Title |
The warfarin–cranberry juice interaction revisited: A systematic in vitro–in vivo evaluation
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Published in |
Journal of experimental pharmacology, July 2010
|
DOI | 10.2147/jep.s11719 |
Pubmed ID | |
Authors |
Ngoc Ngo, Scott J Brantley, Daniel R Carrizosa, Angela DM Kashuba, E Claire Dees, David J Kroll, Nicholas H Oberlies, Mary F Paine |
Abstract |
BACKGROUND: Cranberry products have been implicated in several case reports to enhance the anticoagulant effect of warfarin. The mechanism could involve inhibition of the hepatic CYP2C9-mediated metabolic clearance of warfarin by components in cranberry. Because dietary/natural substances vary substantially in bioactive ingredient composition, multiple cranberry products were evaluated in vitro before testing this hypothesis in vivo. METHODS: The inhibitory effects of five types of cranberry juices were compared with those of water on CYP2C9 activity (S-warfarin 7-hydroxylation) in human liver microsomes (HLM). The most potent juice was compared with water on S/R-warfarin pharmacokinetics in 16 healthy participants given a single dose of warfarin 10 mg. RESULTS: Only one juice inhibited S-warfarin 7-hydroxylation in HLM in a concentration-dependent manner (P < 0.05), from 20% to >95% at 0.05% to 0.5% juice (v/v), respectively. However, this juice had no effect on the geometric mean AUC(0-∞) and terminal half-life of S/R-warfarin in human subjects. CONCLUSIONS: A cranberry juice that inhibited warfarin metabolism in HLM had no effect on warfarin clearance in healthy participants. The lack of an in vitro-in vivo concordance likely reflects the fact that the site of warfarin metabolism (liver) is remote from the site of exposure to the inhibitory components in the cranberry juice (intestine). |
X Demographics
Geographical breakdown
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United Kingdom | 1 | 100% |
Demographic breakdown
Type | Count | As % |
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Scientists | 1 | 100% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
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Unknown | 22 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
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Student > Bachelor | 6 | 27% |
Student > Ph. D. Student | 2 | 9% |
Researcher | 2 | 9% |
Student > Master | 2 | 9% |
Student > Postgraduate | 2 | 9% |
Other | 3 | 14% |
Unknown | 5 | 23% |
Readers by discipline | Count | As % |
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Pharmacology, Toxicology and Pharmaceutical Science | 5 | 23% |
Medicine and Dentistry | 4 | 18% |
Nursing and Health Professions | 2 | 9% |
Agricultural and Biological Sciences | 1 | 5% |
Mathematics | 1 | 5% |
Other | 2 | 9% |
Unknown | 7 | 32% |