약사가 운영하는 항응고 약물 상담실 환자의 건강기능식품 복용 실태와 상호작용
Dietary Supplement Intake and Interactions among Pharmacist-Managed Anticoagulation Clinic Patients
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Despite its complex pharmacokinetic and pharmacodynamic profile, warfarin is still one of the most widely used oral anticoagulant agents. Patients taking warfarin are at particular risk of interactions with dietary supplements, yet approximately 30% use herbal or natural product supplements on a regular basis. Attaining optimal anticoagulation with this agent is clinically challenging in view of its potential interaction with many dietary supplements. The aim of this study was to present information about dietary supplement intake and interactions between warfarin and those dietary supplements. A retrospective, observational case-control study set within three pharmacist-managed anticoagulation clinics in a teaching hospital was performed. Patients were included (n=398), if they were seen for an clinic visit during the 1-month period from January 1st-31st 2010 and under the stable anticoagulation control for 3 months(July 1-30 September 2009) and then evaluated for the presence or absence of 3 investigational factors of INR changes, dietary supplement intake and adverse effects. Thirteen of 66 patients who were taking dietary supplements were identified having clinically significant interactions with warfarin. The use of a dietary supplement with warfarin was associated with an increase in bleeding events (oddsratio 2.2, 95% confidence interval, 1.10-4.50)In conclusion, as dietary supplements continue to grow in popularity, patients and pharmacists should be vigilant of potential dietary supplement-drug interactions.
Abstract
Despite its complex pharmacokinetic and pharmacodynamic profile, warfarin is still one of the most widely used oral anticoagulant agents. Patients taking warfarin are at particular risk of interactions with dietary supplements, yet approximately 30% use herbal or natural product supplements on a regular basis. Attaining optimal anticoagulation with this agent is clinically challenging in view of its potential interaction with many dietary supplements. The aim of this study was to present information about dietary supplement intake and interactions between warfarin and those dietary supplements. A retrospective, observational case-control study set within three pharmacist-managed anticoagulation clinics in a teaching hospital was performed. Patients were included (n=398), if they were seen for an clinic visit during the 1-month period from January 1st-31st 2010 and under the stable anticoagulation control for 3 months(July 1-30 September 2009) and then evaluated for the presence or absence of 3 investigational factors of INR changes, dietary supplement intake and adverse effects. Thirteen of 66 patients who were taking dietary supplements were identified having clinically significant interactions with warfarin. The use of a dietary supplement with warfarin was associated with an increase in bleeding events (oddsratio 2.2, 95% confidence interval, 1.10-4.50)In conclusion, as dietary supplements continue to grow in popularity, patients and pharmacists should be vigilant of potential dietary supplement-drug interactions.
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