MEDICAL NEWS & PERSPECTIVES
measures of quality of life in patients, vidual patient’s quality of life during treat-
even after controlling for potentially con-
founding variables of age, sex, perfor-
mance status, and previous adjuvant che-
motherapy. In particular, patients with
2 variant forms of the DPYD gene were
significantly less likely than those with
a form of the gene known as DPYD*5 to
report fatigue. A genetic marker near the
TYMS gene was associated with fatigue,
distress, and patient outlook, but the re-
sults were not statistically significant.
However, variations in the MTHFR gene
did not show a significant correlation
with measures of quality of life.
The study “raises the possibility that
a patient’s genetic makeup may not only
contribute to disease outcome and re-
sponse to specific chemotherapeutic
drugs but also may influence the indi-
Study Reveals Ginseng Supplements
May Hamper Effects of Anticlotting Drug
Mike Mitka
G
INSENG , A POPULAR HERBAL
supplement that proponents
tout as a tonic for improved en-
ergy and vitality, reduces the effects of
the anticlotting medication warfarin,
according to a study by University of
Chicago researchers.
The discovery was surprising, said
the researchers, because ginseng taken
alone also can promote bleeding and de-
lay clot formation. These new find-
ings mean that when physicians pre-
scribe warfarin, they need to ask the
patient about their ginseng use, said
study author Chun-Su Yuan, MD, PhD,
a professor of anesthesia and critical
care at the University of Chicago.
The study appears in the July 6 An-
nals of Internal Medicine (Ann Intern
Med. 2004;141:23-27).
“Warfarin has a narrow therapeutic
index, which means precise dosing is
crucial,” said Yuan, who is also the di-
rector of the university’s Tang Center
674 JAMA, August 11, 2004—Vol 292, No. 6 (Reprinted)
Downloaded From: http://jama.jamanetwork.com/ by a Ndsu Library Periodicals User on 05/21/2015
who are predisposed to fatigue and
ment,” said Robert Diasio, MD, of the
University of Alabama at Birmingham’s
Comprehensive Cancer Center. How-
ever, he added, more research examin-
ing the genes identified in this study is
needed to validate these findings.
The genetic variants tested were cho-
sen for their relationship to the cancer
treatment, not specifically to quality of
life, noted Sloan. “No doubt there are
other markers among the myriad avail-
able that might be more strongly re-
lated to quality-of-life variables,” he said.
IMPACT ON CARE
Studies that find additional meaning-
ful genetic markers may influence how
physicians treat cancer patients with im-
mediate and follow-up care. Patients
for Herbal Medicine Research. “With
too small a dose, the risk of clots in-
creases, but too much can cause seri-
ous bleeding,” he noted. “So a sub-
stance such as ginseng that alters
warfarin’s effects, even slightly, can have
significant consequences.”
Yuan said a larger trial needs to be
conducted to verify his results. In the
meantime, however, he would advise
patients taking warfarin to avoid gin-
seng supplements rather than having
a physician increase the warfarin dose
to counter the herbal supplement’s
effects.
About 3 million individuals in the
United States take warfarin daily to
prevent blood clots from forming or
growing larger. The drug is often pre-
scribed for patients with certain types
of irregular heartbeat and those who
have had a myocardial infarction or
heart valve replacement surgery.
The researcher’s conclusions about a
warfarin-ginseng interaction are based
on results from a 4-week, randomized,
©2004 American Medical Association. All rights reserved.
other indicators of poor quality of life
may be candidates for particular che-
motherapy regimens. They also may
find relief through pharmacologic and
psychosocial interventions following
their cancer treatments.
“The ultimate goal would be to use
information about a cancer patient’s ge-
netic makeup to tailor individualized
treatments for quality-of-life deficits in
precisely the same manner that has been
envisioned for treating the tumor it-
self,” said Sloan.
The work, added Diasio, marks the be-
ginning of studies “that will need to be
conducted in the future to examine what
appears to be still another important way
by which changes in the genome may in-
fluence how we practice oncology.” 䊐
double-blind, placebo-controlled trial
of 20 young healthy adults, who were
given warfarin plus either ginseng or
placebo.
In the study, all patients received
warfarin (5 mg/d) for the first 3 con-
secutive days during week 1 and again
in week 4. During the second week, 12
individuals took 1 gram of powdered
ginseng in capsules twice daily for 3
consecutive weeks while the other 8 re-
ceived a placebo in a similar manner.
The researchers monitored blood lev-
els of warfarin and the clotting ability
of the blood and found that after 2
weeks, daily doses of ginseng signifi-
cantly reduced the blood levels and the
anticlotting effects of warfarin.
The researchers did not uncover the
exact mechanism that allows ginseng
to affect warfarin, but they speculated
that substances (ginsenosides) within
ginseng may enhance the function of
enzymes that break down warfarin
clearing it from the blood stream more
rapidly. 䊐