American Society of Regional Anesthesia and Pain Medicine August 2016 - 38


Table 1: Herbal and nutritional supplements commonly used by adults in the United States.
Supplement*

Fish Oil/Omega-3

Glucosamine

Usage†

7.8%

2.6%

Chondroitin

Common uses

Effects on hemostasis

Cognitive and
cardiovascular health

CYP enzyme effects. (↑INR);
antiplatelet aggregation effects
(inhibition correlated to cAMP levels in
platelets).17

Joint health, arthritis
relief

Cytochrome P450 (CYP) enzyme
effects. (↑INR)3

Peak effect
(Tmax)

Elimination
half-life (T1/2)

EPA: 3-44
hrs, source
dependent4

EPA: 1.63-3.27
days1

DHA: 2-3
times higher2

DHA: 0.89- 2.57
days3

4 hrs6

15 hrs4

3-9 hrs4,6

5 hrs5

Probiotics/Prebiotics

1.6%

Immune and digestive
health

None known

N/A

N/A

Melatonin

1.3%

Sleep, anxiolysis

↓Factor VIII:C & ↓fibrinogen, dosedependent6

30-60 min9

20-50 min7

Coenzyme Q10
(CoQ10)

1.3%

Cardiovascular
health, treatment of
CoQ10 deficiencies

Structurally similar to vitamin K;
mechanism unclear - increased
warfarin effects in some studies and
decreased in others10,17

6 hrs10

33-92 hrs8,17

Echinacea

0.9%

Immune system
function, cold
prophylaxis

CYP enzyme effects. Reduced warfarin
effects (↓INR). Can cause allergic
reactions including anaphylaxis.10,16

0.5-4 hrs
(rats)9

8.28 hrs (rats)11

0.8%

Urinary tract health,
antioxidant

Flavonoids, phenolics,
proanthocyanidins found in cranberry
juice are thought to have some
antiplatelet properties10,13

8-10 hrs11

N/A

Cranberry

Garlic

0.8%

Cardiovascular
health, antisepsis

Inhibits platelet aggregation12 CYP
enzyme effects. (↑INR)13 ↓fibrinogen14

30-120
min15

Allylmercapturic
acid:
5-7 hrs16
Allicin: 6-11 days
(in vitro)17

~ 4 hrs17
Ginseng

0.7%

Cardiovascular
health, adaptogen

Ginsenosides Re
and Rg1:
0.7-4 hrs17

Inhibits platelet aggregation18,19 ↑TT,
↑aPTT20,21

Ginsenosides Rb1
and Rd:
19-22 hrs17

Gingko biloba

0.7%

Cognitive and
cardiovascular health

Inhibits platelet-activating factor
(PAF),22 reduces platelet aggregation23

* Includes pills/capsules - does not include usual dietary sources.
†
Usage statistics from 2012 NHIS by adults in the United States.

38
2

American Society of Regional Anesthesia and Pain Medicine
2016

2-3 hrs24

3-10 hrs26



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