Which herbs, although considered generally safe and effective (in recommended dosages) by non-U.S. regulatory authorities, should be avoided in patients also taking aspirin, ibuprofen, or warfarin? (Select all that apply.)
a. Garlic
b. Ginkgo
c. Goldenseal
d. Feverfew
e. Flaxseed
ANS: A, B, D
Garlic, ginkgo, and feverfew all inhibit platelet aggregation and therefore could increase the risk of bleeding when taken concomitantly with NSAIDs like aspirin and ibuprofen, or with the blood thinner warfarin (Coumadin). Patients should be cautioned accordingly. Patients should make sure their doctors know they are taking these herbal products before having surgery or general anesthesia due to the increased risk of intraoperative bleeding.
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