Warfarin 與Glucosamine 潛在交互作用之文獻回顧

A Literature Review of Potential Interaction between Warfarin and Glucosamine

施心筑(Hsin-Chu Shih) ； 鍾雅旬(Ya-Hsun Chung) ； 吳佳憓(Jia-Hui Wu) ； 陳崇鈺(Chung-Yu Chen) ； 尤琬筑(Wan-Chu Yu) ； 許郁笙(Yu-Sheng Hsu)

《臺灣臨床藥學雜誌》 24卷4期 (2016/12) Pp. 282-289

https://doi.org/10.6168/FJCP.2016.2404.03

摘要

目的：Warfarin 交互作用是一重要的用藥安全議題，報導指出退化性關節炎的用藥之一葡萄糖胺 (glucosamine) 與warfarin 具有潛在的交互作用，確切機轉未明，推論可能是因為增加warfarin 的抗凝血作用導致出血機率增加。本文目的為評估現有兩者交互作用的資料，提供臨床建議。方法：本文以關鍵字warfarin、coumarin、4-hydroxycoumarin、glucosamine、interaction 分別搜尋刊登在PubMed（1946 年至2015 年11 月）與EMBASE（1947年至2015 年4 月）資料庫文獻及華藝線上圖書館，探討warfarin 與glucosamine 潛在交互作用的相關性。資料搜尋不限制種族、語言與文獻種類，若文獻資訊不足則不予採用。結果：經兩位作者擬定關鍵字及搜尋資料庫，並交叉比對檢索結果後，符合搜尋條件者只有6 篇，其中動物實驗1 篇，個案報告3 篇，藥物不良反應 (adverse drug reaction, ADR) 通報案例相關文獻2 篇。根據目前個案報告及ADR 通報案例顯示warfarin 與葡萄糖胺可能存有潛在的交互作用，且多以INR 數值改變為主，較少提及出血情形。結論：目前仍缺乏直接的證據證實warfarin 與葡萄糖胺之間具有交互作用，但無法排除此可能性。對於正在使用warfarin 的病人若有需求仍可使用葡萄糖胺，但建議不超過一般使用劑量（1,500 毫克／天），且病人服用時必須留意出血的徵兆，如牙齦出血、容易瘀青、流鼻血等，處方醫師也須謹慎地監測病人INR 數值的變化。

關鍵字

Warfarin ； 葡萄糖胺 ； 交互作用

並列摘要

Objective: Warfarin interaction has been essential medication safety concerns. There have been reported glucosamine, which is commonly used for osteoarthritis, may increase the risk of bleeding by enhancing anticoagulant effect of warfarin. However, mechanism of the potential interaction between warfarin and glucosamine is unclear. The aim of this study is to evaluate existing data regarding interaction between warfarin and glucosamine, and further to provide clinical suggestions. Methods: A literature search of Pubmed database from year 1946 to November 2015 and EMBASE database from year 1947 to April 2015, as well as AiritiLibrary (since year 2000) was conducted. The databases were searched using the terms ＂warfarin,＂ ＂coumarin,＂ ＂4-hydroxycoumarin,＂ ＂glucosamine,＂ and ＂interaction.＂ No restrictions on race, age, language, country of origin, and study types. Furthermore, literature was excluded if information was insufficient to extract. Results: Two authors defined keywords, searched database, and independently reviewed articles as well as extracted data. There were 6 papers included for review, including one animal study, three case reports, and two Adverse Drug Reaction (ADR) reports. These studies suggest that warfarin and glucosamine may have potential drug-drug interaction (DDI), and the main outcome of the DDI is international normalized ratio (INR) change rather than bleeding. Conclusions: Currently, direct evidences support potential interaction between warfarin and glucosamine is lacking. We still recommend closely monitoring the INR, if co-administration of warfarin and glucosamine cannot be avoided. Otherwise, patients should be adequately informed actively reporting any bleeding signs, unusual bruising, do not take glucosamine over usual dose (1,500 mg/d).

並列關鍵字

Warfarin ； Glucosamine ； Interaction