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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