Warfarin 與Glucosamine 潛在交互作用之文獻回顧

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).