Salvia miltiorrhiza · PhytoNexus

01 Identity and provenance

Accepted binomial: Salvia miltiorrhiza
Common names: Danshen
Family (APG IV): Lamiaceae
Part used: Root
Verification tier: Tier 2 · Verified Clinical columns reviewed and a source is on record.
Reviewer note (2026 audit): Yu CM et al. Chinese herbs and warfarin potentiation by danshen | Chan K et al. J Pharm Pharmacol 1995;47:402-6 | VERIFIED 2026 (batch 2) - synthetic analogue, application, interactions, side effects and references populated from retrieved primary/regulatory sources. Interactions labelled CLINICAL vs THEORETICAL. Marketed-formulation column intentionally blank. | INTERACTION

02 Constituent chemistry

Chemical class	Marker compound	Synthetic analogue in use
Diterpenoid quinones, phenolic acids	Tanshinone IIA Root	Antiplatelet agents; no structural analogue. Tanshinones and salvianolic acids act on platelet aggregation and the extrinsic coagulation pathway.

The analogue column is what makes the interaction reasoning tractable: where a constituent has a marketed structural counterpart, the counterpart's interaction profile is the starting hypothesis for the plant.

Looking up structures and physicochemical properties from PubChem…

03 Stated application

Reported activity: Angina pectoris, myocardial infarction and cerebrovascular disease in East Asian practice; listed in the Chinese Pharmacopoeia.
Reported adverse effects: Bleeding risk when combined with anticoagulants or antiplatelets. Otherwise generally well tolerated at usual doses.

04 Interaction matrix

Source column, verbatim: MAJOR - AVOID WITH WARFARIN. Both pharmacokinetic and pharmacodynamic interaction. Multiple human case reports of over-anticoagulation and bleeding, including profound anticoagulation after mitral valve replacement. Rat work shows danshen alters R- and S-warfarin pharmacokinetics, raises plasma concentrations of both enantiomers and prolongs prothrombin time. Also inhibits platelet aggregation - caution with any antiplatelet. This is among the best-evidenced herb-drug interactions in the literature.
Normalised onto 2 canonical drug classes below.

Curated from the reviewed source

Drug class	Severity	Mechanism type	Provenance	Expected effect
Anticoagulants (vitamin-K antagonists, DOACs) Haemostasis	3Major	PD-additive + PK-CYP2C9	curated A	INR destabilisation in either direction; ecchymosis, epistaxis, gum bleed…	why ▾
Class mechanism. Coumarin-, salicylate- and coumestan-bearing botanicals add to vitamin-K-antagonist effect; several also compete for CYP2C9 and CYP3A4, raising S-warfarin exposure. Botanicals rich in vitamin K1 act in the opposite direction and blunt anticoagulation. Expected INR destabilisation in either direction; ecchymosis, epistaxis, gum bleeding, GI or intracranial haemorrhage. Management Do not start or stop the botanical without INR cover. Check INR at 3-5 days and again at 2 weeks. Document the product, batch and dose in the anticoagulation record. Onset rapid Evidence A - human data with a cited source Matched on “warfarin” Find evidence for this pair Map this mechanism
Antiplatelet agents Haemostasis	3Major	PD-additive	curated A	Prolonged bleeding time, surgical and post-procedural bleeding, bruising,…	why ▾
Class mechanism. Organosulfur compounds, gingerols, salicylates, ginkgolides and eugenol inhibit thromboxane A2 synthesis, platelet aggregation and PAF-mediated activation, duplicating the pharmacology of aspirin and P2Y12 blockers. Expected Prolonged bleeding time, surgical and post-procedural bleeding, bruising, haematuria. Management Stop the botanical 7-14 days before elective surgery or neuraxial anaesthesia. Record it on the pre-operative medicines list. Onset rapid Evidence A - human data with a cited source Matched on “antiplatelet” Find evidence for this pair Map this mechanism

05 Hazard register

pharmacological class - avoid with warfarin (pharmacokinetic and

06 Confusable material

These entries could be mistaken for this one in trade, in the herbarium, or in a prescription. Powdered material is often indistinguishable, so the check is macroscopic, microscopic and chromatographic rather than nominal.

Salvia hispanica Chia	Lamiaceae	Same genus (Salvia)
Salvia officinalis Sage	Lamiaceae	Same genus (Salvia)
Salvia rosmarinus Rosemary	Lamiaceae	Same genus (Salvia)

07 Mechanism map

Chemistry sorts to the left, pharmacology to the right. Dashed edges are predicted. Drag nodes, scroll to zoom, export at 3× for a figure.

species

chemical class

marker compound

drug class

expected effect

hazard

08 Open literature

Abstract-scoped query built from this binomial, its common names and its marker compounds, run live against Europe PMC, PubMed and OpenAlex, then ranked locally against an evidence hierarchy.

Checking openFDA spontaneous reports…

09 Isomechanistic neighbours

Species whose interaction profile overlaps this one, ranked by shared severity weight rather than by count — a shared contraindication counts for more than a shared minor signal. Practical use: these are the plants you should not stack with this one, because the mechanisms summate.

Species	Family	Shared classes	Jaccard
Matricaria chamomilla Chamomile	Asteraceae	2	0.67
Oenothera biennis Evening Primrose	Onagraceae	2	0.67
Serenoa repens Saw Palmetto	Arecaceae	2	0.67
Gaultheria fragrantissima Wintergreen	Ericaceae	2	0.67
Salix alba White Willow	Salicaceae	2	0.67
Filipendula ulmaria Meadowsweet	Rosaceae	2	0.67

10 References and notes

Source column: Chan TYK. Ann Pharmacother 2001;35:501-4. doi:10.1345/aph.19029

Chan TYK. Ann Pharmacother 2001

Chan TYK 2001 manual

35:501-4. doi:10.1345/aph.19029

doi:10.1345/aph.19029 manual

BibTeX for all 2 records

@article{ChanTYK2001,
  title = {Chan TYK. Ann Pharmacother 2001},
  author = {Chan TYK},
  year = {2001},
}

@article{anon,
  title = {35:501-4. doi:10.1345/aph.19029},
  doi = {10.1345/aph.19029},
}

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