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تعداد آیتم قابل مشاهده باقیمانده : -28 مورد

Medications that interfere with the effect of warfarin

Medications that interfere with the effect of warfarin
May increase INR May decrease INR

Acetaminophen

Allopurinol

Amiodarone

Androgens
  • Methyltestosterone
  • Oxandrolone
  • Testosterone

Antibiotics

  • Cephalosporins
  • Doxycycline
  • Fluoroquinolones
    • Ciprofloxacin
    • Levofloxacin
    • Moxifloxacin
    • Norfloxacin
  • Macrolides
    • Azithromycin
    • Clarithromycin
    • Erythromycin
  • Metronidazole
  • Penicillins (exceptions: dicloxacillin and nafcillin may decrease the INR)
    • Amoxicillin
    • Amoxicillin-clavulanate
  • Trimethoprim-sulfamethoxazole

Azole antifungals*

  • Fluconazole
  • Miconazole (oral)
  • Voriconazole
 Cancer therapies
  • Capecitabine
  • Fluorouracil (5-FU)
  • Imatinib
  • Tamoxifen

Cholesterol-lowering agents (exception: cholestyramine may decrease the INR)

  • Fenofibrate
  • Fluvastatin
  • Gemfibrozil
  • Lovastatin
  • Rosuvastatin
  • Simvastatin

Cimetidine

Glucocorticoids
  • Methylprednisolone
  • Prednisone

Omeprazole (case reports with other proton pump inhibitors)

Serotonin reuptake inhibitors
  • Duloxetine
  • Fluoxetine
  • Fluvoxamine
  • Venlafaxine

Sitaxentan (not available in United States)

Tramadol		 Antibiotics
  • Dicloxacillin
  • Griseofulvin
  • Nafcillin
  • Rifampin

Azathioprine

Cholestyramine

Enzyme-inducing antiseizure medications
  • Carbamazepine
  • Phenobarbital
  • Phenytoin (mixed effects described)

Ritonavir

Saint John's wort

Sucralfate

Vitamin K
This is a partial list of medications that may increase or decrease warfarin effect on the INR. The patient's medications should be analyzed closely for drug interactions with warfarin, especially when initiating or altering therapy. The effect of a drug interaction can be unpredictable; thus, individuals receiving interacting medications are likely to require increased INR monitoring. Additional medications may increase bleeding risk independent of (or in addition to) effects on the INR (eg, NSAIDs, antiplatelet medications). Refer to UpToDate for additional details. Drug interactions may be evaluated using the drug interactions program included within UpToDate.

INR: international normalized ratio; NSAIDs: nonsteroidal anti-inflammatory drugs.

* A more moderate effect on INR control may also be seen with posaconazole and itraconazole.

¶ In addition to potentially increasing the INR, serotonin reuptake inhibitors may also increase bleeding risk by inhibiting platelet reuptake of serotonin.
References:
  1. Greenblatt DJ, von Moltke L. Interaction of warfarin with drugs, natural substances, and foods. J Clin Pharmacol 2005; 45:127.
  2. Holbrook A, Schulman S, Witt D, et al. Evidenced-based management of anticoagulant therapy: Antithrombotic therapy and prevention of thrombosis, 9th ed. Chest 2012; 141:e152S.
  3. Hazlewood KA, Fugate SE, Harrison DL. Effect of oral corticosteroids on chronic warfarin therapy. Ann Pharmacother 2006; 40:2101.
  4. UpToDate Lexidrug. More information available at https://online.lexi.com/.
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