Warfarin Interactions with Drugs, Herbals and Supplements> </HEAD> <BODY BGCOLOR="#ffffff"> <CENTER><FONT COLOR="#0000ff" SIZE="+2"><IMG SRC="List%26TablesHeading.jpg" WIDTH="254" HEIGHT="77" ALIGN="BOTTOM" BORDER="0" NATURALSIZEFLAG="3"><BR> </FONT><TABLE WIDTH="650" BORDER="0" CELLSPACING="0" CELLPADDING="0"> <TR> <TD WIDTH="100%"> <P><CENTER> <B><U><FONT COLOR="#000000" SIZE="+4" FACE="Arial Black">Warfarin</FONT></U></B></CENTER></TD> </TR> <TR> <TD WIDTH="100%"> <P><CENTER><B><FONT FACE="Arial Black">INTERACTIONS WITH DRUGS, HERBALS AND SUPPLEMENTS</FONT></B> </CENTER></TD> </TR> </TABLE> <TABLE WIDTH="587" BORDER="1" CELLSPACING="0" CELLPADDING="0" HEIGHT="1244"> <TR> <TD WIDTH="52%" HEIGHT="30"><B><FONT COLOR="#ff0000" SIZE="+2" FACE="Arial Black">CAN INCREASE INR</FONT></B></TD> <TD WIDTH="48%" HEIGHT="30"><FONT COLOR="#ffffff">MECHANISM OF ACTION</FONT></TD> </TR> <TR> <TD WIDTH="52%" HEIGHT="21"><B><FONT COLOR="#0000ff" FACE="Arial Black">DRUGS</FONT></B></TD> <TD WIDTH="48%" HEIGHT="21"><B><FONT COLOR="#0000ff" FACE="Arial Black">MECHANISM OF INTERACTION</FONT></B></TD> </TR> <TR> <TD WIDTH="52%" HEIGHT="21"><FONT FACE="Arial Black">Acetaminophen</FONT></TD> <TD WIDTH="48%" HEIGHT="21"><FONT FACE="Arial Black">Unknown</FONT></TD> </TR> <TR> <TD WIDTH="52%" HEIGHT="21"><FONT FACE="Arial Black">Amiodarone</FONT></TD> <TD WIDTH="48%" HEIGHT="21"><FONT FACE="Arial Black">2C9 inhibition</FONT></TD> </TR> <TR> <TD WIDTH="52%" HEIGHT="21"><FONT FACE="Arial Black">Cimetidine</FONT></TD> <TD WIDTH="48%" HEIGHT="21"><FONT FACE="Arial Black">Enzyme inhibition</FONT></TD> </TR> <TR> <TD WIDTH="52%" HEIGHT="21"><FONT FACE="Arial Black">Ciprofloxacin</FONT></TD> <TD WIDTH="48%" HEIGHT="21"><FONT FACE="Arial Black">Enzyme inhibition</FONT></TD> </TR> <TR> <TD WIDTH="52%" HEIGHT="21"><FONT FACE="Arial Black">Clarithromycin</FONT></TD> <TD WIDTH="48%" HEIGHT="21"><FONT FACE="Arial Black">Enzyme inhibition</FONT></TD> </TR> <TR> <TD WIDTH="52%" HEIGHT="21"><FONT FACE="Arial Black">Clofibrate</FONT></TD> <TD WIDTH="48%" HEIGHT="21"><FONT FACE="Arial Black">Enzyme inhibition</FONT></TD> </TR> <TR> <TD WIDTH="52%" HEIGHT="21"><FONT FACE="Arial Black">Erythromycin</FONT></TD> <TD WIDTH="48%" HEIGHT="21"><FONT FACE="Arial Black">Enzyme inhibition</FONT></TD> </TR> <TR> <TD WIDTH="52%" HEIGHT="21"><FONT FACE="Arial Black">Fluconazole</FONT></TD> <TD WIDTH="48%" HEIGHT="21"><FONT FACE="Arial Black">2C9 inhibition</FONT></TD> </TR> <TR> <TD WIDTH="52%" HEIGHT="21"><FONT FACE="Arial Black">Fluvastatin</FONT></TD> <TD WIDTH="48%" HEIGHT="21"><FONT FACE="Arial Black">2C9 inhibition</FONT></TD> </TR> <TR> <TD WIDTH="52%" HEIGHT="21"><FONT FACE="Arial Black">Fluvoxamine</FONT></TD> <TD WIDTH="48%" HEIGHT="21"><FONT FACE="Arial Black">Enzyme inhibition</FONT></TD> </TR> <TR> <TD WIDTH="52%" HEIGHT="21"><FONT FACE="Arial Black">Gemfibrozil</FONT></TD> <TD WIDTH="48%" HEIGHT="21"><FONT FACE="Arial Black">Enzyme inhibition</FONT></TD> </TR> <TR> <TD WIDTH="52%" HEIGHT="21"><FONT FACE="Arial Black">Isonizid</FONT></TD> <TD WIDTH="48%" HEIGHT="21"><FONT FACE="Arial Black">Enzyme inhibition</FONT></TD> </TR> <TR> <TD WIDTH="52%" HEIGHT="21"><FONT FACE="Arial Black">Itraconazole</FONT></TD> <TD WIDTH="48%" HEIGHT="21"><FONT FACE="Arial Black">Enzyme inhibition</FONT></TD> </TR> <TR> <TD WIDTH="52%" HEIGHT="21"><FONT FACE="Arial Black">Ketoconazole</FONT></TD> <TD WIDTH="48%" HEIGHT="21"><FONT FACE="Arial Black">Enzyme inhibition</FONT></TD> </TR> <TR> <TD WIDTH="52%" HEIGHT="21"><FONT FACE="Arial Black">Lovastatin</FONT></TD> <TD WIDTH="48%" HEIGHT="21"><FONT FACE="Arial Black">Enzyme inhibition</FONT></TD> </TR> <TR> <TD WIDTH="52%" HEIGHT="21"><FONT FACE="Arial Black">Metronidazole</FONT></TD> <TD WIDTH="48%" HEIGHT="21"><FONT FACE="Arial Black">2C9 inhibition</FONT></TD> </TR> <TR> <TD WIDTH="52%" HEIGHT="21"><FONT FACE="Arial Black">NSAIDS</FONT></TD> <TD WIDTH="48%" HEIGHT="21"><FONT FACE="Arial Black">Platelet inhibition</FONT></TD> </TR> <TR> <TD WIDTH="52%" HEIGHT="21"><FONT FACE="Arial Black">Propafenone</FONT></TD> <TD WIDTH="48%" HEIGHT="21"><FONT FACE="Arial Black">Enzyme inhibition</FONT></TD> </TR> <TR> <TD WIDTH="52%" HEIGHT="21"><FONT FACE="Arial Black">Simvastatin</FONT></TD> <TD WIDTH="48%" HEIGHT="21"><FONT FACE="Arial Black">Enzyme inhibition</FONT></TD> </TR> <TR> <TD WIDTH="52%" HEIGHT="21"><FONT FACE="Arial Black">Tamoxifen</FONT></TD> <TD WIDTH="48%" HEIGHT="21"><FONT FACE="Arial Black">Enzyme inhibition</FONT></TD> </TR> <TR> <TD WIDTH="52%" HEIGHT="21"><FONT FACE="Arial Black">Thyroid hormones</FONT></TD> <TD WIDTH="48%" HEIGHT="21"><FONT FACE="Arial Black">Increased Vit K catabolism</FONT></TD> </TR> <TR> <TD WIDTH="52%" HEIGHT="21"><FONT FACE="Arial Black">Tramadol</FONT></TD> <TD WIDTH="48%" HEIGHT="21"><FONT FACE="Arial Black">Enzyme inhibition</FONT></TD> </TR> <TR> <TD WIDTH="52%" HEIGHT="21"><FONT FACE="Arial Black">TMP/SMX</FONT></TD> <TD WIDTH="48%" HEIGHT="21"><FONT FACE="Arial Black">2C9 inhibition</FONT></TD> </TR> <TR> <TD HEIGHT="21" WIDTH="52%"><FONT FACE="Arial Black">Zafirlukast</FONT></TD> <TD HEIGHT="21" WIDTH="48%"><FONT FACE="Arial Black">2C9 inhibition</FONT></TD> </TR> <TR> <TD HEIGHT="21" WIDTH="52%"><B><FONT COLOR="#0000ff" FACE="Arial Black">HERBALS / SUPPLEMENTS</FONT></B></TD> <TD HEIGHT="21" WIDTH="48%"> </TD> </TR> <TR> <TD HEIGHT="21"><FONT FACE="Arial Black">Garlic</FONT></TD> <TD HEIGHT="21"><FONT FACE="Arial Black">Inhibition of platelet aggregation</FONT></TD> </TR> <TR> <TD HEIGHT="21"><FONT FACE="Arial Black">Ginger</FONT></TD> <TD HEIGHT="21"><FONT FACE="Arial Black">Decrease thromboxame production</FONT></TD> </TR> <TR> <TD HEIGHT="21"><FONT FACE="Arial Black">Feverfew</FONT></TD> <TD HEIGHT="21"><FONT FACE="Arial Black">Inhibition of platelet aggregation</FONT></TD> </TR> <TR> <TD HEIGHT="21"><FONT FACE="Arial Black">Ginkgo biloba</FONT></TD> <TD HEIGHT="21"><FONT FACE="Arial Black">Inhibition of platelet aggregation</FONT></TD> </TR> <TR> <TD HEIGHT="21"><FONT FACE="Arial Black">Kava</FONT></TD> <TD HEIGHT="21"><FONT FACE="Arial Black">Inhibition of platelet aggregation</FONT></TD> </TR> <TR> <TD HEIGHT="21"><FONT FACE="Arial Black">Papain</FONT></TD> <TD HEIGHT="21"><FONT FACE="Arial Black">Inhibition of platelet aggregation</FONT></TD> </TR> <TR> <TD HEIGHT="21"><FONT FACE="Arial Black">Danshen</FONT></TD> <TD HEIGHT="21"><FONT FACE="Arial Black">Inhibition of platelet aggregation</FONT></TD> </TR> <TR> <TD HEIGHT="21"><FONT FACE="Arial Black">Dong quai</FONT></TD> <TD HEIGHT="21"><FONT FACE="Arial Black">Inhibition of platelet aggregation</FONT></TD> </TR> <TR> <TD HEIGHT="21"><FONT FACE="Arial Black">Vitamin E</FONT></TD> <TD HEIGHT="21"><FONT FACE="Arial Black">Weak antiplatelet effect above 800 mg/D</FONT></TD> </TR> <TR> <TD HEIGHT="70"><FONT FACE="Arial Black">Others: </FONT><FONT SIZE="-1" FACE="Arial">Herbal teas than contain tonka beans, melilot (sweet cloverr), sweet woodruff, alfalfa, anise, arnica, artemisia, asa foetida, bogbean, bromelains, capsicum, celery, chamomile, fenugreek, horse chesnut, licorice, parseley passionflower, prickly ash, quassia, redclover.</FONT></TD> <TD HEIGHT="70"> </TD> </TR> <TR> <TD HEIGHT="30"><B><FONT COLOR="#ff0000" SIZE="+2" FACE="Arial Black">CAN DECREASE INR</FONT></B></TD> <TD HEIGHT="30"> </TD> </TR> <TR> <TD HEIGHT="21" WIDTH="52%"><B><FONT COLOR="#0000ff" FACE="Arial Black">DRUGS</FONT></B></TD> <TD HEIGHT="21" WIDTH="48%"><B><FONT COLOR="#ffffff" FACE="Arial Black">MECHANISM OF INTERACTION</FONT></B></TD> </TR> <TR> <TD HEIGHT="21"><FONT FACE="Arial Black">Barbiturates</FONT> </TD> <TD HEIGHT="21"><FONT FACE="Arial Black">Enzyme induction</FONT></TD> </TR> <TR> <TD HEIGHT="21" WIDTH="52%"><FONT FACE="Arial Black">Carbamazepine</FONT></TD> <TD HEIGHT="21" WIDTH="48%"><FONT FACE="Arial Black">Enzyme induction</FONT></TD> </TR> <TR> <TD HEIGHT="21" WIDTH="52%"><FONT FACE="Arial Black">Dicloxacilline</FONT></TD> <TD HEIGHT="21" WIDTH="48%"><FONT FACE="Arial Black">Enzyme induction</FONT></TD> </TR> <TR> <TD HEIGHT="21" WIDTH="52%"><FONT FACE="Arial Black">Methimazole</FONT></TD> <TD HEIGHT="21" WIDTH="48%"><FONT FACE="Arial Black">Decreased K catabolism</FONT></TD> </TR> <TR> <TD HEIGHT="21" WIDTH="52%"><FONT FACE="Arial Black">Propylthiouracil</FONT></TD> <TD HEIGHT="21" WIDTH="48%"><FONT FACE="Arial Black">Decreased K catabolism</FONT></TD> </TR> <TR> <TD HEIGHT="21" WIDTH="52%"><FONT FACE="Arial Black">Rifampin</FONT></TD> <TD HEIGHT="21" WIDTH="48%"><FONT FACE="Arial Black">Enzyme induction</FONT></TD> </TR> <TR> <TD HEIGHT="21"><B><FONT COLOR="#0000ff" FACE="Arial Black">HERBALS / SUPPLEMENTS</FONT></B></TD> <TD HEIGHT="21"> </TD> </TR> <TR> <TD HEIGHT="21"><FONT FACE="Arial Black">Coenzyme Q 10</FONT></TD> <TD HEIGHT="21"><FONT FACE="Arial Black">Structural similarity to vitamin K</FONT></TD> </TR> <TR> <TD HEIGHT="21"><FONT FACE="Arial Black">Ginseng</FONT></TD> <TD HEIGHT="21"><FONT FACE="Arial Black">Possible gensenoside antagonism of K</FONT></TD> </TR> <TR> <TD HEIGHT="21"><FONT FACE="Arial Black">Green tea</FONT></TD> <TD HEIGHT="21"><FONT FACE="Arial Black">High vitamin K content</FONT></TD> </TR> <TR> <TD HEIGHT="21"><FONT FACE="Arial Black">Others: </FONT><FONT SIZE="-1" FACE="Arial">Food rich in vitamin K, a natural antagonist of warfarin: green tea, dark green leafy vegetables (spinach, collard greens, broccoli, brussels sprouts), cabbage, raw forms of vegetables like endives, green scallions, green mustard, green turnips, watercress.</FONT></TD> <TD HEIGHT="21"><FONT FACE="Arial Black">High vitamin K content</FONT> </TD> </TR> <TR> <TD HEIGHT="30" WIDTH="52%"><FONT COLOR="#ff0000" SIZE="+2" FACE="Arial Black">INCREASE, THEN DECREASE</FONT></TD> <TD HEIGHT="30" WIDTH="48%"> </TD> </TR> <TR> <TD HEIGHT="21" WIDTH="52%"><FONT FACE="Arial Black">Phenytoin</FONT><br></TD> <TD HEIGHT="21" WIDTH="48%"><FONT FACE="Arial Black">Protein displacement, followed by enzyme induction</FONT></TD> </TR> </TABLE></CENTER></P> <B><FONT SIZE="-1" FACE="Arial"><BR> </FONT></B> <CENTER> <B><FONT SIZE="-1" FACE="Arial"> <HR NOSHADE> </FONT></B><br> <table width="700" border="1" cellspacing="0" cellpadding="0"> <tr> <td><div align="center"><B><U><FONT color="#0000FF" FACE="Arial Black">SOURCES</FONT></U></B></div></td> </tr> <tr> <td><B><FONT SIZE="-1" FACE="Arial">Practical Tips for Warfarin Dosing and Monitoring. Amir Jaffe, MD., Cleveland Clinic Journal of Medicine, Vol 70 No4, April 2003</FONT></B></td> </tr> <tr> <td><B><FONT SIZE="-1" FACE="Arial">Smolinske SC. Dietary supplement-drug interactions. J Am Med Womens Assoc. 1999;54:191-192. </FONT></B></td> </tr> <tr> <td><B><FONT SIZE="-1" FACE="Arial">Fugh-Berman A. Herb-drug interactions. Lancet. 2000;355:134-138</FONT><FONT SIZE="-1">. </FONT></B></td> </tr> <tr> <td><B><FONT SIZE="-1" FACE="Arial">Interactions between warfarin and nutritional supplements: PATIENT CARE / Aug 15, 2000 <www.patientcareonline.com></FONT></B></td> </tr> </table> <p><B><U><FONT color="#FF0000" FACE="Arial Black">SITE LINKS</FONT><FONT FACE="Arial Black"><BR> </FONT></U><FONT SIZE="-1" FACE="Arial"><A HREF="Anticoagulants.html">Anticoagulants.html</A></FONT></B><BR> <B><FONT SIZE="-1" FACE="Arial"><A HREF="DrugInteractions.html">DrugInteractions.html</A></FONT></B><BR> <B> <img src="../../BARS/IXSX.jpg" width="177" height="75" border="0" usemap="#Map"> <map name="Map"> <area shape="rect" coords="4,5,81,70" href="IX.html"> <area shape="rect" coords="87,4,171,69" href="index.html"> </map> <BR> <A HREF="Lists.html">Lists & Tables </A></B></p> <B><A HREF="Lists.html"><HR NOSHADE> </A></B> </CENTER> </BODY> </HTML>