title: Elevated International Normalized Ratio in a Patient Taking Warfarin and Mauby: A Case Report.
abstract: We describe a 70-year-old Haitian man who had been taking warfarin for 5 years for atrial fibrillation and pulmonary hypertension. This patient had his international normalized ratio (INR) checked in the pharmacist-run anticoagulation clinic and was followed monthly. Prior to the interaction, his INR was therapeutic for 5 months while taking warfarin 10.5 mg/d. The patient presented with an INR > 8.0. Patient held 4 days of warfarin and restarted on warfarin 8.5 mg/d. Two weeks later, his INR was 2.5. After continuing dose, patient presented 2 weeks later and INR was 4.8. Upon further questioning, the patient stated he recently began ingesting mauby. Mauby is a bitter dark liquid extracted from the bark of the mauby tree that is commonly used in the Caribbean population as a folk remedy with many health benefits. This case report illustrates that mauby may have a probable drug-herb interaction (Naranjo Algorithm Score of 6) when given with warfarin. There is a lack of published literature and unclear information on the Internet describing the interaction of mauby and warfarin. Health professionals should be cautious regarding interactions between warfarin and mauby until the interaction is fully elucidated.
authors.affiliation: 1 Department of Pharmacy Practice, Touro College of Pharmacy, New York, NY, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Sorbera
authors.affiliation: 2 Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Fort Lauderdale, FL, USA.
authors.forename: Tina
authors.initials: T
authors.lastname: Joseph
authors.affiliation: 3 Pharmacotherapy Services, The Brooklyn Hospital Center, Brooklyn, NY, USA.|4 Department of Pharmacy Practice, Arnold and Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, NY, USA.
authors.forename: Robert V
authors.initials: RV
authors.lastname: DiGregorio
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D031953:Colubrina; D004347:Drug Interactions / Q000502:physiology; D006801:Humans; D019934:International Normalized Ratio / Q000639:trends; D008297:Male; D024301:Plant Bark; D010936:Plant Extracts / Q000008:administration & dosage / Q000009:adverse effects* / Q000302:isolation & purification; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D010936:Plant Extracts; D014859:Warfarin
keywords: Colubrina arborescens; INR; anticoagulation; mauby; warfarin