A study conducted with 45 patients with class IV cardiac function examined the effects of ginseng combined with digoxin for the treatment of congestive heart failure (CHF) (Ding et al. 1995). Patients were randomized into three groups of 15 to be treated with either digoxin alone, ginseng alone, or a combination of digoxin and ginseng. The hemodynamic and biochemical results obtained in the group receiving the combination of digoxin and ginseng were the most significant compared with patients receiving either digoxin alone or ginseng alone. The authors suggest that this herb acted synergistically with digoxin and was a safe and effective treatment for CHF patients.

Orally administered Panax ginseng may counter the effects of morphine in mice with morphine-induced immune suppression by lowering plasma corticosterone levels (Kim et al. 1999). Concomitant administration of ginseng total saponin (100 mg/kg po for 9 days) blocked the elevations in serum corticosterone levels associated with morphine (20 mg/kg subcutaneously for 4 days). In addition, it has been reported that ginseng blocks the analgesic effects of opioids and may offer a clinically useful option for the treatment of opioid dependence and abuse (Takahashi and Tokuyama 1998).

There have been reports of a possible interaction between ginseng and phenelzine (Jones and Runikis 1987). This interaction has resulted in symptoms ranging from manic-like episodes to headache and tremulousness. While the mechanism for this suspected interaction remains unclear, it is thought that ginsenosides inhibit cyclic AMP phosphodiesterase and affect cortical steroid secretion. This activity may explain the psychoactive effects of ginsenosides either alone or in combination with monoamine oxidase inhibitors.

There is a case report of an interaction between ginseng and warfarin in a 47-year-old heart valve replacement patient (Cheng 2000); (Janetsky and Morreale 1997). Within two weeks of adding ginseng to his medication regimen, his INR declined from 3.1 to 1.5. Upon discontinuing the ginseng, his INR value rose to 3.3 over a two week period. INR values should be monitored carefully in patients taking ginseng with warfarin. Studies confirming this interaction have not been performed and the mechanism remains unclear.

Cheng TO. Ginseng-warfarin interaction. ACC Curr J Rev. 2000;9(1):84.

Ding DZ, Shen TK, Cui YZ, et al. The effects of red ginseng on the congestive heart failure and its mechanism [in Chinese]. Chung Kuo Chung His I Chieh Ho Tsa Chih. 1995;15(6):325-327.

Janetsky K, Morreale A. Probable interaction between warfarin and ginseng. Am J Health-Syst Pharm. 1997;54:692-693.

Jones BD, Runikis AM. Interaction of ginseng with phenelzine [letter]. J Clin Psychopharmacol. 1987;7(3):201-202.

Kim YR, Lee SY, Shin BA, Kim KM. Panax ginseng blocks morphine-induced thymic apoptosis by lowering plasma corticosterone level. Gen Pharmacol. 1999;32:647-652.

Takahashi M, Tokuyama S. Pharmacological and physiological effects of ginseng on actions induced by opioids and psychostimulants. Meth Find Exp Clin Pharmacol. 1998;20(1):77-84.