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Interactions

Interactions with Drugs

Research in humans suggests that American ginseng may reduce the anticoagulant (blood thinning) effects of warfarin (Coumadin®). In addition, based on limited animal research, and anecdotal reports of nosebleeds and vaginal bleeding in humans, ginseng may increase the risk of bleeding when taken with other drugs that increase the risk of bleeding. Examples include aspirin, anticoagulants ("blood thinners") such as heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®). In contrast, there is a case of the effectiveness of the "blood thinner" warfarin (Coumadin®) being reduced when taken at the same time as ginseng, with effects on levels of the blood test used to measure warfarin effects being altered (decreased "INR").

Based on human research, ginseng may lower blood sugar levels. This effect may be greater in patients with diabetes than in non-diabetic individuals. Caution is advised when using medications that may also lower blood sugar. Patients taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare provider. Medication adjustments may be necessary.

Headache, tremors, mania, or insomnia may occur if ginseng is combined with prescription anti-depressant drugs called monoamine oxidase inhibitors (MAOIs) such as isocarboxazid (Marplan®), phenelzine (Nardil®), and tranylcypromine (Parnate®).

Based on case reports, ginseng may alter the effects of blood pressure or heart medications, including calcium channel blockers such as nifedipine (Procardia®). There is preliminary evidence that ginseng may increase the QTc interval (thus increasing the risk of abnormal heart rhythms) and decrease diastolic blood pressure two hours after ingestion in healthy adults. Therefore, caution is advised with other medications that may alter QTc. There is a reported case of decreased effects of the diuretic drug furosemide (Lasix®) when used with ginseng. A Chinese study reports that the effects of the cardiac glycoside drug digoxin (Lanoxin®) may be increased when used with ginseng in patients with heart failure. Do not combine ginseng with heart or blood pressure medications without first consulting a qualified healthcare provider.

There is limited laboratory evidence that ginseng may contain estrogen-like chemicals, and may affect medications with estrogen-like or estrogen-blocking properties. This has not been well demonstrated in humans.

In theory, ginseng may interfere with the way the body processes certain drugs using the liver's "cytochrome P450" enzyme system. As a result, the levels of these drugs may be increased in the blood and may cause increased effects or potentially serious side effects. A pharmacist should be consulted before taking and herbs or supplements.

The analgesic effect of opioids may be inhibited by ginseng. Ginseng may interact with sedatives.

Many tinctures contain high levels of alcohol, and may cause nausea or vomiting when taken with metronidazole (Flagyl®) or disulfiram (Antabuse®). In a preliminary study, ginseng was reported to increase the removal of alcohol from the blood, although this has not been well substantiated.

Interactions with Herbs and Dietary Supplements

Based on human research, ginseng may lower blood sugar levels. This effect may be greater in patients with diabetes than in non-diabetic individuals. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.

Headache, tremors, mania, and insomnia may occur if ginseng is combined with supplements that have monoamine oxidase inhibitor (MAOI) activity or that interact with MAOI drugs.

Based on case reports, ginseng may raise or lower blood pressure. Use caution if combining ginseng with other products that can affect blood pressure.

There is preliminary evidence that ginseng may increase the QTc interval (thus increasing the risk of abnormal heart rhythms) and decrease diastolic blood pressure two hours after ingestion in healthy adults. Therefore, caution is advised with other agents that may cause abnormal heart rhythms.

Based on limited animal research and anecdotal reports of nosebleeds and vaginal bleeding in humans, ginseng may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, some cases with garlic, and fewer cases with saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.

In theory, ginseng may decrease the effects of diuretic herbs like horsetail or licorice. Ginseng may interact with sedatives.

In theory, ginseng may interfere with the way the body processes certain herbs or supplements using the liver's "cytochrome P450" enzyme system. As a result, the levels of other herbs or supplements to be too high in the blood. It may also alter the effects that other herbs or supplements possibly have on the P450 system such as cat's claw or echinacea.

There is limited laboratory evidence that ginseng may contain estrogen-like chemicals, and may affect agents with estrogen-like or estrogen-blocking properties. This has not been demonstrated in humans.