Management: Avoid such combinations when possible. ,/c]n`4Q%9o1_L;%".X"& Monitor for signs and symptoms of bleeding if vitamin K antagonists and Ginkgo biloba are used concomitantly.Ginseng (American): May decrease the serum concentration of Warfarin.Glucagon: May enhance the anticoagulant effect of Vitamin K Antagonists.Glucosamine: May enhance the anticoagulant effect of Warfarin.Glutethimide: May increase the metabolism of Vitamin K Antagonists. If calciphylaxis is diagnosed, discontinue therapy and treat calciphylaxis as appropriate. Management: Consider using low-molecular-weight heparin or heparin instead of warfarin. Monitor patients closely for reduced vitamin K antagonist effects (eg, decreased INR, thrombosis) when these agents are combined.Chondroitin Sulfate: May enhance the anticoagulant effect of Warfarin.Cimetidine: May enhance the anticoagulant effect of Vitamin K Antagonists. Coumadin (warfarin) has to be monitored on a routine basis to ensure that the patient is receiving the correct dosage. Cautions Page 10 10. Leflunomide may diminish the anticoagulant effect of Vitamin K Antagonists.Letermovir: May decrease the serum concentration of Warfarin.LevOCARNitine: May enhance the anticoagulant effect of Vitamin K Antagonists.Levomilnacipran: May enhance the adverse/toxic effect of Vitamin K Antagonists. Management: Avoid concurrent use of vitamin K antagonists and enzalutamide when possible. Consider using an alternative, nonhormonal contraceptive.Proguanil: May enhance the anticoagulant effect of Warfarin.Propacetamol: May enhance the anticoagulant effect of Vitamin K Antagonists. Efavirenz may increase the serum concentration of Vitamin K Antagonists.Elexacaftor, Tezacaftor, and Ivacaftor: May increase the serum concentration of Warfarin.Enzalutamide: May decrease the serum concentration of Vitamin K Antagonists. A test strip is inserted into the meter, and then a lancet (a medical pricking needle) is used to obtain blood which is applied to the test strip. INR monitoring is essential for all patients treated with warfarin International Normalised Ratio (INR) testing is well established as an integral part of warfarin treatment. Patients with renal impairment are at increased risk for bleeding diathesis; frequent INR monitoring is recommended.• Thyroid disease: Use with caution in patients with thyroid disease; warfarin responsiveness may increase (ACCP [Ageno 2012]).• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. PMS) and Serophene (Fertility). Management: Avoid as needed use of salicylates in patients taking vitamin K antagonists. Properly timed sexual intercourse is important for good results. Monitoring Page 5 i) JAPC consensus and agreement for the management of sub-therapeutic INR Page 6 ii) Factors affecting warfarin sensitivity Page 6 iii) Common drug interactions with warfarin Page 7 6. The *2 allele is reported to occur with a frequency of 4% to 11% in African-Americans and Caucasians, respectively, while the *3 allele frequencies are 2% to 7% respectively.
Monitor patients extra closely (INR and signs/symptoms of bleeding) when using this combination.Frankincense, Indian: May enhance the anticoagulant effect of Warfarin.Fusidic Acid (Systemic): May increase the serum concentration of Vitamin K Antagonists. AzaTHIOprine: May diminish the anticoagulant effect of Vitamin K Antagonists. It works by making your blood clot more slowly. In contrast, enhanced anticoagulant effects have also been noted with some products.
Several studies have confirmed that 5mg initiation achieves therapeutic anticoagulation as rapidly as 10mg initiation but with a lower frequency of supra-therapeutic INRs. Specifically, the risk for bleeding-related events may be increased.
LMWH or heparin should be resumed close to delivery.
This appears most likely with daily acetaminophen doses exceeding 1.3 or 2 g/day for multiple consecutive days.Adalimumab: May decrease the serum concentration of Warfarin.Agents with Antiplatelet Properties (e.g., P2Y12 inhibitors, NSAIDs, SSRIs, etc.
Management: Consider avoiding coadministration of St John's Wort and vitamin K antagonists. In women who are at a very high risk for thromboembolism (older generation mechanical prosthesis in mitral position or history of thromboembolism), warfarin can be used throughout pregnancy and replaced with LMWH or heparin near term; the use of low-dose aspirin is also recommended (ACCP [Bates 2012] AHA/ACC [Nishimura 2014]). Specifically, the risk for bleeding may be increased.Limaprost: May enhance the adverse/toxic effect of Anticoagulants.
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