*2.6. Drug Interactions*

Ginger may also potentially interfere with the bioavailability of many oral pharmaceutical substances, either by increasing their absorption from the gastrointestinal tract or preventing their metabolism in the liver after absorption [92,93].

The most notable is the potential interaction between ginger and anticoagulant therapy as ginger is known to possess anti-platelet aggregation properties. Some case reports have suggested that ginger may interact with warfarin and increase the risk of prolonged bleeding [94–97]. Additionally, a prospective longitudinal study reported that ginger was associated with an increased risk of self-reported bleeding among patients taking warfarin, even though no significant risk of increasing blood clotting time was found [98]. However, a study investigating the effect of ginger on the pharmacokinetics and pharmacodynamics of warfarin in healthy volunteers co-administered with 0.4 g of ginger extract did not find evidence of interactions [99]. Furthermore, the effect of ginger on platelet aggregation and coagulation remains equivocal, according to a systematic review by Marx et al. [100] that included eight clinical trials and two observational studies. Hence, the European medicines agency did not find the case reports on the potential interactions between ginger and warfarin to be convincing [101].

Studies have shown that ginger may potentially interact with drugs such as crizotinib (an anti-cancer drug) [102], cyclosporine (an immunosuppressant) [103], metronidazole (an antibiotic) [104], and ketoconazole (an antifungal) [105]. With the increased use of ginger and its derivatives as nutraceuticals, more research is needed to identify and confirm potential ginger-drug interactions to reduce and avoid side effects induced by unfavourable interactions.

### **3. Pathophysiology of IDA and Its Treatment**
