Angelica sinensis

Dong quai/Drug Interactions:

  • AcetaminophenAcetaminophen: In animal research, intragastric administration of a dong quai extract dose-dependently prevented liver toxicity induced by acetaminophen in mice without affecting the serum acetaminophen concentration (89).
  • Analgesic agentsAnalgesic agents: According to laboratory research, ligustilide, a constituent of Angelica sinensis, may have analgesic effects (29).
  • Antiarrhythmic agentsAntiarrhythmic agents: In animal research, dong quai injection had antiarrhythmic effects during myocardial ischemia-reperfusion (10). Dong quai decreased cardiac excitability and prolonged the atrial refractory period.
  • AntibioticsAntibiotics: According to secondary sources, dong quai may demonstrate bactericidal action toward both Gram-negative and Gram-positive bacteria. Dong quai inhibited the growth of Bacillus dysenteriae, Bacillus typhi, Bacillus comma, Bacillus paratyphi, Escherichia coli, Mycobacterium avium, Salmonella typhi and paratyphi, Shigella dysenteriae, Vibrio cholerae, Proteus vulgaris, alpha- and beta-hemolytic streptococci, Corynebacterium diphtheriae, Staphylococcus aureus, Shigella flexneri, and Pseudomonas aeruginosa.
  • Anticoagulants and antiplateletsAnticoagulants and antiplatelets: Dong quai should not be used concurrently with anticoagulants or other agents which predispose users to bleeding (38; 35; 90; 64; 65; 91; 66; 62; 67; 92; 74). It has been mentioned in several reviews that dong quai may increase the risk of bleeding and potentiate the effects of warfarin (Coumadin?) or heparin therapy (62; 63; 53). Other blood-thinning medicines that may interact in a similar manner include clopidogrel (Plavix?), aspirin, rivaroxaban (Xarelto?), dabigatran (Pradaxa?), enoxaparin (Lovenox?), and dalteparin (Fragmin?). According to one case report, a female patient's coagulation values returned to acceptable levels one month after discontinuing dong quai (66). Dong quai root contains ferulic acid, which inhibits platelet aggregation by inhibiting cyclooxygenase (COX) and thromboxane A2 synthesis pathways in vitro and in vivo (38; 93).
  • Antidepressants, selective serotonin reuptake inhibitors (SSRIs)Antidepressants, selective serotonin reuptake inhibitors (SSRIs): According to secondary sources, some compounds in dong quai may increase the effects of SSRIs.
  • AntidiabeticsAntidiabetics: According to secondary sources, dong quai preparations may contain high levels of sucrose, which may theoretically interfere with blood sugar control.
  • AntihypertensivesAntihypertensives: Coumarin derivatives found in dong quai root possess calcium antagonistic properties (38; 64), which have produced antihypertensive effects in animal studies (38; 64). Hypertension following dong quai consumption has also been reported (49). Theoretically, dong quai may interfere with agents used for blood pressure control.
  • AntineoplasticsAntineoplastics: In animal research, dong quai increased tumor necrosis factor production (15). In vitro, dong quai inhibited cell proliferation in several cell types with an antitumor effect (57; 58). Furanocoumarins from dong quai have been found to promote antitumor activity in cultured cells by stimulating macrophages, enhance phagocytosis, inhibit tumor growth, and inhibit tumors from metastasizing (56). In mice research, dong quai extracts had antitumor activity (15; 16). In vitro, a mixture containing astragalus and angelica had antiproliferative effects on renal cells by regulating cell signaling pathways (59). Ligustilide may have anticancer and antitumor effects (29).
  • AntispasmodicsAntispasmodics: According to secondary sources, dong quai has antispasmodic properties.
  • BenzodiazepinesBenzodiazepines: In animal research, phellopterin, one of the furanocoumarins of dong quai root, inhibited the binding of diazepam to central nervous system benzodiazepine receptors in rat brain cells (94).
  • BleomycinBleomycin: Dong quai reduced bleomycin-induced alveolitis and fibrosis in rats (34).
  • Calcium-channel blockersCalcium-channel blockers: Coumarin derivatives found in dong quai root possess calcium antagonistic properties, which have produced antihypertensive effects in animal studies (38; 64). In one case report, a hemodialysis patient taking nifedipine experienced two episodes of hypotension during dialysis after taking dong quai for chronic anemia for one month (48).
  • Central nervous system stimulants Central nervous system stimulants: Phellopterin, one of the furanocoumarins of dong quai root, inhibits the binding of diazepam to central nervous system (CNS) benzodiazepine receptors in rat brain cells (94).
  • ContraceptivesContraceptives: Dong quai may compete with oral contraceptives for estrogen receptor sites, resulting in possible additive or inhibitory effects (53). In one clinical trial, dong quai did not produce estrogen-like responses in endometrial thickness or vaginal maturation (76).
  • Disulfiram (Antabuse?)Disulfiram (Antabuse?): According to secondary sources, liquid preparations of dong quai may contain alcohol and theoretically may cause nausea or vomiting when taken with disulfiram (Antabuse?).
  • Gastrointestinal agentsGastrointestinal agents: According to secondary sources, dong quai has traditionally been associated with gastrointestinal symptoms, including laxative effects and diarrhea, upset stomach, nausea, vomiting, loss of appetite, burping, or bloating.
  • Hormonal agentsHormonal agents: Dong quai may interfere with progesterone, tamoxifen, or raloxifene binding to estrogen receptors (53). Dong quai may stimulate the corpora lutea to secrete progesterone (95; 96). In vitro biochemical research on the bioactivity of dong quai showed little estrogen receptor binding (31). Saliva from women taking dong quai was found to have low estradiol levels (31). Dong quai may competitively inhibit estradiol binding to estrogen receptors, increase ceruloplasmin oxidase activity, and decrease luteinizing hormone levels (73). In rats, Angelica sinensis had estrogenic effects (97; 98). In a human research, dong quai water extract combined with 17beta-estradiol stimulated the proliferation of MCF-7 cells by weak estrogen-agonist effects, and demonstrated growth stimulation effects on BT-20 cells with or without 17beta-estradiol (99).
  • LaxativesLaxatives: According to secondary sources, traditional Chinese medicine practitioners have noted an occasional laxative effect or gastrointestinal distress in patients taking dong quai for long periods of time.
  • Metronidazole (Flagyl?)Metronidazole (Flagyl?): According to secondary sources, liquid preparations of dong quai may contain alcohol and theoretically may cause nausea or vomiting when taken with metronidazole (Flagyl?).
  • Neurologic agentsNeurologic agents: In laboratory research, ligustilide, the constituent of Angelica sinensis, had neuroprotective effects(29).
  • Nonsteroidal anti-inflammatory agents (NSAIDs)Nonsteroidal anti-inflammatory agents (NSAIDs): NSAIDs, particularly aspirin, may interact with dong quai due to antiplatelet activity, increasing the risk of bleeding (100). Ligustilide, a constituent of Angelica sinensis, may have analgesic effects (29). Dong quai may reduce anti-inflammatory effects by inhibiting the release of serotonin from platelets (101). Dong quai inhibited thromboxane A2 formation and prostaglandin E2 production (64; 102).
  • Photosensitizing agentsPhotosensitizing agents: According to secondary sources, chemicals in dong quai may cause increased (possibly severe) photosensitivity and should be avoided with other drugs that cause photosensitivity, such as tretinoin (Retin-A?, Renova?), and some types of antidepressants, cancer drugs, antibiotics, or antipsychotic medications with photosensitizing potential.
  • Pulmonary agentsPulmonary agents: In human research, a 25% Angelica sinensis injection improved pulmonary hemodynamics by significantly reducing levels of serum endothelin-1, angiotensin-II (AT-II), mean pulmonary arterial pressure, pulmonary vascular resistance, and endogenous digitalis-like factor (EDF), as well as significantly increasing PaO2 levels (79).
  • VasodilatorsVasodilators: Furanocoumarins, which inhibit cAMP-phosphodiesterase activity, may be responsible for the vasodilatory action of dong quai (61). Ligustilide may have vasodilation effects (29).

    • Dong quai/Herb/Supplement Interactions:

  • Analgesic agentsAnalgesic agents: According to laboratory research, ligustilide, a constituent of Angelica sinensis, may have analgesic effects (29).
  • Antiarrhythmic agentsAntiarrhythmic agents: In animal research, dong quai injection had antiarrhythmic effects during myocardial ischemia-reperfusion (10). Dong quai decreased cardiac excitability and prolonged the atrial refractory period.
  • Antibacterial agentsAntibacterial agents: According to secondary sources, dong quai may demonstrate bactericidal action toward both Gram-negative and Gram-positive bacteria. Dong quai inhibited the growth of Bacillus dysenteriae, Bacillus typhi, Bacillus comma, Bacillus paratyphi, Escherichia coli, Mycobacterium avium, Salmonella typhi and paratyphi, Shigella dysenteriae, Vibrio cholerae, Proteus vulgaris, alpha- and beta-hemolytic streptococci, Corynebacterium diphtheriae, Staphylococcus aureus, Shigella flexneri, and Pseudomonas aeruginosa.
  • Anticoagulants and antiplateletsAnticoagulants and antiplatelets: Dong quai should not be used concurrently with anticoagulants or other agents which predispose users to bleeding (38; 35; 90; 64; 65; 91; 66; 62; 67; 92; 74). It has been mentioned in several reviews that dong quai may increase the risk of bleeding and potentiate the effects of warfarin (Coumadin?) or heparin therapy (62; 63; 53). Dong quai root contains ferulic acid, which inhibits platelet aggregation by inhibiting cyclooxygenase (COX) and thromboxane A2 synthesis pathways in vitro and in vivo (38; 93).
  • Antidepressants, selective serotonin reuptake inhibitors (SSRIs)Antidepressants, selective serotonin reuptake inhibitors (SSRIs): According to secondary sources, some compounds in dong quai may increase the effects of SSRIs.
  • Antineoplastic herbsAntineoplastic herbs: In animal research, dong quai increased tumor necrosis factor production (15). In vitro, dong quai inhibited cell proliferation in several cell types with an antitumor effect (57; 58). Furanocoumarins from dong quai have been found to promote antitumor activity in cultured cells by stimulating macrophages, enhance phagocytosis, inhibit tumor growth, and inhibit tumors from metastasizing (56). In mice research, dong quai extracts had antitumor activity (15; 16). In vitro, a mixture containing astragalus and angelica had antiproliferative effects on renal cells by regulating cell signaling pathways (59). Ligustilide may have anticancer and antitumor effects (29)
  • AntioxidantsAntioxidants: In theory, dong quai may increase the effects of antioxidants.
  • AntispasmodicsAntispasmodics: According to secondary sources, dong quai has antispasmodic properties.
  • Central nervous system stimulantsCentral nervous system stimulants: Phellopterin, one of the furanocoumarins of dong quai root, inhibited the binding of diazepam to central nervous system benzodiazepine receptors in rat brain cells (94).
  • ContraceptivesContraceptives: Dong quai may compete with oral contraceptives for estrogen receptor sites, resulting in possible additive or inhibitory effects (53). In one clinical trial, dong quai did not produce estrogen-like responses in endometrial thickness or vaginal maturation (76).
  • Gastrointestinal agentsGastrointestinal agents: According to secondary sources, dong quai has traditionally been associated with gastrointestinal symptoms, including laxative effects and diarrhea, upset stomach, nausea, vomiting, loss of appetite, burping, or bloating.
  • Hormonal agentsHormonal agents: Dong quai may stimulate the corpora lutea to secrete progesterone (95; 96). In vitro biochemical research on the bioactivity of dong quai showed little estrogen receptor binding (31). Saliva from women taking dong quai was found to have low estradiol levels (31). Dong quai may competitively inhibit estradiol binding to estrogen receptors, increase ceruloplasmin oxidase activity, and decrease luteinizing hormone levels (73). In rats, Angelica sinensis had estrogenic effects (97; 98). In a human research, dong quai water extract combined with 17beta-estradiol stimulated the proliferation of MCF-7 cells by weak estrogen-agonist effects, and demonstrated growth stimulation effects on BT-20 cells with or without 17beta-estradiol (99).
  • HypoglycemicsHypoglycemics: According to secondary sources, dong quai preparations may contain high levels of sucrose, which may theoretically interfere with blood sugar control.
  • HypotensivesHypotensives: Coumarin derivatives found in dong quai root possess calcium antagonistic properties, which have produced antihypertensive effects in animal studies (38; 64). Theoretically, coadministration of dong quai with antihypertensives may increase the risk of hypotension.
  • LaxativesLaxatives: According to secondary sources, traditional Chinese medicine practitioners have noted an occasional laxative effect or gastrointestinal distress in patients taking dong quai for long periods of time.
  • Neurologic agentsNeurologic agents: In laboratory research, ligustilide, the constituent of Angelica sinensis, had neuroprotective effects(29).
  • PhotosensitizersPhotosensitizers: According to secondary sources, chemicals in dong quai may cause increased (possibly severe) photosensitivity.
  • St. John's wortSt. John's wort: Theoretically, St. John's wort may potentiate the photosensitizing effects of dong quai (69; 51), although a literature review reveals no reports of such an interaction.
  • Vitamin EVitamin E: According to anecdotal evidence, dong quai may aid in the absorption and utilization of vitamin E.

    • Dong quai/Food Interactions:

  • Insufficient available evidence.

    • Dong quai/Lab Interactions:

  • Blood pressureBlood pressure: Coumarin derivatives found in dong quai root possess calcium antagonistic properties, which have produced antihypertensive effects in animal research (38; 64).
  • Hematological parametersHematological parameters: There are several reports of dong quai having antithrombotic effects in animal research and in vitro (38; 35; 90). Treatment with dong quai significantly improved alpha-granule membrane protein, thromboxane B(2), platelet count (PC), the one-minute platelet aggregation rate, and von Willebrand factor-related antigen; 6-keto-PGF(1a) did not improve (81).
  • Hormone levelsHormone levels: Dong quai may stimulate the corpora lutea to secrete progesterone (95; 96). Saliva from women taking dong quai was found to have low estradiol levels (31). Dong quai may competitively inhibit estradiol binding to estrogen receptors, increase ceruloplasmin oxidase activity, and decrease luteinizing hormone levels (73).
  • Immunologic parametersImmunologic parameters: In human research, RG-CMH, which contains Angelica sinensis extract, caused a significant delay in the reduction of leukocyte and neutrophil levels (103).
  • International normalized ratio (INR)International normalized ratio (INR): Dong quai has produced antithrombolitic effects in vitro (38; 67), and has been noted to elevate the INR (66; 67; 92). In a human case report, a patient's INR was stabilized at 2 and 3 by taking warfarin 5mg daily; her INR doubled four months after adding dong quai 565mg 1-2 times daily. Her INR was normalized within four weeks when dong quai was discontinued.
  • Nitric oxideNitric oxide: A combination of Ligusticum chuanxiong and dong quai significantly increased nitric oxide production in vascular smooth muscle cells (104).
  • Prothrombin time (PT)Prothrombin time (PT): Intravenous dong quai alone or in combination with warfarin prolonged prothrombin time (90; 105).
  • Pulmonary parametersPulmonary parameters: Treatment with dong quai significantly reduced levels of mean pulmonary arterial pressure (mPAP), pulmonary vascular resistance (PVR), blood ET-1, AT-II and EDF by 18 ? 5%, 27 ? 8%, 20 ? 6%, 36 ? 9%, and 38 ? 11%, respectively (79). PaO2 was significantly increased (p<0.05). In a different study, dong quai produced significant improvement on pulmonary hypertension, blood viscosity, hematocrit, and the level of thromboxane (TX)A2 decreased significantly; blood gas, blood pressure, and prostaglandin (PG)I2 levels remained unchanged (106). In human research, intravenous Angelica sinensis decreased mean pulmonary arterial pressure and increased cardiac output and PaO2 (80).
  • Urologic parametersUrologic parameters: In human research using a dong quai combination product called Shen Yan Ling?, urine red blood cells were resolved in 50%, and proteinuria was also eliminated in 38% of the patients treated (107).