Safety Information

Published: 30 April 2018

Early Warning System - Monitoring Communication

Medsafe emphasises that patients should NOT stop using any medicine or medical device subject to a monitoring communication. If you have any concerns with a medicine or medical device you are using, please contact your health professional. A monitoring communication does not mean that the medicine or medical device causes an adverse event.

Beware turmeric/curcumin containing products can interact with warfarin


17 April 2018

The Centre for Adverse Reaction Monitoring (CARM) recently received a case report describing a patient taking warfarin who began taking a turmeric containing product. The patient had stable INR measurements, but within a few weeks of commencing turmeric their INR increased to over 10. There is a risk of serious bleeding when the INR gets this high.

The reporter considered that the turmeric containing product had interacted with warfarin.  

Products Affected

There are a number of turmeric/curcumin containing natural health products available in New Zealand. They are marketed as dietary supplements for joint, digestive and cardiovascular support. This warning does not apply to turmeric used in food.

Advice

Check the listed ingredients on each natural health product you are thinking of taking. Make sure they don’t interfere with any other medicine you may be taking.  If you are unsure talk to your pharmacist or doctor.

Always tell your doctor or pharmacist about any natural health products you are taking, including turmeric/curcumin.

Additional Information

Some studies have concluded that curcumin, an active component of turmeric (Curcuma longa), exerts numerous effects including anti-inflammatory, NSAID-like effects (1-3). There have been case reports of raised INR when NSAIDs are taken with warfarin.

Antiplatelet effects of curcumin have also been described (2-4). This is a potential concern for patients who are taking any medicine(s) that can affect bleeding (eg, antiplatelets, anticoagulants, non-steroidal anti-inflammatory drugs or selective serotonin reuptake inhibitors). Concurrent use of turmeric/curcumin containing natural health products with these medicines may result in prolonged bleeding times and should be avoided (5).

The antiplatelet effects of curcumin do not explain the increase in the patient’s INR, but show that it may have additive effects when used with warfarin.

Regulator Actions

Medsafe continues to monitor reports of adverse reactions to turmeric/curcumin containing products.

Reporting

Consumers and healthcare professionals are encouraged to send reports of suspected adverse reactions to the Centre for Adverse Reactions Monitoring.

Medsafe cannot give advice about an individual’s medical condition. If you have any concerns about a medicine or natural health product you are taking Medsafe encourages you to talk to your healthcare professional.

References
  1. Aggarwal BB, Harikumar KB. 2009. Potential therapeutic effects of curcumin, the anti-inflammatory agent, against neurodegenerative, cardiovascular, pulmonary, metabolic, autoimmune and neoplastic diseases. Int J Biochem Cell Biol 41: 40-59

  2.  Fadus MC, Lau C, Bikhchandani J, Lynch HT. 2017. Curcumin: An age-old anti-inflammatory and anti-neoplastic agent. J Tradit Complement Med 7: 339-46
  3. Perrone D, Ardito F, Giannatempo G, Dioguardi M, Troiano G, Lo Russo L, A DEL, Laino L, Lo Muzio L. 2015. Biological and therapeutic activities, and anticancer properties of curcumin. Exp Ther Med 10: 1615-23
  4. Simon Mills; Kerry Bone. 2004. The Essential Guide To Herbal Safety: Elsevier. 609-13 pp.
  5. Medical Economics. 2004. PDR® For Herbal Medicines 3rd Edition: Thomson PDR. 988 pp.