Warfarin With Fluoroquinolones, Sulfonamides, or Azole Antifungals: Interactions and the Risk of Hospitalization for Gastrointestinal Bleeding
- 6 August 2008
- journal article
- Published by Wiley in Clinical Pharmacology & Therapeutics
- Vol. 84 (5), 581-588
- https://doi.org/10.1038/clpt.2008.150
Abstract
The aim of this study was to determine whether a potential pharmacokinetic interaction between warfarin and orally administered anti‐infectives increases the risk of hospitalization for gastrointestinal (GI) bleeding in warfarin users. We conducted a nested case–control and case–crossover study using US Medicaid data. Logistic regression was used to determine the association between GI bleeding and prior use of ciprofloxacin, levofloxacin, gatifloxacin, co‐trimoxazole, or fluconazole vs. no exposure and also vs. use of cephalexin, which would not be expected to interact with warfarin. All of the anti‐infectives examined were associated with elevated odds ratios (ORs) when compared to no exposure to these drugs. With cephalexin data as the reference, the ORs for co‐trimoxazole (OR: 1.68 (95% confidence interval (CI): 1.21–2.33) in the prior 6–10 days) and fluconazole (OR: 2.09 (95% CI: 1.34–3.26) in the prior 11–15 days) were significantly elevated. Warfarin users who had received an anti‐infective agent showed a substantially increased risk of GI bleeding. However, a drug–drug interaction with warfarin was evident only for co‐trimoxazole and fluconazole. Clinical Pharmacology & Therapeutics (2008); 84 , 5, 581–588 doi:10.1038/clpt.2008.150Keywords
This publication has 33 references indexed in Scilit:
- Bleeding Complications With Warfarin UseArchives of Internal Medicine, 2007
- Clinical classification schemes for predicting hemorrhage: Results from the National Registry of Atrial Fibrillation (NRAF)American Heart Journal, 2006
- Effect of Ciprofloxacin on the Pharmacokinetics and Pharmacodynamics of WarfarinClinical Infectious Diseases, 1996
- Positive Predictive Value of ICD-9 Codes in the Identification of Cases of Complicated Peptic Ulcer Disease in the Saskatchewan Hospital Automated DatabaseEpidemiology, 1996
- Interaction of Dietary Factors with Oral Anticoagulants: Review and ApplicationsJournal of the American Dietetic Association, 1995
- Diarrhoea, vitamin K, and warfarinThe Lancet, 1994
- Adverse reaction reporting of interaction between warfarin and fluoroquinolonesArchives of Internal Medicine, 1991
- Antibiotic-associated hypoprothrombinaemiaJournal of Antimicrobial Chemotherapy, 1988
- Bleeding in patients with infections. Are antibiotics helping or hurting?Archives of Internal Medicine, 1982
- Interindividual Differences in the Response to Oral AnticoagulantsDrugs, 1977