Interaction between gemfibrozil and warfarin: case report and review of the literature.

Pharmacotherapy. 2009 Jun; 29(6): 744-8Dixon DL, Williams VGAbstract Possible procoagulant effects can occur when lipid-lowering fibric acid derivatives, such as gemfibrozil and fenofibrate, are taken concomitantly with warfarin. Although there are several detailed reports of fenofibrate potentiating the anticoagulant effects of warfarin, few case reports have been published regarding an interaction between gemfibrozil and warfarin. We describe a 62-year-old man who was taking warfarin for paroxysmal atrial fibrillation and came to the anticoagulation clinic for a routine follow-up. For 9 months, the patient's international normalized ratio (INR) had been stable (target range 2.0-3.0) with warfarin 45 mg/week. At this clinic visit, however, his INR was supratherapeutic at 5.8; the only identified change in his drug therapy was the addition of gemfibrozil 600 mg twice/day, started 3 weeks earlier. The patient denied any changes in his dietary intake of vitamin K, alcohol use, or addition of nonprescription or herbal agents. Recent laboratory tests revealed no signs of thyroid abnormalities and only an insignificant elevation in his alanine aminotransferase level. His warfarin dose was decreased to 35-37.5 mg/week (a 22% reduction), and a therapeutic INR was maintained until gemfibrozil was later discontinued because of myalgia. After consecutive subtherapeutic INRs, his warfarin dose was increased to 45 mg/week and a therapeutic INR was maintained. Use of the Drug Interaction Probability Scale indicated that the likelihood of the gemfibrozil-warfarin interaction was probable. The exact mechanism of the proposed interactions between fibric acid derivatives and warfarin remains unknown but may be multifactorial through inhibition of cytochrome P450 isoenzymes, displacement from protein binding sites, or changes in coagulation factor synthesis. Regardless of the fibric acid derivative chosen, an empiric dosage reduction of 20% and close INR monitoring are warranted in patients receiving warfarin.

Anti-allergic effects of herbal product from Allium cepa (bulb).

J Med Food. 2009 Apr; 12(2): 374-82Kaiser P, Youssouf MS, Tasduq SA, Singh S, Sharma SC, Singh GD, Gupta VK, Gupta BD, Johri RKAllium cepa (Family Liliaceae) is a reputed Indian medicinal herb that is prescribed as an effective remedy for several ailments in the Ayurvedic system of medicine. The aim of this study was to evaluate its efficacy against various events responsible for Type I allergic reactions. A herbal fraction (ALC-02) from A. cepa (bulb) inhibited histamine release and attenuated intracellular calcium levels in Compound 48/80-induced rat peritoneal mast cells. It also prevented Compound 48/80-mediated systemic anaphylaxis while lowering histamine levels in plasma. ALC-02 suppressed carrageenan-induced rat paw edema. It inhibited eosinophil peroxidase activity and protein content in bronchoalveolar lavage fluid (BALF) of ovalbumin-challenged mice. In this experiment ALC-02 also caused a substantial reduction in lipid peroxidation in BALF/lung tissue and augmented superoxide dismutase activity in lung tissue. ALC-02 suppressed erythrocytic lysis caused by Triton X-100. A significant quenching of 1,1-diphenyl-2-picrylhydrazyl radical by ALC-02 was observed. The results have shown a promising anti-allergic profile of ALC-02 that could be attributed to its potential antihistaminic, anti-inflammatory, and antioxidant activities.

Integration of complementary medical treatments with rehabilitation from the perspectives of patients and their caregivers: A qualitative inquiry.

Clin Rehabil. 2009 May 15; Chang LH, Wang JObjective: This article uses a qualitative design and examines how patients and their caregivers integrate pluralistic health practices into rehabilitation from their perspectives. Design: Ethnography was used as the framework for research design. Data were collected via participant observation, taped in-depth interviews and regular chart review, and all interviews were transcribed verbatim. Setting: An inpatient rehabilitation unit in Taiwan. Subjects: Twenty-one patients, their caregivers and their rehabilitation professionals. Results: The patients and their caregivers used pluralistic illness explanations and treatments to make sense of their suffering, to control healing and to find the hope that rehabilitation professionals often deliberately avoided giving. Spiritual healing and therapies related to Traditional Chinese Medicine, such as functional food and herbal medicines, were popular alternative therapeutics. Although the patients and their caregivers perceived opposition from the medical staff on the unit, they used a variety of covert strategies to integrate their pluralistic illness explanations and treatments into their daily routines without openly challenging the rehabilitation primacy. Conclusion: Aware of the rehabilitation staff's opposition, the patients and caregivers resorted to a variety of underground strategies to conceal their use of complementary medical treatments.