Pentosan Polysulfate Sodium with Chamomile Interaction Details
Brand Names Associated with Pentosan Polysulfate Sodium
- Elmiron®
- Pentosan Polysulfate
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Jan 02, 2024
Interaction Effect
Increased risk of bleeding
Interaction Summary
Theoretically, coumarins present in chamomile may potentiate the effect of anticoagulants. Scopoletin-7-glucoside is a coumarin present in Roman chamomile, while umbelliferone, another coumarin, has been isolated from German chamomile . A case report described multiple internal hemorrhages in a 70-year-old woman following concomitant use of warfarin and chamomile . Caution is advised.
Severity
Major
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
Caution is advised if chamomile and anticoagulants are used concomitantly. Monitor the patient for signs and symptoms of excessive bleeding.
Mechanism Of Interaction
Additive anticoagulant effect
Literature Reports
A) A case report described multiple internal hemorrhages in a 70-year-old woman following concomitant use of warfarin and Matricaria chamommilla (chamomile). The patient had a history of mechanical mitral valve placement and atrial fibrillation and her medications included warfarin (stable dose of 4 mg 3 days/wk, 6 mg 4 days/wk for 11 months), amiodarone (taken concurrently with warfarin for 3 years), digoxin, synthroid, alendronate, metoprolol, and calcium-vitamin D. Five days prior to current presentation, the patient was diagnosed with an upper respiratory tract infection but was discharged without antibiotics. At that time, she had a hemoglobin level of 117 g/L, platelet count of 193 X 109 /L, and an INR of 3.6 (therapeutic range, 2.5 to 3.5). After discharge, she experienced pedal edema and used a chamomile-based skin lotion 4 to 5 times per day in an attempt to relieve it. In addition, she drank 4 to 5 cups of chamomile tea per day to soothe her sore throat. The patient claimed that she usually used both chamomile products once or twice daily. Five days post-discharge, she presented with shortness of breath on exertion, bilateral pedal edema, and had bruising in her perineal area, across her lower abdomen, and over her left hip. A complete blood count revealed a hemoglobin concentration of 80 g/L, platelet counts of 218 X 109/L, and an INR of 7.9. A CT scan revealed retroperitoneal hematoma in the pelvis and bilateral rectal muscle bleeding. The patient received 3 units of red blood cells and 2 units of plasma, and coagulation status was maintained using IV heparin therapy. The hemorrhages ultimately dissipated, heparin was discontinued, and warfarin dose was adjusted to achieve a stable INR of 2.5. It was postulated that the coumarin constituents of chamomile may have resulted in an additive anticoagulation effect .
Pentosan Polysulfate Sodium Overview
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Pentosan polysulfate is used to relieve bladder pain and discomfort related to interstitial cystitis, a disease that causes swelling and scarring of the bladder wall. Pentosan polysulfate is similar to a class of medications called low molecular weight heparins. It works by preventing irritation of the bladder walls.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
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