Aspirin/garlic/milk thistle extract interaction: Epistaxis: case report

A 25-year-old man developed epistaxis due to a drug interaction between aspirin and a herbal medicine containing garlic and milk thistle extract.

The man, who had been self-medicating with aspirin 75 mg/day for perceived high blood pressure for the past 2 weeks, presented with a 1-day history of recurrent, worsening epistaxis.

Fluid resuscitation was performed, and the man's nose was packed. Despite nasal packing, blood was still oozing into his throat posteriorly. He underwent nasal endoscopy under local anaesthesia, which showed moderate oozing from his posterior right inferior turbinate, and his lateral nasal wall adjacently. Oxidised cellulose was applied, and his nose was re-packed; he was subsequently hospitalised. The pack was removed after 24 hours, and his epistaxis eventually settled. Further investigations revealed he had also started taking tablets containing garlic and milk thistle extract [dosage and therapeutic indication not stated] at the same time as aspirin. He was advised to discontinue aspirin and other OTC medications. After 3 days in hospital, he was discharged on chlorhexidine/neomycin cream.Author Comment"[Complementary and alternative medicine] has been shown to have some beneficial uses, but the potential side-effects of such therapies and the possible herb-drug interactions that can occur cannot be ignored."

References

1. Shakeel M, Trinidade A, McCluney N, Clive B.Complementary and alternative medicine in epistaxis: A point worth considering during the patient's history. European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine 17: 17-19, No. 1, Feb 2010. Available from: URL: http://dx.doi.org/10.1097/MEJ.0b013e32832b1679. - United Kingdom.