxin

McRae S. Elevated serum digoxin levels in a patient taking digoxin and Siberian ginseng. Can Med Assoc J 1996 155 1237-1237. 

Chow L, Johnson M, Wells A, Dasgupta A. Effect of the traditional Chinese medicines Chan Su, Lu-Shen-Wan, Dan Shen, and Asian Ginseng on serum digoxin measurement by Tina-quant (Roche) and Synchron LX system (Beckman) digoxin immunoassays. J Clin Lab Anal 2003 17 22-27. 

Uses Type 2 DM Action a-Glucosidase inhibitor delays digestion of carbohydrates Dose Initial 25 mg PO rid maint 50-100 mg rid (w/ 1st bite of each meal) Caution [B, —] Contra DKA, obst/inflammatory GI disorders SCr >2 mg/dL Disp Tabs SE Flatulence, D, abd pain Interactions T Effects W/ celery, coriander, juniper berries, ginseng, garlic X- effects W/ENH, niacin, intestinal absorbents, amylase, pancreatin X- effects OF digoxin, propranolol, ranitidine EMS Can X- digoxin level-monitor ECG in pts on digoxin therapy OD May cause severe adverse GI Sxs symptomatic and supportive... 

Digoxin Eleuthero or Siberian ginseng (Eleutherococcus senticocus) Raises digoxin concentrations Patients exhibit unchanged ECG despite digoxin concentration of 5 x 2 nM/1. 

Siberian ginseng Similar to ginseng May raise digoxin levels. May affect warfarin (increased INR)... 

Ginseng ASA, NSAIDs Antidiabetic agents Clopidogrel, ticlopidine CNS stimulants, caffeine Corticosteroids Digoxin MAO inhibitors Warfarin Additive antiplatelet effects Additive hypoglycemia Additive antiplatelet effects Additive CNS toxicity Additive CNS toxicity Falsely elevated levels Increased toxicity Increased risk of bleeding... 

In animal studies, ginsenoside Rbl decreases blood pressure, perhaps owing to relaxation of smooth muscle (25). In humans, small studies suggest ginseng may decrease systolic blood pressure at a dose of 4.5 g/day (45), and enhance the efficacy of digoxin in class IV heart failure (46). In contrast, ginsenoside Rgl has been purported to have hypertensive effects (4). Finally,... 

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