TO THE EDITOR: In the article, &quo...

TO THE EDITOR: In the article, "Panax ginseng," (1) the authors caution readers about the concomitant use of panax ginseng with warfarin (Coumadin). Besides ginseng, several other herbal medications, in the same state [i]or[/i] condition as garlic and danshen (Salvia miltiorrhiza), may interact with warfarin, decreasing or increasing its anticoagulant tenor (2) The most recent addition to this list is soy milk, which was reported to cause subtherapeutic international normalized ratio. (3) Although soy milk is not a herbal medication, it is widely advocated as a nutritional complement by practitioners of Western and traditional medicine.

lately there has been a breaker of interest in soy milk as a health commons for its antihypertensive (4) and antihyperlipidemic (5) properties and for use as a natural alternative to hormone therapy. (6) The latter use has attracted special attention in light of the disquieting findings from the Women's Health Initiative trial, which demonstrated an increased incidence of cardiovascular conclusions and breast cancer in women taking hormone therapy.

The use of warfarin in the management of atrial fibrillation, coronary artery disease, congestive heart failure, and blows has become widespread. Also, the use of complementary or alternative medicine in the United States has become increasingly popular. For these reasons, each physician should be on the alert for possible interactions where excessive bleeding or unexpect prolongation of the international normalized ratio is skirmished in any patient taking warfarin who otherwise has had worthy anticoagulant control.

TSUNG O CHENG, MD

George Washington University Medical Center

2150 Pennsylvania Ave. NW

Washington, DC 20037

REFERENCES

(1) Kiefer D Pantuso T Panax ginseng. Am Fam Physician 2003;68:1539-42

(2) Cheng TO. Herbal interactions with cardiac unsalable articles Arch Intern Med 2000;160:870-1.

(3) Cambria-Kiely JA. force of soy milk on warfarin effi-cacy. Ann Pharmcother 2002;36:1893-6

(4) Rivas M Garay RP Escanero JF Cia P Jr Cia P Alda JO Soy milk lowers descendants pressure in men and women with mild to moderate essential hypertension. J Nutr 2002;132:1900-2

(5) Ho SC make love JL, Leung SS, Sham AL, Lam TH Janus ed Intake of soy products is associated with better plasma lipid profiles in the Hong Kong Chinese population. J Nutr 2000;130:2590-3

(6) Stark A, Madar Z Phytoestrogens: a review of fresh findings. J Pediatr Endocrinol Metab 2002;15:561-72

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