Pentosan Polysulfate Sodium with Ginger 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
Excessive anticoagulation occurred in a 76-year-old woman previously treated effectively with phenprocoumon, after she regularly consumed an unknown quantity of ginger over several weeks. Clinical trials have demonstrated a significant effect on platelet aggregation only following a single oral dose of 10 grams of powdered ginger, a higher dose than that usually used . Clinical trials using smaller daily doses of raw ginger, cooked ginger, and dried ginger have not shown a significant effect on platelet aggregation . Ginger extract did not significantly alter blood coagulation parameters either alone or in combination with warfarin in rats . In vitro data demonstrate that ginger may inhibit platelet aggregation . The extraction method used may significantly affect the ability of ginger to inhibit platelet aggregation .
Severity
Moderate
Onset
Delayed
Evidence
Probable
How To Manage Interaction
The clinical significance of any effect ginger may have on platelet aggregation is undetermined. Caution is advised if ginger and an anticoagulant are taken concomitantly. Studies suggest that over 4 grams of dried or 15 grams raw ginger root daily must be ingested in order to have any effect on blood coagulation.
Mechanism Of Interaction
Additive antiplatelet effects; ginger may inhibit thromboxane B2 formation and thromboxane synthetase and increase prostacyclin levels
Literature Reports
A) A prospective, longitudinal study of 171 adults on warfarin assessing the effect of complementary and alternative medicine (CAM) on self reported bleeding, and international normalized ratio (INR), concomitant use of coenzyme Q10 and ginger was associated with an increase in the number of self-reported bleeding events. Study patients were on warfarin therapy for duration of at least 4 months. Patients recorded information about their warfarin use including other medications used, bleeding events, and other adverse events for 16 weeks. Additionally, INR values were also collected. CAM therapies included in the study were bromelain, cayenne, chamomile, Coenzyme Q10, Devil's claw, flaxseed oil, garlic, ginger, ginkgo, ginseng, glucosamine, halibut liver oil, parsley, passion flower, salmon oil, St. John's wort, vitamin E, and willow bark. Ginger was independently associated with increased risk of self-reported bleeding (OR, 3.20; 95% CI, 2.42 to 4.24). Among other CAM therapies, based on the adjusted multivariate analysis, coenzyme Q10 (OR, 3.69; 95% CI, 1.88 to 7.24) was independently associated with an increased risk of self-reported bleeding. The use of two or more CAM therapies in addition to warfarin also significantly increased the number of self-reported bleeding events (OR, 2.11, 95% CI, 1.07 to 4.16). The concurrent use of ginger and warfarin was not associated with a significant increase in supratherapeutic INR values. Notably, doses of CAM products used were variable and data were not always available .
B) Powdered ginger significantly inhibited platelet aggregation in a placebo-controlled study of 20 patients with coronary artery disease. Patients received powdered ginger, 10 grams as a single dose. Ginger reduced adenosine diphosphate (ADP)- and epinephrine-induced platelet aggregation (p less than 0.05). The platelet response appears to be dose-dependent, as ginger 4 grams daily for 1.5 and 3 months did not exert any appreciable effect on platelet aggregation, fibrinogen, or fibrinolytic activity. All patients had a history of myocardial infarction greater than 6 months old, and all were taking nitrates and aspirin. Aspirin was discontinued 2 weeks prior to the study .
C) Raw ginger root had no significant effect on platelet function in 18 healthy volunteers in a randomized, placebo-controlled crossover study. Subjects received either raw Brazilian ginger root 15 grams, cooked stem ginger 40 grams, or placebo for 2 weeks. Subjects discontinued use of any medications for 1 month prior to the study. The mean decrease in thromboxane production was 1 +/- 9% for ginger root and 1 +/- 8% for stem ginger as compared to placebo (p=0.984). Mean thromboxane B2 production was unchanged .
D) Dried ginger did not affect platelet function in a randomized, double-blind, placebo-controlled study of 8 healthy male subjects. Subjects received 2 grams dried ginger. The change in bleeding time in the ginger group was not significant, but bleeding time was somewhat less after ginger use than pre-treatment or placebo. Ginger did not significantly inhibit aggregation induction ex vivo by either ADP, ristocetin, arachidonic acid, or collagen 3 and 24 hours after consumption .
E) A 76-year-old woman on long-term phenprocoumon therapy developed epistaxis and an excessively elevated International Normalized Ratio (INR) after several weeks of ingesting a regular diet of ginger products. The patient's INR had remained stable on phenprocoumon prior to initiation of ginger. At the time of hospital admission, her INR was greater than 10 (target of 2.0 to 3.0) and partial thromboplastin time (PTT) was prolonged to 84.4 seconds. Normalization of INR and PTT occurred after administration of vitamin K, and the patient's INR remained stable after resumption of therapy with the same dose of phenprocoumon. The study authors assign ginger and phenprocoumon co-treatment a 'probable cause' rating on the Naranjo probability scale, for the excessive anticoagulation reported .
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.
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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.
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