warfarin과 타물질(약품)의 혼용, 관련증상 外

화학약품 정보에서 몇가지 발췌하였습니다.   Interactions : 테트라시클린(항생제) An apparent interaction between tetracycline & warfarin is reported in a 50 yr old man receiving oral warfarin sodium (Coumadin) at a dose of 5-7.5 mg on alternate nights & who was given 250 mg of oral tetracycline hydrochloride 4 times/day for approx 1 yr for chronic blepharitis. Six wks after tetracycline was initiated the patient's International Normalized Ratio (INR) had increased to 7.66 from a previous value of 2.2. Monitoring over the next several months indicated that the changes in INR generally paralleled changes in the dosage of tetracycline & adjustments in the warfarin dosage were required. After tetracycline was discontinued the INR returned to stable levels while the patient took a consistent warfarin dosage. Interactions : 인삼 A probable interaction between warfarin and ginseng (Ginsana) is reported in a 47-yr-old man with a mechanical heart valve on anticoagulation therapy with 37.5 mg/wk of warfarin sodium who started taking ginseng capsules 3 times/day in an effort to boost his energy level. The patient's international normalized ratio (INR) had ranged from 3.0 to 4.0, but 2 wk after taking ginseng, the patient's INR declined to 1.5. Ginseng was discontinued, and the INR returned to 3.3 in 2 wk. Interactions : 당뇨치료제(troglitazone) The apparent potentiating effect of troglitazone on warfarin's international normalized ratio (INR) is described in a 51-yr-old man with a history of severe peripheral vascular disease, diabetes mellitus, hypertension, and depression taking warfarin sodium at a dose of 45 mg/wk along with other medications; 200 mg/day of oral troglitazone was started for the first 2 wk and then 400 mg/day thereafter. The patient's INR, which was 3.3 five days before troglitazone therapy was started, rose to 5.5 seventeen days after the therapy was started. There were no changes in the patient's drug regimen other than the addition of troglitazone. Warfarin sodium was withheld for 2 days immediately after the high INR was reported, and the dosage was lowered to 5 mg/day and further reduced to 32.5 mg/wk. Seven days after the last adjustment, the patient's INR was 2.9 and 8 days after that it was 2.8; after the patient was stabilized on 400 mg/day of troglitazone, his daily warfarin sodium doses totalled 32.5 mg/wk. Interactions : 녹차 The case of a 44-yr-old man in whom the effect of 7.5 mg/day warfarin sodium (Coumadin) was apparently inhibited by the ingestion of one-half to 1 gallon of green tea per day is described. It was noted that the patient had an international normalized ratio (INR) of 3.2 about 1 month before entering the clinic and an INR of 3.79 on entering the clinic. Twenty-two days later, his INR was 1.37 and 1 month later it was 1.14. It was subsequently discovered that the patient began drinking green tea daily about 1 wk before the INR of 1.37. On discontinuation of the green tea, his INR increased to 2.55. Interactions : 용량 실험 The effects of moricilzine hydrochloride on the pharmacokinetics, pharmacodynamics, & plasma protein binding of warfarin sodium (Coumadin) were studied in healthy males (ages 21-35 yr) who received a single oral dose of 25 mg warfarin in tablet form alone or with 250 mg moricizine every 8 hr. The terminal elimination rate constant of warfarin was increased by about 10% in the presence of moricizine. However, oral plasma clearance, apparent volume of distribution, max peak plasma concn, time to reach peak concn, & protein binding were unaffected. There was no evidence of a pharmacodynamic interaction based on the prothrombin time profile. Moricizine does not have a clinically significant effect on the pharmacokinetics & pharmacodynamics of warfarin. Interactions : KGK-피에 좋다는 중국 전통 한약제인 듯. Kangen-Karyu (KGK), containing six herbs, is a formula created under the theory of Chinese traditional medicine (CTM) to invigorate the `blood' and dispel `blood stasis', which arises from poor blood circulation. The present study was conducted to eval‎uate the interactions between KGK and warfarin. Warfarin was administered orally or intravenously to KGK-treated rats, and plasma warfarin concentration and prothrombin time were measured. Although KGK did not influence the absorption or serum protein binding of warfarin, KGK significantly suppressed the metabolism and elimination of warfarin. This interaction depends on the dosage of KGK, and ten times the amount of the human daily dose of KGK did not exhibit pharmacokinetic interaction with warfarin, suggesting that KGK did not influence the effect of warfarin unless the daily dose was strictly maintained. Warfarin alone significantly prolonged mice tail-bleeding time, which was further prolonged significantly by KGK at a dose that did not exhibit pharmacokinetic interactions with warfarin, suggesting that KGK and warfarin might synergistically prevent thrombosis, and that combined use of these drugs could be therapeutically valuable. When physicians or pharmacists utilize combined therapy using warfarin and KGK, they must make a careful effort to check the coagulative status and regulate the dosage of each drug /CASE REPORTS(피부)/ The most common adverse reactions to warfarin sodium are hematological, but skin reactions can be a problem. A 47-yr-old female was receiving warfarin sodium subsequent to development of pulmonary emboli. She developed a generalized maculopapular rash after receiving warfarin and SMZ. The SMZ/TMP was discontinued, but the rash became worse. Warfarin was then suspected because the patient reported that itching intensified after her daily dose. A one-dose trial with a dye-free tablet was unsuccessful and warfarin was discontinued. Since the rash improved, a rechallenge with dye-free warfarin 1 mg was then performed to confirm‎ the allergy. The itching returned immediately. Since the rechallenge was positive, treatment with enoxaparin was begun.   /CASE REPORTS(술)/ The complications of hypoprothrombopenia is likely to occur in warfarin therapy in the presence of alcoholic liver disease. This case report describes a 59 yr-old Hispanic male, on warfarin sodium (Coumadin) following a ventricular thrombus, who experienced excessive anticoagulation following a weekend of binge drinking. The patient presented to the anticoagulant clinic with a three-day history of vomiting blood and an INR of 32.0. The patient was given Vitamin K 5 mg IM and admitted to the hospital for observation.   /CASE REPORTS/ 임신 /a 1968 report of/ nasal hypoplasia in the offspring of a woman treated with warfarin during pregnancy an assoc has been made between the use of coumarin deriv & Conradi syndrome which consists of nasal hypoplasia with calcific strippling of the secondary epiphyses. The dose given to the mother was ... 2.5 to 10 mg per day during 1st trimester. One patient received coumadin during only 1st 8 wks & another took phenindione. Nasal obstruction complicated the neonatal course of these infants who were of low birth wt. Three of the children were reported to be blind but their long term development is still unknown. Eleven ... /other/ cases ... /are reported on warfarin therapy during pregnancy & its association with multiple congenital anomalies & phenotypic chondrodysplasia punctata/. ... /A summary of/ clinical data ... cites five offspring with CNS problems incl hydrocephalus /resulting from warfarin therapy/. The pathology of a human fetus exposed to warfarin has been reported.   /CASE REPORTS (비아그라)/ The case of a 61-yr-old man who developed an elevated international normalized ratio (INR) and epistaxis 6-7 days following an inadvertent switch from the Coumadin brand of 5-7.5 mg/day warfarin sodium to a generic product is described. Concomitant therapy included sildenafil. It was noted that 15 days before the epistaxis, the patient's INR was 2.5. He held his warfarin dose as instructed, and within 4 days the INR was below the therapeutic range of 2-3 and 35 mg/wk warfarin was resumed.   /CASE REPORTS (부작용)/ The case of a 31-yr-old man with recurrent pulmonary thromboembolism who experienced an increase in sensitivity to warfarin therapy as a result of liver dysfunction secondary to congestive heart failure (CHF) is reported. After 10 wk of warfarin therapy, he presented to the hospital with dyspnea, leg pain, and chest pain. He was then found to have hepatomegaly with abnormal liver function tests. He was treated with intravenous and oral warfarin in the hospital and discharged home on warfarin 3 mg daily. His international normalized ratio (INR) was 2.5 on day 21. However, on day 50, his INR was >6. He was told to stop warfarin for 2 days and then reduce the dosage to 2.5 mg daily. On his next admission, his INR was >6, but after warfarin withdrawal was 2.9. When he was discharged 3 wk later, his INR had been stable at 2-2.5 for almost 1 wk while he was on 1 mg/day warfarin. In the next 12 months, he was hospitalized 3 times because of CHF. His warfarin requirements varied between 1-1.5 mg daily. Because of worsening CHF and liver congestion, he became more sensitive to warfarin, with an INR of 3.9 while he was on 0.75 mg daily. Warfarin was then stopped. He died from pulmonary hypertension and CHF 18 months after the first hospital admission.