Also indexed as: Betimol, Ticlid
Summary of
Interactions with Vitamins, Herbs, and Foods
In some cases, an herb or supplement may appear in more than one category, which may seem
contradictory. For clarification, read the full article for details about the summarized
interactions.
Avoid: Adverse interaction—Avoid these supplements when taking this
medication because taking them together may cause undesirable or dangerous results. |
Asian ginseng*
Dan shen
Devil’s claw*
Dong quai*
Fenugreek*
Garlic*
Ginkgo biloba*
Horse chestnut*
Quinine*
Red clover*
Salicylate-containing herbs* such as meadowsweet, poplar, willow,
and wintergreen
Sweet clover*
Sweet woodruff*
|
Check: Other—Before taking any of these supplements or eating any of
these foods with your medication, read this article in full for details. |
Eleuthero
Ginger
|
| Depletion or interference |
None known
|
| Side effect reduction/prevention |
None known
|
| Supportive interaction |
None known
|
| Reduced drug
absorption/bioavailability |
None known
|
An asterisk (*) next to an item in the summary indicates that the
interaction is supported only by weak, fragmentary, and/or contradictory scientific
evidence.
Interactions with Herbs
Asian
ginseng (Panax ginseng)
Ginseng was associated with a decrease in
warfarin activity in a case study.1 This report suggests that ginseng may
affect parameters of bleeding. Therefore, people taking ticlopidine should consult with a
physician knowledgeable about botanical medicines before taking Asian ginseng or eleuthero/Siberian ginseng (Eleutherococcus
senticosus).
Dan shen (Salvia miltiorrhiza)
Dan shen, a Chinese herb, was associated with increased warfarin activity in two cases.2
3 Although warfarin acts differently from ticlopidine, both affect parameters of
bleeding. Until more is known, people taking ticlopidine should use dan shen only under close
medical supervision. Sage (Salvia
officinalis), a plant relative of dan shen found in the West, has not been not associated
with interactions involving warfarin.
Devil’s
claw (Harpagophytum procumbens)
Devil’s claw was associated with purpura (bleeding under the skin) in a patient treated
with warfarin.4 As with dan shen,
until more is known, people taking ticlopidine should avoid taking devil’s claw
concurrently.
Garlic
(Allium sativum)
Garlic has been shown to help prevent
atherosclerosis (hardening of the arteries), perhaps by reducing the ability of platelets
to stick together.5 Interfering with the action of platelets results in an increase
in the tendency toward bleeding6 and in theory could dangerously enhance the effect
of ticlopidine. Standardized extracts of garlic have been associated with bleeding in people
only on rare occasions.7 People taking ticlopidine should consult with a doctor
before taking products containing standardized extracts of garlic or eating more than one
clove of garlic daily.
Ginger
(Zingiber officinale)
Ginger has been shown to reduce platelet stickiness in test tubes. Although there appear to be
no reports of interactions with platelet inhibiting drugs, people should talk with a
healthcare professional if they are taking a platelet inhibitor and wish to use
ginger.8
Ginkgo
biloba
Ginkgo extracts may reduce the ability of platelets to stick together, possibly increasing the
tendency toward bleeding.9 In a rat study, a high intake of ginkgo increased the
action of ticlopidine in a way that could prove dangerous if the same effect occurred in
people.10 Standardized extracts of ginkgo have been associated with two cases of
spontaneous bleeding, although the ginkgo extracts were not definitively shown to be the cause
of the problem.11 12 People taking ticlopidine should use ginkgo
extracts only under the supervision of a doctor.
Herbs containing coumarin-derivatives
Although there are no specific studies demonstrating interactions with platelet inhibitors,
the following herbs contain coumarin-like substances that may cause bleeding and therefore
interact with ticlopidine. These herbs include
dong quai, fenugreek, horse chestnut, red clover, sweet clover, and sweet woodruff.
Quinine
(Cinchona sp.)
Quinine, a chemical found in cinchona bark and available as a drug product, has been reported
to increase warfarin activity.13
Although warfarin and ticlopidine are both considered “blood thinners,” they have
significantly different actions. Therefore, it remains unclear whether the reported
interaction between quinine and warfarin would occur between ticlopidine and quinine.
Salicylate-containing herbs
Like ticlopidine, salicylates interfere with the action of platelets. Various herbs, including
meadowsweet (Filipendula
ulmaria), poplar (Populus tremuloides),willow (Salix alba), and wintergreen
(Gaultheria procumbens) contain salicylates. Though similar to aspirin, plant salicylates have been shown to have
different actions in test tube studies.14 Furthermore, salicylates are poorly
absorbed and likely do not build up to levels sufficient to cause negative interactions that
aspirin might cause.15 No reports have been published of negative interactions
between salicylate-containing plants and aspirin or aspirin-containing drugs.16
Therefore concerns about combining salicylate-containing herbs and any drug remain
theoretical, and the risk of causing bleeding problems may be low.
Interactions with Foods and Other Compounds
Food
Ticlopidine should be taken with food to minimize gastrointestinal upset.17
References:1. Janetzky K, Morreale AP. Probable interaction between warfarin and
ginseng. Am J Health Syst Pharm 1997;54:692–3.
2. Yu CM, Chan JCN, Sanderson JE. Chinese herbs and warfarin potentiation
by “danshen.” J Intern Med 1997;241:337–9.
3. Tam LS, Chan TYK, Leung WK, Critchley JAJH. Warfarin interactions with
Chinese traditional medicines: Danshen and methyl salicylate medicated oil. Aust NZ J
Med 1995;25:258.
4. Shaw D, Leon C, Kolev S, Murray V. Traditional remedies and food
supplements: a 5-year toxicological study (1991–1995). Drug Saf
1997;17:342–56.
5. Rose KD, Croissant PD, Parliment CF, Levin MB. Spontaneous spinal
epidural hematoma with associated platelet dysfunction from excessive garlic ingestion: A case
report. Neurosurgery 1990;26:880–2.
6. Gadkari JV, Joshi VD. Effect of ingestion of raw garlic on serum
cholesterol level, clotting time and fibrinolytic activity in normal subjects. J Postgrad
Med 1991;37:128–31.
7. Burnham BE. Garlic as a possible risk for postoperative bleeding.
Plast Reconst Surg 1995;95:213.
8. Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide
for Health-Care Professionals. London: The Pharmaceutical Press, 1996, 135–7.
9. Kleijnen J, Knipschild P. Ginkgo biloba. Lancet
1992;340:1136–9.
10. Kim YS, Pyo MK, Park KM. Antiplatelet and antithrombotic effects of a
combination of ticlopidine and Ginkgo biloba ext (EGb 761). Thromb Res
1998;91:33–8.
11. Rosenblatt M, Mindel J. Spontaneous hyphema associated with ingestion
of Ginkgo biloba extract. N Engl J Med 1997;336:1108.
12. Rowin J, Lewis SL. Spontaneous bilateral subdural hematoma with
chronic Ginkgo biloba ingestion. Neurology 1996;46:1775–6.
13. Tatro D, ed. Anticoagulants-quinine derivatives. In Drug
Interaction Facts. St. Louis, MO: Facts and Comparisons, Jul 1993.
14. Wichtl M, Bisset NG, eds. Herbal Drugs and
Phytopharmaceuticals Stuttgart: Medpharm GmBH Scientific Publishers. 1994.
15. Janssen PL, Katan MB, van Staveren WA, et al. Acetylsalicylate and
salicylates in foods. Cancer Lett 1997:114(1–2):163–4.
16. McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal
Product Association’s Botanical Safety Handbook. Boca Raton, FL: CRC Press, 1997,
154–5.
17. Threlkeld DS, ed. Blood Modifiers, Antiplatelet Agents, Ticlopidine
HCl. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons,
Jan 1992, 85c–5g.