INTERACTION BETWEEN REISHI 'LING ZHI' MUSHROOM AND WARFARIN

WHAT IS IT?

• Reishi mushroom is commonly known as ‘Ling Zhi’ in Chinese with a scientific name, ‘Ganoderma lucidum’.
• Reishi mushroom is primarily composed of complex carbohydrates called water-soluble polysaccharides, triterpeniods, proteins and amino acids which aids in its beneficial effects.

RATIONALE:

• The polysaccharide content of Reishi mushroom is responsible for possible anticancer and immun0stimulatory effects.
• May also provide hepatoprotective action, antiviral activity, and beneficial effect on the cardiovascular system, rheumatoid arthritis, chronic fatigue syndrome, and diabetes. 

BLOOD THINNING PROPERTIES:

Many references stated that Reishi mushroom has some interactions with anticoagulants where it may enhances the blood thinning properties; to cause bleeding in patient. This interaction is summarized by UpToDate, where the risk associated with concomitant use of Reishi mushroom and warfarin is classified as Category D.

Category D: Consider Therapy Modification

“Data demonstrate that the two medications may interact with each other in a clinically significant manner. A patient-specific assessment must be conducted to determine whether the benefits of concomitant therapy outweigh the risks. Specific actions must be taken in order to realize the benefits and/or minimize the toxicity resulting from concomitant use of the agents. These actions may include aggressive monitoring, empiric dosage changes, choosing alternative agents”

RECOMMENDATION:

Caution is advised in people with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.

References:

1. http://www.reishi.com/what-is-reishi.html

2. http://www.drugs.com/npp/reishi-mushroom.html

3. http://www.uptodate.com.

4. https://my.clevelandclinic.org

WHO SHOULD NOT RECEIVE EXPRESSED BREAST MILK (EBM)

Human milk contains antibodies and other protective factors, but in the case of certain pathogens, it may also pose a possible risk of infection for the infant. The benefits for the infant to continue receiving EBM must be considered against the possible severity of the disease. It would be wise if the breast milk that is to be given to infants are tested for pathogens and the risks that the milk could expose are being elucidated first, before consumption. Here are some measures that could done to reduce the risk of infants receiving milk that is dangerous to them:

Risk Assessment of the Source (non-birth) Mother:

An assessment of the clinical status of the source mother at the time of breast milk collection/expression or feeding with regard to:

• the presence of fever
• the presence of rash (including vesicles on the breast), and
• the presence of mastitis, breast abscess or bleeding nipple.

Checking the source mother’s antenatal serology for previous results, e.g. syphilis, hepatitis C (HCV) antibodies, hepatitis B (HBV), and Human Immunodeficiency virus (HIV) antibodies.

Checking for a history of HBV vaccination.

Checking medications prescribed to the source mother.

Where recent serological results are lacking, discussing risk factors for blood borne viruses (HIV, HBV and HCV) and syphilis in the source mother. These include:

• Injecting drug use
• Birthplace or previous residence or travel in a country with high prevalence of HIV or other blood borne viruses (as identified by an appropriate specialist)
• Tattoo or piercing
• History of syphilis (including date and treatment)
• Blood transfusion history or possible iatrogenic exposure to a blood borne virus, and
• Unprotected sex with a partner who has or is at risk of having a blood borne virus

Serological & Breast Milk Screening:

Testing should be expedited, in order to inform appropriate treatment to the baby, should it be required. It is recommended that at the time of the exposure the following should be collected from the source mother and the mother of the exposed baby:

Blood	HIV RNA NAT, HIV proviral DNA (if available) and HIV antibody/ antigen test. However this information will be unlikely to be available in time to guide initiation of prophylactic therapy of the baby.
	HCV antibody test, HCV RNA test
	HBV surface antigen, HBV core antibody
Breast Milk	Cytomegalovirus (CMV) NAT (if baby is less than one month of age, or has underlying immune deficiency illness)

References:

1. Maternity-breast milk: Safe management <http://www.health.nsw.gov.au/policies/>

2. <https://www.breastfeeding.asn.au/bf-info/breastfeeding-and-work/expressing-and-storing-breastmilk>

3. Malaysian Dietary Guideline

Pharmacy Drug Info (May-Jun 2015) : Hormone Replacement Therapy

Pharmacy Drug Info (July-Aug 2015) : Mites & Scabies