Siberian Ginseng Asian Ginseng and Ashwagandha

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There is one case report of interference of Siberian ginseng in serum digoxin measurement. A 74-year-old man had a steady serum digoxin level of 0.9-2.2 ng/mL for 10 years. His serum digoxin increased to 5.2 ng/mL on one occasion after taking Siberian ginseng. Although the level was toxic, the patient did not experience any sign or symptoms of digoxin toxicity. The patient stopped taking Siberian ginseng, and his digoxin level returned to normal (106). However, in our experience, Siberian ginseng only has a very modest interference with the FPIA and most digoxin assays we tested had no effect at all (107). Therefore, in the case report, it is possible that the patient ingested some other herbal remedy mislabeled as Siberian ginseng. Mislabeling of Chinese herbs has been previously reported. Asian ginseng, which is prepared from a different herb than Siberian ginseng, also showed modest interference with the FPIA but other digoxin immunoassays were not affected at all (107).

More recently, Ashwagandha (loosely also called Indian ginseng) has become available on the U.S. market. Although labeled as "ginseng products," this herbal supplement is prepared from entirely different plants. Ashwagandha (Withania somnifera) has been used in Ayurvedic medicine for over 3000 years as an aphrodisiac, liver tonic, anti-inflammatory agent, and astringent. The major biochemical constituents

Table 2

Interference of Herbal Products in Digoxin Immunoassays

Table 2

Interference of Herbal Products in Digoxin Immunoassays

Herbal Product

Interference

Comments

Chan Su

High

Chan Su has active components such as bufalin that cross-react with digoxin immunoassays. Most assays are affected. FPIA showed high interference

Uzara root (diuretic)

Moderate-High

Additive effect with digoxin also interferes with digoxin immunoassays

Siberian ginseng

Low-Moderate

May falsely increase digoxin level measured by FPIA and falsely lower digoxin level using MEIA. Other digoxin assays such as Roche, Beckman, Bayer show no interference

DanShen

Low

May interfere with FPIA assay for digoxin. Other immunoassays not affected

FPIA, fluorescence polarization immunoassay; MEIA, microparticle enzyme immunoassay.

FPIA, fluorescence polarization immunoassay; MEIA, microparticle enzyme immunoassay.

of Ashwagandha are steroidal alkaloids and steroidal lactones in a class of compounds termed as "withanolides," which have structural similarity with digoxin. Although Ashwagandha showed a very modest interference with the FPIA, other digoxin assays such as the Tina-quant (Roche) assay and the Beckman assay on the Synchron LX analyzer are totally free from interference of Indian ginseng (108).

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