What is the dermatologic preoperative evaluation and management of ginseng?

Updated: Mar 16, 2020
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Of the 38% of Americans using herbal medications in the past 2 years, 28% of them were ginseng users. Ginseng has been labeled as an adaptogen because it reputedly protects the body against stress and restores homeostasis. Most pharmacologic actions are attributed to the ginsenosides that belong to a group of compounds known as steroidal saponins.

Ginseng has a broad but incompletely understood pharmacologic profile because of the many heterogeneous and sometimes opposing effects of different ginsenosides. The underlying mechanism appears to be similar to that classically described for steroid hormones. A potential therapeutic use for this herb has to do with its ability to lower postprandial blood glucose levels both in patients with type 2 diabetes mellitus and in those without diabetes. This insulinlike effect may create unintended hypoglycemia, particularly in patients who have fasted before surgery.

A concern exists about the effect of ginseng on coagulation pathways. Ginsenosides inhibit platelet aggregation in vitro and in laboratory rats. They prolong the coagulation times of thrombin and activated partial thromboplastin. One study suggests that the antiplatelet activity of panaxynol, a constituent of ginseng, may be irreversible in humans. These findings await further confirmation. Although ginseng may inhibit the coagulation cascade, its use has been associated with a significant decrease in warfarin anticoagulation in 1 reported case. The pharmacokinetics of ginsenosides show an elimination half-life of 0.8-7.4 hours. These data suggest that patients should discontinue ginseng at least 24 hours prior to surgery. However, because the platelet inhibition caused by ginseng may be irreversible, patients probably should discontinue ginseng use at least 7 days prior to surgery.

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