CYP2C9-mediated warfarin and milk thistle interaction.

In vitro studies suggest a CYP2C9-mediated interaction between milk thistle and warfarin, but there has been no in vivo case report on this interaction. A White Hispanic man in his 30s was well controlled on warfarin therapy for mitral valve replacement. His INR increased from 2.64 to 4.12, and he denied changes to his medications and diet but noted starting a 'liver cleanse' supplement which contained milk thistle (200 mg). After stopping the supplement his INR normalized, and he remains on the same warfarin dose. This is the first in vivo report of an interaction between milk thistle and warfarin. © 2019 John Wiley & Sons Ltd.

Citation

David Benjamin Lash, Shereen Ward. CYP2C9-mediated warfarin and milk thistle interaction. Journal of clinical pharmacy and therapeutics. 2020 Apr;45(2):368-369

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PMID: 31633199

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