Holistic Health Potential Interactions Between Warfarin and Herbs By Cathy Wong facebook twitter Cathy Wong is a nutritionist and wellness expert. Her work is regularly featured in media such as First For Women, Woman's World, and Natural Health. Learn about our editorial process Cathy Wong Medically reviewed by Medically reviewed by Violetta Shamilova, PharmD on April 21, 2020 Violetta Shamilova, PharmD, is a board-licensed pharmacist. She is an assistant professor at the Touro College School of Health Sciences, and has worked at CVS pharmacy for five years. She completed the certified APhA Delivering Medication Therapy Management Services course. Learn about our Medical Review Board Violetta Shamilova, PharmD on April 21, 2020 Print Many common herbs and nutritional supplements, if taken with the prescription drug warfarin (Coumadin), may change the effectiveness of the drug and potentially result in deadly adverse effects. Warfarin has a narrow therapeutic index (there is a small difference between the minimum effective and minimum toxic doses). Some herbs and supplements contain substances that may raise the risk of bleeding complications, while others work against warfarin, making people more prone to develop blood clots or stroke. Hailshadow / Getty Images If you are taking the drug or any other prescription medication, it is crucial that you talk with your doctor about any herbal or nutritional supplement (including food powders, oils, teas, or juices), you are taking or are considering taking. Here are some of the herbs and supplements that may interact with warfarin. Alfalfa - contains vitamin KAlpha-linolenic acid (ALA) - e.g. flaxseed oil, pumpkin seed oilBoswellia (Boswellia serrata)Camellia sinensis - e.g. black tea, green teaChamomile (Matricaria chamomilla)CocoaCoenzyme Q10CranberryDanshen (Salvia miltiorrhiza) - may decrease platelet aggregation and increase the bleeding risk.DHA (docosahexaenoic acid)/ EPA (eicosapentaenoic acid)Dong quai (Angelica sinensis) - may inhibit platelet aggregation and increase the risk of bleeding.Feverfew (Tanacetum parthenium)Fish oil / omega-3 fatty acidsGamma-linolenic acid (GLA) - e.g. evening primrose oil. Could have anticoagulant effects.Garlic (Allium sativum)Ginger (Zingiber officinale)Ginkgo bilobaGinseng (all types)Glucosamine - may increase the anticoagulant effects of warfarin and increase the risk of bleeding, alone or in combination with chondroitin.Goji berry / Chinese wolfberry (Lycium barbarum)GoldensealKava kavaLicorice Milk thistleN-acetyl glucosaminePolicosanol - may inhibit platelet aggregationPsylliumRed yeast riceSaw palmetto (Serenoa repens)St. John's wort - may decrease the therapeutic effects of warfarin.Vitamin EVitamin K - may reduce the anticoagulant effect of warfarin.White willow bark - may increase the risk of bleeding.Topical wintergreen oil products (due to systemic absorption of methyl salicylate in wintergreen gels, lotions, cream, ointment, and spray.Turmeric/curcuminWormwood (Artemisia absinthium)Yarrow Other Herbs and Supplements With Warfarin Interactions Other herbs and supplements that may interact with warfarin: Acerola, acetyl-L-carnitine, activated charcoal, African wild potato, agar, agrimony, alchemilla, alder buckthorn, allspice, aloe, American chestnut, American elder, Andrographis, aniseed, antioxidants, apitherapy, arnica, asafoetida, ascorbigen, avocado Baikal skullcap, barley, basil, bee pollen, berberine, bilberry, bishops weed, bistort, bitter orange, black currant, black mulberry, black and white pepper, black root, black seed, bladderwrack, blond psyllium, blue flag, blue-green algae, bogbean, boldo, borage, broccoli, bromelain, buchu, bupleurum, burdock, butternut Cabbage, caffeine, capsicum, carrageenan, cascara, cassia, cat's claw, celery, celery seed, chanca piedra, Chinese prickly ash, chitosan, chlorella, chrysin, cinchona, clove, cod liver oil, codonopsis, coffee, cola nut, coleus, colocynth, coltsfoot, conjugated linoleic acid, cordyceps, corn silk, cranberry, cumin Dandelion, deer tongue, devil's claw, DHA, DHEA, dehydroepiandrosterone, DMSO Eastern hemlock, echinacea, eucalyptus, European barberry, European buckthorn, European chestnut, European mandrake, evodia Fennel, fenugreek, flaxseed, flaxseed oil, fo-ti, forsythia, fulvic acid Gamboge, gamma linolenic acid, german chamomile, glucomannan, goat's rue, goji, goldenseal, goldthread, gossypol, grape, great plantain, greater bindweed, green coffee, guarana, guggul, Hesperidin, higenamine, holy basil, honey, honeysuckle, hops, horny goat weed, horse chestnut, horseradish, hu zhang Iceland moss, Indian frankincense, Indian gooseberry, indole-3-carbinol, inositol nicotinate, IP-6, ipriflavone Jalap, Japanese apricot, jiaogulan, Karaya gum, kava, kinetin, kiwi, krill oil, kudzu L-arginine, L-carnitine, lime, limonene Magnesium, magnolia, maitake mushroom, mangosteen, manna, marijuana, marjoram, marshmallow, meadowsweet, melatonin, melilot, mesoglycan, methoxylated flavones, Mexican scammony root, moringa, Mormon tea, myrrh N-acetyl cysteine, nattokinase, noni, nopal (cactus), nutmeg Olive, onion, oolong tea, oregano, Oregon grape Palm oil, pantethine, papain, papaya, passionflower, pau d'arco, pectin, peony, peppermint, Phellodendron, pomegranate, poplar, prickly ash, propionyl-L-carnitine, propolis, pue-erh tea, purple nut sedge, pycnogenol Quassia, quercetin, quillaia, quince, quinidine Raspberry ketone, red clover, reishi mushroom, resveratrol, rhatany, Rhodiola, rhubarb, rice bran, rose hip, rosemary, royal jelly Safflower, sage, saw palmetto, schisandra, sea buckthorn, selenium, senna, serrapeptase, Siberian ginseng, slippery elm, smartweed, soy, spinach, stinging nettle, strawberry, sulforaphane, summer savory, swallowroot, sweet clover, sweet vernal grass, sweet woodruff Tannic acid, tarragon, thyme, tiratricol, tonka beans, tragacanth, tree turmeric Umckaloabo Valerian, vanadium, vinpocetine, vitamin A, vitamin C Water avens, watercress, wild carrot, wild cherry, wild lettuce, willow Yarrow, yellow dock, yerba mate, Yohimbe Using Herbs and Supplements With Warfarin This is not a complete list and it is essential that you speak with your physician before starting any form of alternative medicine or changing your prescribed treatment regimen. Keep in mind that the side effects and potential drug interactions for many herbs and supplements are poorly understood. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Ge B, Zhang Z, Zuo Z. Updates on the clinical evidenced herb-warfarin interactions. Evid Based Complement Alternat Med. 2014;2014:957362. doi:10.1155/2014/957362 Additional Reading Açıkgöz SK, Açıkgöz E. Gastrointestinal bleeding secondary to interaction of Artemisia absinthium with warfarin. Drug Metabol Drug Interact. 2013;28(3):187-9. doi: 10.1515/dmdi-2013-0021. Chan HT, So LT, Li SW, Siu CW, Lau CP, Tse HF. Effect of herbal consumption on time in therapeutic range of warfarin therapy in patients with atrial fibrillation. J Cardiovasc Pharmacol. 2011 Jul;58(1):87-90. doi: 10.1097/FJC.0b013e31821cd888. Chen XW, Sneed KB, Pan SY, Cao C, Kanwar JR, Chew H, Zhou SF. Herb-drug interactions and mechanistic and clinical considerations. Curr Drug Metab. 2012 Jun 1;13(5):640-51. Milić N, Milosević N, Golocorbin Kon S, Bozić T, Abenavoli L, Borrelli F. Warfarin interactions with medicinal herbs. Nat Prod Commun. 2014 Aug;9(8):1211-6. Na DH, Ji HY, Park EJ, Kim MS, Liu KH, Lee HS. Evaluation of metabolism-mediated herb-drug interactions. Arch Pharm Res. 2011 Nov;34(11):1829-42. doi: 10.1007/s12272-011-1105-0. Epub 2011 Dec 3. Natural Standards Comprehensive Database. Warfarin. Therapeutic Research Faculty. Rivera CA, Ferro CL, Bursua AJ, Gerber BS. Probable interaction between Lycium barbarum (goji) and warfarin. Pharmacotherapy. 2012 Mar;32(3):e50-3. doi: 10.1002/j.1875-9114.2012.01018.x. Zhou X, Chan K, Yeung JH. Herb-drug interactions with Danshen (Salvia miltiorrhiza): a review on the role of cytochrome P450 enzymes. Drug Metabol Drug Interact. 2012 Mar 2;27(1):9-18. doi: 10.1515/dmdi-2011-0038.