Ticlopidine

Alternative Medicine The following information is specific for alternative and complementary medicine. For additional evidence-based information on diseases, conditions, symptoms, diagnosis, treatment and wellness issues, continue searching the Healthwise Knowledgebase.

Also indexed as:

Betimol, Ticlid

Ticlopidine is a platelet inhibiting drug. It is used to prevent stroke and to treat intermittent claudication and other conditions.

Herbs

Summary of Interactions for Ticlopidine

Depletion or interference	None known
Adverse interaction	Asian ginseng* Dan shen Devil's claw* Dong quai* Fenugreek* Garlic* Ginkgo biloba* Horse chestnut* Quinine* Red clover* Salicylate-containing herbs* such as meadowsweet, poplar, willow, and wintergreen Sweet clover* Sweet woodruff*
Side effect reduction/prevention	None known
Supportive interaction	None known
Reduced drug absorption/bioavailability	None known
Other (see text)	Eleuthero Ginger

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions with Herbs

Asian ginseng(Panax ginseng)

Ginseng was associated with a decrease in warfarin activity in a case study.¹ This report suggests that ginseng may affect parameters of bleeding. Therefore, people taking ticlopidine should consult with a physician knowledgeable about botanical medicines before taking Asian ginseng or eleuthero/Siberian ginseng (Eleutherococcus senticosus).

Dan shen (Salvia miltiorrhiza)

Dan shen, a Chinese herb, was associated with increased warfarin activity in two cases.^{2, 3} Although warfarin acts differently from ticlopidine, both affect parameters of bleeding. Until more is known, people taking ticlopidine should use dan shen only under close medical supervision. Sage(Salvia officinalis), a plant relative of dan shen found in the West, has not been not associated with interactions involving warfarin.

Devil's claw(Harpagophytum procumbens)

Devil's claw was associated with purpura (bleeding under the skin) in a patient treated with warfarin.⁴ As with dan shen, until more is known, people taking ticlopidine should avoid taking devil's claw concurrently.

Garlic(Allium sativum)

Garlic has been shown to help prevent atherosclerosis (hardening of the arteries), perhaps by reducing the ability of platelets to stick together.⁵ Interfering with the action of platelets results in an increase in the tendency toward bleeding⁶ and in theory could dangerously enhance the effect of ticlopidine. Standardized extracts of garlic have been associated with bleeding in people only on rare occasions.⁷ People taking ticlopidine should consult with a doctor before taking products containing standardized extracts of garlic or eating more than one clove of garlic daily.

Ginger(Zingiber officinale)

Ginger has been shown to reduce platelet stickiness in test tubes. Although there appear to be no reports of interactions with platelet inhibiting drugs, people should talk with a healthcare professional if they are taking a platelet inhibitor and wish to use ginger.⁸

Ginkgo biloba

Ginkgo extracts may reduce the ability of platelets to stick together, possibly increasing the tendency toward bleeding.⁹ In a rat study, a high intake of ginkgo increased the action of ticlopidine in a way that could prove dangerous if the same effect occurred in people.¹⁰ Standardized extracts of ginkgo have been associated with two cases of spontaneous bleeding, although the ginkgo extracts were not definitively shown to be the cause of the problem.^{11, 12} People taking ticlopidine should use ginkgo extracts only under the supervision of a doctor.

Herbs containing coumarin-derivatives

Although there are no specific studies demonstrating interactions with platelet inhibitors, the following herbs contain coumarin-like substances that may cause bleeding and therefore interact with ticlopidine. These herbs include dong quai, fenugreek, horse chestnut, red clover, sweet clover, and sweet woodruff.

Quinine (Cinchona sp.)

Quinine, a chemical found in cinchona bark and available as a drug product, has been reported to increase warfarin activity.¹³ Although warfarin and ticlopidine are both considered "blood thinners," they have significantly different actions. Therefore, it remains unclear whether the reported interaction between quinine and warfarin would occur between ticlopidine and quinine.

Salicylate-containing herbs

Like ticlopidine, salicylates interfere with the action of platelets. Various herbs, including meadowsweet(Filipendula ulmaria), poplar (Populus tremuloides), willow(Salix alba), and wintergreen (Gaultheria procumbens) contain salicylates. Though similar to aspirin, plant salicylates have been shown to have different actions in test tube studies.¹⁴ Furthermore, salicylates are poorly absorbed and likely do not build up to levels sufficient to cause negative interactions that aspirin might cause.¹⁵ No reports have been published of negative interactions between salicylate-containing plants and aspirin or aspirin-containing drugs.¹⁶ Therefore concerns about combining salicylate-containing herbs and any drug remain theoretical, and the risk of causing bleeding problems may be low.

Other Interactions

Food

Ticlopidine should be taken with food to minimize gastrointestinal upset.¹⁷

References

1. Janetzky K, Morreale AP. Probable interaction between warfarin and ginseng. Am J Health Syst Pharm 1997;54:692-3.
2. Yu CM, Chan JCN, Sanderson JE. Chinese herbs and warfarin potentiation by "danshen." J Intern Med 1997;241:337-9.
3. Tam LS, Chan TYK, Leung WK, Critchley JAJH. Warfarin interactions with Chinese traditional medicines: Danshen and methyl salicylate medicated oil. Aust NZ J Med 1995;25:258.
4. Shaw D, Leon C, Kolev S, Murray V. Traditional remedies and food supplements: a 5-year toxicological study (1991-1995). Drug Saf 1997;17:342-56.
5. Rose KD, Croissant PD, Parliment CF, Levin MB. Spontaneous spinal epidural hematoma with associated platelet dysfunction from excessive garlic ingestion: A case report. Neurosurgery 1990;26:880-2.
6. Gadkari JV, Joshi VD. Effect of ingestion of raw garlic on serum cholesterol level, clotting time and fibrinolytic activity in normal subjects. J Postgrad Med 1991;37:128-31.
7. Burnham BE. Garlic as a possible risk for postoperative bleeding. Plast Reconst Surg 1995;95:213.
8. Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health-Care Professionals. London: The Pharmaceutical Press, 1996, 135-7.
9. Kleijnen J, Knipschild P. Ginkgo biloba. Lancet 1992;340:1136-9.
10. Kim YS, Pyo MK, Park KM. Antiplatelet and antithrombotic effects of a combination of ticlopidine and Ginkgo biloba ext (EGb 761). Thromb Res 1998;91:33-8.
11. Rosenblatt M, Mindel J. Spontaneous hyphema associated with ingestion of Ginkgo biloba extract. N Engl J Med 1997;336:1108.
12. Rowin J, Lewis SL. Spontaneous bilateral subdural hematoma with chronic Ginkgo biloba ingestion. Neurology 1996;46:1775-6.
13. Tatro D, ed. Anticoagulants-quinine derivatives. In Drug Interaction Facts. St. Louis, MO: Facts and Comparisons, Jul 1993.
14. Wichtl M, Bisset NG, eds. Herbal Drugs and Phytopharmaceuticals Stuttgart: Medpharm GmBH Scientific Publishers. 1994.
15. Janssen PL, Katan MB, van Staveren WA, et al. Acetylsalicylate and salicylates in foods. Cancer Lett 1997:114(1-2):163-4.
16. McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Product Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, 1997, 154-5.
17. Threlkeld DS, ed. Blood Modifiers, Antiplatelet Agents, Ticlopidine HCl. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Jan 1992, 85c-5g.

---

Last Review: 01-21-2009

Copyright © 2009 Aisle7  All rights reserved.  www.Aisle7.net

Please read the disclaimer about the limitations of the information provided here. Do NOT rely solely on the information in this article.

Learn more about Aisle7.

Learn more about the authors of Using Medicines with Vitamins and Herbs

The information presented in Aisle7 is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires February 2010.

	Go to top of page
This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.