Ginseng Drug Interactions
When certain medications are taken in combination with ginseng, drug interactions may occur that could lead to complications. To help prevent problems, you may want to avoid taking ginseng supplements with "blood-thinning" medicines, diabetes medications, and medications that are metabolized by enzymes in the liver. Since many drugs can cause ginseng interactions, make sure to tell your healthcare provider about all other medications you are taking.
Even though ginseng is a natural product, it can potentially interact with several medications. In fact, ginseng may cause significant interactions with many medications, too many to list. Most ginseng drug interactions fall into the following categories:
- Interactions that can cause excessive bleeding
- Interactions with diabetes medications
- Interactions that affect the way liver enzymes metabolize other drugs
- Other miscellaneous drug interactions.
This article refers to Panax ginseng (also known as Asian ginseng, Chinese ginseng, and Korean ginseng). This type of ginseng should not be confused with American ginseng or Siberian ginseng, which are entirely different herbs.
Ginseng Interactions and Bleeding
Theoretically, ginseng could decrease the ability of blood platelets to stick together. While this may be a beneficial action in many situations, it can also increase the risk of bleeding. It is not clear if this is a significant problem in humans.
Until more information is available, it should be assumed that combining ginseng with medications that increase the risk of bleeding could lead to dangerous problems (such as internal bleeding). Some of these "blood-thinning" medicines that may lead to ginseng drug interactions include:
- Antithrombin (ATryn®, Thrombate III®)
- Apixaban (Eliquis®)
- Aspirin (Bayer® and others)
- Bivalirudin (Angiomax®)
- Cilostazol (Pletal®)
- Clopidogrel (Plavix®)
- Dabigatran etexilate mesylate (Pradaxa®)
- Dipyridamole (Persantine®)
- Drotrecogin alfa (Xigris®)
- Eptifibatide (Integrilin®)
- Fondaparinux (Arixtra®)
- Heparin or heparin-like products, including dalteparin (Fragmin®), enoxaparin (Lovenox®), or tinzaparin (Innohep®)
- Lepirudin (Refludan®)
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as:
- Celecoxib (Celebrex®)
- Diclofenac (Cambia™, Cataflam®, Flector®, Solaraze® Gel, Voltaren®, Voltaren® Gel, Voltaren®-XR, Voltaren Ophthalmic®, Zipsor™)
- Ibuprofen (Motrin®, Advil®, Nuprin®)
- Indomethacin (Indocin®, Indocin SR®)
- Ketoprofen (Orudis®, Actron®, Oruvail®)
- Ketorolac (Toradol®)
- Meloxicam (Mobic®)
- Naproxen (Naprosyn®) or naproxen sodium (Aleve®, Anaprox®, Naprelan®)
- Several others (see List of NSAIDs for a more complete list of these medications)
- Alteplase (Activase®)
- Reteplase (Retavase®)
- Streptokinase (Streptase®)
- Tenecteplase (TNKase®)
- Ticagrelor (Brilinta®)
- Ticlopidine (Ticlid®)
- Tirofiban (Aggrastat®)
- Warfarin (Coumadin®, Jantoven®).
Do not combine ginseng with any such medications without your healthcare provider's approval and supervision. It should be noted that there have been reports that ginseng could actually make warfarin less effective (which is the opposite of what would be expected), increasing the risk of blood clots.
Due to the unpredictability of interactions between ginseng and "blood-thinning" medications, your healthcare provider may recommend against combining them at all or may recommend increased monitoring to detect any problems.