Basic Information
ID DDInter2168 and DDInter1951
Interaction Coadministration with coenzyme Q10 (also known as ubiquinone or ubidecarenone) may reduce the hypoprothrombinemic effect of warfarin and other oral anticoagulants. The exact mechanism of interaction is unknown, although coenzyme Q10 is structurally related to menaquinone (vitamin K2) and may have procoagulant effects.
Management In general, patients should consult a healthcare provider before taking any herbal or alternative medicine. Given the potential for interaction and the narrow therapeutic index of oral anticoagulants, these drugs should preferably not be used with coenzyme Q10. If they are given together, the INR must be checked frequently and anticoagulant dosage adjusted accordingly, particularly following initiation, discontinuation or change of dosage of coenzyme Q10 in patients who are stabilized on their anticoagulant regimen.
References [1] Spigset O "Reduced effect of warfarin caused by ubidecarenone." Lancet 344 (1994): 1372-3 [2] "Product Information. Coumadin (warfarin)." DuPont Pharmaceuticals (2001): [3] Heck AM, DeWitt BA, Lukes AL "Potential interactions between alternative therapies and warfarin." Am J Health Syst Pharm 57 (2000): 1221-7; quiz 1228-30 [4] Engelsen J, Nielsen JD, Winther K "Effect of coenzyme Q10 and Ginkgo biloba on warfarin dosage in stable, long-term warfarin treated outpatients. A randomised, double blind, placebo-crossover trial." Thromb Haemost 87 (2002): 1075-6
Alternative for Ubidecarenone C01E
Regadenoson Ivabradine
Alternative for Warfarin B01A
Ticagrelor Betrixaban Rivaroxaban Cilostazol Apixaban Clopidogrel
Iloprost Lepirudin Acenocoumarol Urokinase Cangrelor
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Potential Metabolism Interactions
Substrate-Substrate Interaction：If more than one drug is metabolized by the same CYP, it is possible that its metabolism is inhibited because of the competition between the drugs. That means, it can be useful to lower the dosage of the drugs in the drug-cocktail because they remain longer in the organism than in monotherapy.
Inhibitor-Inhibitor Interaction：Combining two or more inhibitors of one CYP, should be compensated by lowering the dosage of these drugs because the metabolism is reduced and the drugs remain longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.
Inhibitor-Substrate Interaction：Combining drugs that have inhibitory effect and are substrates of one particular CYP, should be compensated by lowering the dosage. They rest longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.