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Licensed Unlicensed Requires Authentication Published by De Gruyter June 15, 2013

Gastrointestinal bleeding secondary to interaction of Artemisia absinthium with warfarin

Sadık Kadri Açıkgöz EMAIL logo and Eser Açıkgöz


Artemisia absinthium, also known as wormwood, is used widely as an herbal medicine. In this report, we introduce an 82-year-old Turkish woman who was treated with warfarin for atrial fibrillation and was hospitalized for gastrointestinal bleeding as a result of extremely elevated international normalized ratio (INR) after consumption of A. absinthium. Naranjo adverse drug reaction probability scale score was 6, which indicated a probable relationship between the patient’s elevated INR and her concomitant use of wormwood and warfarin. Clinicians should be vigilant about potential dangers of herbal medicines taken with conventional drugs, and patients taking drugs with a narrow therapeutic index, such as warfarin, should be educated about avoiding consumption of herbal medicines.

Corresponding author: Sadık Kadri Açıkgöz, Department of Cardiology, Turkiye Yuksek Ihtisas Education and Research Hospital, Kızılay Sokak, Sıhhiye, Ankara 06100, Turkey


1. Deans SG, Kennedy AI. Artemisia absinthium. In: Wright CW, editor. Artemisia. London: Taylor and Francis, 2002:79–89.Search in Google Scholar

2. Craciunescu O, Constantin D, Gaspar A, Toma L, Utoiu E, Moldovan L. Evaluation of antioxidant and cytoprotective activities of Arnica montana L. and Artemisia absinthium L. ethanolic extracts. Chem Cent J 2012;6:97.10.1186/1752-153X-6-97Search in Google Scholar PubMed PubMed Central

3. Koul MK. Medicinal plants of Kashmir and Ladakh, temperate and cold Arid Himalaya. New Delhi. Tagore Garden, Delhi: Indus Publishing Company, 1997:102.Search in Google Scholar

4. Kültür S. Medicinal plants used in Kirklareli Province (Turkey). J Ethnopharmacol 2007;111:341–64.10.1016/j.jep.2006.11.035Search in Google Scholar PubMed

5. Chinese Pharmacopoeia. Uighur Medicines. Beijing: China Chemical Industry Press, 2005:181–2.Search in Google Scholar

6. Bellakhdar J. Contribution à l étude de la pharmacopée marocaine. Rabat: Edition techniques nord-africaines, 1987:202.Search in Google Scholar

7. Baytop T. Therapy with medicinal plants in Turkey. Istanbul: Istanbul University Press, 1984:166–7.Search in Google Scholar

8. Yildiz K, Basalan M, Duru Ö, Gökpinar S. Antiparasitic efficiency of Artemisia absinthium on Toxocara cati in naturally infected cats. Turkiye Parazitol Derg 2011;35:10–4.10.5152/tpd.2011.03Search in Google Scholar PubMed

9. Ferreira JF, Peaden P, Keiser J. In vitro trematocidal effects of crude alcoholic extracts of Artemisia annua, A. absinthium, Asimina triloba, and Fumaria officinalis: trematocidal plant alcoholic extracts. Parasitol Res 2011;109:1585–92.10.1007/s00436-011-2418-0Search in Google Scholar PubMed

10. Amat N, Upur H, Blazekovic B. In vivo hepatoprotective activity of the aqueous extract of Artemisia absinthium L. against chemically and immunologically induced liver injuries in mice. J Ethnopharmacol 2010;131:478–84.10.1016/j.jep.2010.07.023Search in Google Scholar PubMed

11. Tariku Y, Hymete A, Hailu A, Rohloff J. In vitro evaluation of antileishmanial activity and toxicity of essential oils of Artemisia absinthium and Echinops kebericho. Chem Biodivers 2011;8:614–23.10.1002/cbdv.201000331Search in Google Scholar PubMed

12. Mills E, Montori VM, Wu P, Gallicano K, Clarke M, Guyatt G. Interaction of St John’s wort with conventional drugs: systematic review of clinical trials. BMJ 2004;329:27–30.10.1136/bmj.329.7456.27Search in Google Scholar PubMed PubMed Central

13. Ernst E. The desktop guide to complementary and alternative medicine – an evidence-based approach, 1st ed. London: Mosby, 2002.Search in Google Scholar

14. Ramsay NA, Kenny MW, Davies G, Patel JP. Complementary and alternative medicine use among patients starting warfarin. Br J Haematol 2005;130:777–80.10.1111/j.1365-2141.2005.05689.xSearch in Google Scholar PubMed

15. Bardia A, Nisly NL, Zimmerman MB, Gryzlak BM, Wallace RB. Use of herbs among adults based on evidence-based indications: findings from the National Health Interview Survey. Mayo Clin Proc 2007;82:561–6.10.4065/82.5.561Search in Google Scholar PubMed PubMed Central

16. Bent S. Herbal medicine in the United States: review of efficacy, safety, and regulation: grand rounds at University of California, San Francisco Medical Center. J Gen Intern Med 2008;23:854–9.10.1007/s11606-008-0632-ySearch in Google Scholar PubMed PubMed Central

17. No authors listed. Summaries for patients. Ginseng reduces the effect of warfarin in a study of healthy volunteers. Ann Intern Med 2004;141:I58.10.7326/0003-4819-141-1-200407060-00004Search in Google Scholar PubMed

18. Page RL, Lawrence JD. Potentiation of warfarin by dong quai. Pharmacotherapy 1999;19:870–6.10.1592/phco.19.10.870.31558Search in Google Scholar PubMed

19. Sunter W. Warfarin and garlic. Pharm J 1991;246:722.Search in Google Scholar

20. Madabushi R, Frank B, Drewelow B, Derendorf H, Butterweck V. Hyperforin in St. John’s wort drug interactions. Eur J Clin Pharmacol 2006;62:225–33.10.1007/s00228-006-0096-0Search in Google Scholar PubMed

21. Turfan M, Tasal A, Ergun F, Ergelen M. A sudden rise in INR due to combination of Tribulus terrestris, Avena sativa, and Panax ginseng (Clavis Panax). Turk Kardiyol Dern Ars 2012;40:259–61.10.5543/tkda.2012.45793Search in Google Scholar PubMed

22. Yamaria A, Borikya D, Bouamrania ML, Blaghenb M, Talbi M. A new thiophen acetylene from Artemisia absinthium. J Chin Chem Soc 2004;51:637–8.10.1002/jccs.200400095Search in Google Scholar

Received: 2013-4-15
Accepted: 2013-5-28
Published Online: 2013-06-15
Published in Print: 2013-08-01

©2013 by Walter de Gruyter Berlin Boston

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