A 63-year-old man was recently placed on warfarin (Coumadin) by his nurse practitioner. Which of the following supplements will he need to discontinue?

Choice A reason: Sam-e is primarily used for depression and joint pain. While it may have mild anticoagulant effects, it is not as significant in potentiating warfarin’s effects as omega-3 fatty acids. Choice B reason: This choice is correct because omega-3 fatty acids have antiplatelet properties and can increase the risk of bleeding when combined with warfarin. Patients on anticoagulants are typically advised to limit or discontinue omega-3 supplementation. Choice C reason: Melatonin is a sleep-regulating supplement and does not significantly affect coagulation or interact with warfarin to increase bleeding risk. Choice D reason: Tryptophan is an amino acid precursor to serotonin used for sleep or mood regulation. It does not have a clinically significant interaction with warfarin.