Warfarin users, beware of antibiotics - Harvard Health (warfarin sodium) is a prescription medicine used to treat blood clots and to lower the chance of blood clots forming in your body. Warfarin often can interact with antibiotics and antifungal medications to. INR with a common, broad-spectrum antibiotic such as erythromycin or ciprofloxacin. Get health information and advice from the experts at Harvard Medical School.
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Cipro - FDA prescribing information, side effects and uses - Prophylaxis and treatment of venous thrombosis and its extension, pulmonary embolism (PE) Initial dose: 2-5 mg PO/IV q Day for 2 days, OR 10 mg PO for 2 days in healthy individuals Initiate warfarin on day 1 or 2 of LMWH or unfractionated heparin therapy and overlap until desired INR, THEN discontinue heparin Check INR after 2 days and adjust dose according to results Typical maintenance dose ranges between 2 and 10 mg/day Consider dosage based on genotype (see Genomic Considerations) Prophylaxis and treatment of systemic embolic complications (eg, stroke) associated with atrial fibrillation (AF) Initial dose: 2-5 mg PO/IV q Day × 2 days, OR 10 mg PO × 2 days in healthy individuals Check INR after 2 days and adjust dose according to results Typical maintenance dose ranges between 2-10 mg/day Consider dosage based on genotype (see Genomic Considerations) ACCP guidelines recommend dabatran 150 mg PO BID over adjusted-dose warfarin therapy for AF unless both AF and mitral stenosis are present Prophylaxis and treatment of thromboembolic complications associated with cardiac valve replacement Initial dose: 2-5 mg PO/IV q Day × 2 days, OR 10 mg PO × 2 days in healthy individuals Check INR after 2 days and adjust dose according to results Typical maintenance dose ranges between 2 and 10 mg/day Consider dosage based on genotype (see Genomic Considerations) Reduction in the risk of death, recurrent MI, and thromboembolic events (eg, stroke, systemic embolization) after MI Initial dose: 2-5 mg PO/IV q Day × 2 days, OR 10 mg PO × 2 days in healthy individuals Check INR after 2 days and adjust dose according to results Typical maintenance dose ranges between 2 and 10 mg/day Consider dosage based on genotype (see Genomic Considerations) ACCP 2012 guidelines recommend against using pharmacogenetic testing for guiding doses CYP2C9 and vitamin K epoxide reductase complex, subunit 1 (VKORC1) genotype information can assist in selecting starting dose If genotype information unavailable, usual starting dose is 2-5 mg/day (modify based on other patient factors) Range of expected therapeutic doses based on CYP2C9 and VKORC1 genotypes are listed below Indication determines intensity and duration of therapy Individualized doses and monitoring of PT/INR are necessary Monitoring frequency should be daily or once every few days until stabilized; once stable, q4-6 weeks or longer may be appropriate (eg, 12 weeks) Not all factors causing warfarin dose variability are known, but they include age, race, sex, body weht, concomitant medications, and comorbidities, in addition to genetic factors Lower starting doses (ie, 2-5 mg/day × 2 days) recommended with the elderly, hepatic impairment, poor nutrition, CHF, hh bleeding risk, debilitated patients, heart valve replacement, concomitant medications known to increase warfarin effect, or individuals suspected of having genomic variants Perioperative management recommendations: Hold warfarin therapy approximately 5 days before surgery; resume warfarin 12-24 hr after surgery; bridge anticoagulation during interruption in patients at hh thromboembolism risk Minor procedures and dental procedures: See ACCP guidelines for specific recommendations Warfarin has no direct effect on an established thrombus, nor does it reverse ischemic tissue damage Systemic atheroemboli and cholesterol microemboli; some cases have progressed to necrosis or death; discontinue therapy if such emboli occur Pregnant women with mechanical heart valves: Therapy may cause fetal harm; however, benefits may outweh the risks Prevention/treatment: If baseline INR is 1.0-1.3, administer loading dose of 0.1-0.2 mg/kg PO q Day × 1 day; check INR on days 2-4 and adjust daily dose to maintain INR between 2.0 and 3.0 (unless valve replacement indicates a hher range) Use 0.1 mg/kg to initiate therapy with liver impairment or in patients who have had a Fontan procedure Typical maintenance dose: 0.09-0.33 mg/kg/day, with infants Elderly show greater than expected PT/INR response to anticoagulant effects of warfarin, possibly because of decreased hepatic function resulting in decreased warfarin metabolism and impaired synthesis of clotting factors Caution should be used in elderly individuals who have increased risk of hemorrhage Cholesterol embolus syndrome Intraocular hemorrhage Abdominal pain Flatulence Alopecia Rash Pruritus Taste disturbance Tissue necrosis Headache Lethargy Dizziness Hematuria Anemia Hepatitis Respiratory tract bleeding Hypersensitivity reaction Hemorrhage Blood dyscrasias Fever "Purple toe" syndrome Increased fracture risk with long-term usage Calciphylaxis Warfarin sodium can cause major or fatal bleeding; bleeding is more likely to occur during the starting period and with a hher dose (resulting in a hher INR) Risk factors for bleeding include hh intensity of anticoagulation (INR greater than 4), age 65 years or older, hy variable INRs, history of gastrointestinal bleeding, hypertension, cerebrovascular disease, serious heart disease, anemia, malnancy, trauma, renal insufficiency, concomitant drugs, and long duration of warfarin therapy Regular monitoring of INR should be performed on all treated patients; those at hh risk of bleeding may benefit from more frequent INR monitoring, careful dose adjustment to desired INR, and a shorter duration of therapy Patients should be instructed about prevention measures to minimize the risk of bleeding and to immediately report any sns or symptoms of bleeding to their physician Pregnancy, except in women with mechanical heart valves Hemorrhagic tendencies or blood dyscrasias Recent or contemplated CNS or eye surgery or traumatic surgery resulting in large open surfaces Bleeding tendencies associated with CNS hemorrhage, cerebral aneurysms, dissecting aorta, pericarditis and pericardial effusions, bacterial endocarditis, and active ulceration or overt bleeding of the GI, GU, or respiratory tract Threatened abortion, eclampsia, and preeclampsia Unsupervised patients with conditions associated with potential hh level of noncompliance (eg, dementia, alcoholism, psychosis) Spinal puncture and other diagnostic or therapeutic procedures with potential for uncontrollable bleeding Major regional or lumbar block anesthesia Known hypersensitivity Malnant hypertension Lower doses may be warranted in the elderly, debilitated patients, malnutrition, CHF, or liver disease Elicits no direct effect on an established thrombus, nor does it reverse ischemic tissue damage INR 4.0 appears to provide no additional therapeutic benefit in most patients and is associated with a hher risk of bleeding Skin necrosis reported with use; caution in patients at risk for hemorrhage, necrosis, or gangrene Heparin-induced thrombocytopenia, DVT (may defer warfarin until thrombin generation is controlled and thrombocytopenia has resolved) Genetic tests may be warranted to determine best dose for individual patients; variations in CYP2C9 and VKORC1 genes may modify response Advise patients receiving warfarin to carry a notice stating that they are undergoing anticoagulant therapy, to alert medical/emergency personnel Use caution in patients with acute infection or active TB or conditions that may alter normal GI flora; antibiotics and fever may change response to warfarin May release atheromatous plaque emboli; may experience symptoms depending on site of embolization common organs like pancreas, liver, kidneys, and spleen, which may lead to necrosis or death Use caution in patients with prolonged vitamin K insufficiencies Thyroid disease may increase warfarin responsiveness May impair synthesis of coagulation factors in patients with reduced liver function, regardless of etiology, which in turn may lead to increased warfarin sensitivity Lactation Calciphylaxis or calcium uremic arteriolopathy has been reported in patients with and without end-stage renal disease; discontinue warfarin and treat calciphylaxis as appropriate; consider alternative anticoagulant therapy Maintain consistent intake of vitamin K-containing foods; hh vitamin K consumption may decrease warfarin effect Pregnancy category: D for women with mechanical heart valves who are at hh risk for thromboembolism; category X (ie, contraindicated) for other pregnant populations Exposure during pregnancy causes a recognized pattern of major congenital malformations (warfarin embryopathy and fetotoxicity), fatal fetal hemorrhage, and an increased risk of spontaneous abortion and fetal mortality Verify pregnancy status of females of reproductive potential prior to initiating therapy Advise females of reproductive potential to use effective contraception during treatment, and for at least 1 month after final dose of warfarin Lactation: Not excreted in breast milk as reported in limited published study (AAP Committee states compatible with nursing); because of potential for serious adverse reactions, including bleeding in breastfed infant, consider developmental and health benefits of breastfeeding along with mother’s clinical need for therapy; monitor breastfeeding infants for bruising or bleeding Interferes with hepatic synthesis of vitamin K-dependent clotting factors II, VII, IX, and X, as well as proteins C and S; S-warfarin is 4 times more potent than R-warfarin Warfarin depletes functional vitamin K reserves, which in turn reduces synthesis of active clotting factors, by competitively inhibiting subunit 1 of the multi-unit vitamin K epoxide reductase complex 1 (VKOR1) Metabolized primarily via oxidation in the liver by CYP2C9; exerts its anticoagulant effect by inhibiting the protein VKORC1 Dose influenced by genetic factors (CYP2C9, VKORC1 genotypes) Carriers of CYP2C9*2 and CYP2C9*3 require ~19-33% dose reduction, respectively, per allele compared with persons who carry the *1 allele Carriers of the VKORC1 A allele require ~28% dose reduction per allele in their genotype compared with persons who carry none Solution: D10W, NS (? Individual plans may vary and formulary information changes. Cipro is contraindicated in persons with a history of hypersensitivity to Ciprofloxacin, any member of the quinolone class of antibacterials, or any of the product.
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Interactions among Travel Vaccines & Drugs - Chapter 2 - 2016. I am taking Coumadin due to blood clots in my lungs 4 months ago. The clinical snificance of this finding is uncertain. Similarly, a. Coroquine is also reported to decrease the bioavailability of ciprofloxacin and methotrexate.
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Because fluoroquinolones, including Cipro, have been associated with serious adverse reactions (5.1-5.15), reserve Cipro for use in patients who have no alternative treatment options for the following indications: Although treatment of infections due to this organism in this organ system demonstrated a cliniy snificant outcome, efficacy was studied in fewer than 10 patients.
Coumadin, Jantoven warfarin dosing, indications, interactions. Limitations of Use Coumadin has no direct effect on an established thrombus, nor does it reverse ischemic tissue damage. Medscape - Deep vein thrombosis, pulmonary embolism, recurrent myocardial infarction-specific dosing for Coumadin, Jantoven warfarin, frequency-based.