Inhibition of warfarin metabolism and an increase in INR rarely reported with some NSAIDs Increased bleeding risk withoutĪlteration of INR. Interference with primary haemostasis – increased bleeding risk without alteration of INRĭirect mucosal injury, antiplatelet effects may also have a role. fluoxetine, paroxetine, can also inhibit warfarin metabolism Inhibition with platelet function – increased bleeding risk without alteration of INR. Serotonergic agents (SSRIs and venlafaxine) Inhibition of vitamin K synthesis by intestinal flora, inhibition of warfarin metabolismįluconazole, miconazole (including gel and vaginal preparations) Most antibiotics but especially macrolides, metronidazole, quinolones and cotrimoxazole Table 1: Some of the main medicines, medicine classes and other agents that can interact with warfarin Products without consulting their doctor or pharmacist.įor a complete list of interactions and advice on managing interactions suchĪs when to check the INR, refer to appropriate information resources such as a formulary or your PMS system. Patients should also be advised not to take any other prescribed medicines, over-the-counter medicines or food supplements/herbal It is not all-inclusive and practitioners should alwaysĬheck if there is a clinically significant interaction if they are prescribing a medicine for a person taking warfarin. Table 1 shows some of the important interactions with warfarin. To recognise that some interactions cause an increase in bleeding without alteration of the INR, e.g. Whilst most interactions involve a change in the INR, it is important Started or stopped or when the dose is altered. An interaction can occur when the interacting agent is Many medicines and herbal products can interact with warfarin.
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