The short answer
Danshen preparations have been linked to marked excessive anticoagulation in people taking warfarin. The signal supports caution, but the risk is not quantified and the exact preparations in older reports were incompletely described. A monitored study of a multi-ingredient Compound Danshen product had neutral results; it does not clear isolated danshen root or every formula.
What this answer covers
Oral Salvia miltiorrhiza root/rhizome preparations with oral warfarin. Compound Danshen dripping pills include additional ingredients and provide indirect, formulation-limited evidence.
- Supplement or preparation
- Danshen root and rhizome
- Medication ingredient
- warfarin
What does the evidence show?
Two original case reports describe marked anticoagulation during danshen co-use, including one patient after mitral valve replacement. In contrast, a later study enrolled 64 cardiac patients, with 59 completing a self-controlled comparison using Compound Danshen dripping pills. Warfarin was adjusted according to INR, and stable-dose coagulation measures and concentrations did not differ significantly. Follow-up was incomplete. The neutral result is useful counterevidence but concerns a different multi-ingredient product under close dose management.
Which forms and conditions matter?
The compound product contained danshen, notoginseng and borneol. Its results cannot be attributed to isolated danshen root/rhizome or transferred to all commercial formulas. Likewise, excessive anticoagulation in a case report does not prove that absorption or warfarin blood levels increased. The human reports establish a response signal while leaving the mechanism unresolved.
What should I discuss with my care team?
Have the anticoagulation clinician review a proposed danshen product before use. If it is already being taken, provide the formula, dose and start date promptly so INR monitoring and any treatment change can be planned. Do not independently change warfarin or rely on taking the herb a few hours apart. No validated separation schedule was established by these studies.
How certain is the answer?
The evidence combines a small number of uncontrolled cases with a nonrandomized, monitored study of a different formula. That is enough to flag a concern but not to calculate an individual bleeding probability or conclude that all preparations increase concentrations. Exact composition and the distinction between an INR change and a blood-level measurement remain important.
Evidence and practical considerations
Side effects & toxicity
Danshen preparations have been linked to marked excessive anticoagulation in people taking warfarin. The signal supports caution, but the risk is not quantified and the exact preparations in older reports were incompletely described. A monitored study of a multi-ingredient Compound Danshen product had neutral results; it does not clear isolated danshen root or every formula.
- Exact scope
- Oral Salvia miltiorrhiza root/rhizome preparations with oral warfarin. Compound Danshen dripping pills include additional ingredients and provide indirect, formulation-limited evidence. with Oral warfarin, including warfarin sodium tablets with the warfarin active moiety.
- Medication form and route
- oral warfarin
- Timing or duration
- Study-specific durations are described in each source exposure; no universally safe exposure duration has been established.
What remains uncertain
- The evidence combines a small number of uncontrolled cases with a nonrandomized, monitored study of a different formula. That is enough to flag a concern but not to calculate an individual bleeding probability or conclude that all preparations increase concentrations. Exact composition and the distinction between an INR change and a blood-level measurement remain important.
Factors that may matter: Exact supplement preparation and other ingredients; Starting, stopping or changing supplement intake; Baseline anticoagulation control and clinician-supervised monitoring.
Read the supporting source summaries
Source 1: current U.S. regulatory prescribing information
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: Patients prescribed oral warfarin sodium tablets.
The label advises closer INR monitoring when botanicals are started or stopped, identifies variable botanical composition and lists selected potential interactions. Vitamin K intake should remain consistent.
How this applies: Oral warfarin sodium has warfarin as its active moiety. Label-level botanical and vitamin K monitoring advice applies; it is not proof of this exact supplement effect. Oral Salvia miltiorrhiza root/rhizome preparations with oral warfarin. Compound Danshen dripping pills include additional ingredients and provide indirect, formulation-limited evidence.
Regulatory precautions do not quantify the incidence for every exact preparation or prove an interaction for an unlisted ingredient. Warfarin sodium is bridged to the warfarin active moiety only for the oral product.
Source 2: peer-reviewed original research
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: One patient with rheumatic heart disease receiving warfarin.
Markedly excessive anticoagulation was reported during co-use.
How this applies: Direct co-use of Danshen and warfarin. The abstract does not prove a specific extraction method or a measured absorption mechanism for root and rhizome. Exact package scope: Oral Salvia miltiorrhiza root/rhizome preparations with oral warfarin. Compound Danshen dripping pills include additional ingredients and provide indirect, formulation-limited evidence.
Single case; no quantitative incidence, precise botanical standardization, measured absorption or blood-level effect established by the retrieved abstract.
Source 3: peer-reviewed original research
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: One patient receiving warfarin after mitral valve replacement.
Profound excessive anticoagulation was reported; the authors warned against co-use.
How this applies: Direct Danshen and warfarin case after valve surgery. Botanical preparation detail and warfarin concentrations are not established in the inspected abstract. Exact package scope: Oral Salvia miltiorrhiza root/rhizome preparations with oral warfarin. Compound Danshen dripping pills include additional ingredients and provide indirect, formulation-limited evidence.
Single uncontrolled case with insufficient retrieved formulation and mechanism detail.
Source 4: peer-reviewed original research
europepmc.org · Source check Sep 10, 2026
Population: 64 adults with coronary heart disease and atrial fibrillation enrolled; 59 completed the pharmacokinetic study and 41 completed follow-up.
Stable warfarin doses, concentrations and coagulation measures did not differ significantly. No bleeding was reported in the followed subset.
How this applies: Indirect comparison: compound Danshen dripping pills also contained notoginseng and borneol. Neutral monitored results cannot be assigned to isolated Salvia miltiorrhiza root and rhizome. Exact package scope: Oral Salvia miltiorrhiza root/rhizome preparations with oral warfarin. Compound Danshen dripping pills include additional ingredients and provide indirect, formulation-limited evidence.
Nonrandomized self-controlled design, adjusted warfarin dosing, incomplete follow-up. The product also contained notoginseng and borneol; it is not isolated Salvia miltiorrhiza root/rhizome.
Research assessment: · Open full citations ↗
Review and change history
- Publication status
- Published research summary
- Clinical review
- Not yet recorded
| Date | Update |
|---|---|
| Article prepared | |
| Original evidence and contradictory findings assessed for this exact pair. Article drafted and existing statements adjudicated. Clinical sign-off has not been recorded. | |
| Research summary published |
Article revision: 056d54975941c655
This guide brings together the evidence records used by our interaction checker. Each finding retains its own preparation limits, research date, and source summaries.
Full citations require verification. Reading this answer and the source summaries does not.
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Open the interaction checkerInformation, not medical advice. Do not change prescribed treatment based on this guide.