warfarin drug interactions - university of washington
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Warfarin drug interactionsPublished on Anticoagulation Services(https://depts.washington.edu/anticoag/home)
Warfarin drug interactions
Drug Interaction Classification SystemsSignificanceRating (A)
Criteria ManagementRating (B)
Criteria
0 Not listed 0 Not listed1 Severity - Major: The effects are potentially
life-threatening or capable of causing permanentdamage.Documentation: interaction is suspected,probable or established
1 Avoidcombination
2 Severity - Moderate: The effects may causedeterioration in a patient's clinical status.Additional treatment, hospitalization, or anextended hospital stay may be necessary.Documentation: interaction is suspected,probable or established
2 Usually avoidcombination
3 Severity - Minimal: The effects are usually mild;consequences may be bothersome orunnoticeable but should not significantly affect thetherapeutic outcome. Additional treatment isusually not required.Documentation: interaction is suspected,probable or established
3 Minimize risk
4 Severity – Major or ModerateDocumentation: Interaction is possible
4 No actionneeded
5 Severity: MinorDocumention: possibleORSeverity: Major, Moderate or MinorDocumentation: interaction is unlikely
5 No interaction
A. Tatro DS (ed). Drug Interaction Facts. St Louis MO: Wolters Kluwer, 2010B. Hansten P,Horn J. Drug Interactions Analysis and Management. St Louis MO: Wolters Kluwer 2010.
Drug/Drug
ClassEffect on
INRProposed
MechanismSignificance
(A)Managemen
t (B)acarbose increased Unexplained
Mechanisms4 0
acetaminophen
increased Inhibition ofWarfarin
Metabolism
2 3
alcohol(acute use)
increased Inhibition ofWarfarin
4 3
©2014 University of WashingtonPage 1 of 7
Warfarin drug interactionsPublished on Anticoagulation Services(https://depts.washington.edu/anticoag/home)
Metabolismalcohol(chronic
use)
decreased Induction ofWarfarin
Metabolism
4 3
allopurinol increased Inhibition ofWarfarin
Metabolism
4 3
aminoglutethamide
decreased Induction ofWarfarin
Metabolism
2 3
amiodarone increased Inhibition ofWarfarin
Metabolism
1 3
amitriptyline increased Inhibition ofWarfarin
Metabolism
0 4
Androgens increased UnexplainedMechanisms
1 2
aprepitant decreased Induction ofWarfarin
Metabolism
4 3
ascorbicacid
decreased UnexplainedMechanisms
5 3
aspirin/salicylates
no effect IncreasedBleeding
Risk
1 2
azathioprine decreased UnexplainedMechanisms
2 3
azithromycin
increased Inhibition ofWarfarin
Metabolism
1 5
Azole Antifungals
increased Inhibition ofWarfarin
Metabolism
1 3
Barbiturates
decreased Induction ofWarfarin
Metabolism
1 2
bosentan decreased Induction ofWarfarin
Metabolism
2 3
capecitabine
increased Inhibition ofWarfarin
Metabolism
1 3
carbamazepine
decreased Induction ofWarfarin
Metabolism
2 3
carboplatin increased UnexplainedMechanisms
1 0
celecoxib increased Inhibition ofWarfarin
Metabolism
1 4
Cephalosporins
increased DecreasedSynthesis of
ClottingFactors
2 2
chloralhydrate
increased ProteinBinding Disp
lacement
3 3
chloramphe increased Inhibition of 2 0©2014 University of Washington
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Warfarin drug interactionsPublished on Anticoagulation Services(https://depts.washington.edu/anticoag/home)
nicol WarfarinMetabolism
cholestyramine
decreased ReducedAbsorptionof Warfarin
2 3
cimetidine increased Inhibition ofWarfarin
Metabolism
1 2
ciprofloxacin increased Inhibition ofWarfarin
Metabolism
1 3
clarithromycin
increased Inhibition ofWarfarin
Metabolism
1 3
clofibrate increased UnexplainedMechanisms
1 2
clopidogrel/ticlopidine
no effect IncreasedBleeding
Risk
0 4
colestipol decreased ReducedAbsorptionof Warfarin
2 3
Contraceptives, Oral
decreased IncreasedClotting
Factor Synthesis/Activity
0 2
Corticosteroids
either UnexplainedMechanisms
2 4
cyclophosphamide
increased UnexplainedMechanisms
1 3
cyclosporin decreased UnexplainedMechanisms
4 4
delavirdine increased Inhibition ofWarfarin
Metabolism
4 0
diazoxide increased ProteinBinding Disp
lacement
0 4
dicloxacillin decreased Induction ofWarfarin
Metabolism
2 4
diltiazem increased UnexplainedMechanisms
0 4
DirectThrombin
Inh.
increased Additive AnticoagulantResponse
2 0
disopyramide
increased UnexplainedMechanisms
5 4
disulfiram increased Inhibition ofWarfarin
Metabolism
2 2
efavirenz increased Inhibition ofWarfarin
Metabolism
4 0
erythromycin
increased Inhibition ofWarfarin
Metabolism
1 3
ethacrynic increased Protein 4 4©2014 University of Washington
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Warfarin drug interactionsPublished on Anticoagulation Services(https://depts.washington.edu/anticoag/home)
acid Binding Displacement
ethcholvynol
decreased Induction ofWarfarin
Metabolism
2 3
etoposide increased UnexplainedMechanisms
1 0
felbamate increased UnexplainedMechanisms
4 4
fenofibrate increased UnexplainedMechanisms
1 3
fluorouracil increased Inhibition ofWarfarin
Metabolism
1 3
fosphenytoina
either Induction orInhibition of
WarfarinMetabolism
2 3
gefitinib increased UnexplainedMechanisms
2 0
gemcitabine increased UnexplainedMechanisms
1 3
gemfibrozil increased UnexplainedMechanisms
1 2
glutethamide
decreased Induction ofWarfarin
Metabolism
2 2
glyburide increased UnexplainedMechanisms
0 3
griseofulvin decreased Induction ofWarfarin
Metabolism
2 3
heparin/LMWHs
increased Additive AnticoagulantResponse
0 3
ifosfamide increased Inhibition ofWarfarin
Metabolism
4 0
influenzavaccine
increased UnexplainedMechanisms
4 4
isoniazide increased Inhibition ofWarfarin
Metabolism
4 3
isotretinoin increased UnexplainedMechanisms
4 4
leflunamide increased Inhibition ofWarfarin
Metabolism
4 0
levofloxacin increased Inhibition ofWarfarin
Metabolism
1 4
lovastatin increased Inhibition ofWarfarin
Metabolism
1 3
mefloquine increased UnexplainedMechanisms
4 3
menthol decreased UnexplainedMechanisms
4 4
mercaptopu decreased Unexplained 2 3©2014 University of Washington
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Warfarin drug interactionsPublished on Anticoagulation Services(https://depts.washington.edu/anticoag/home)
rine Mechanismsmesalamine increased Unexplained
Mechanisms4 3
methimazole
decreased ReducedCatabolismof Clotting
Factors
1 3
metronidazole
increased Inhibition ofWarfarin
Metabolism
1 2
mineral oil increased UnexplainedMechanisms
5 4
mitotane decreased Induction ofWarfarin
Metabolism
4 3
moxifloxacin increased Inhibition ofWarfarin
Metabolism
1 0
nafcillin decreased Induction ofWarfarin
Metabolism
2 3
nalidixicacid
increased Inhibition ofWarfarin
Metabolism
2 3
neomycin increased ImpairedVitamin KProduction
by Gut Flora
5 3
norfloxacin increased Inhibition ofWarfarin
Metabolism
1 3
NSAIDs no effect IncreasedBleeding
Risk
1 2
ofloxacin increased Inhibition ofWarfarin
Metabolism
1 3
omeprazole increased Inhibition ofWarfarin
Metabolism
4 4
orlistat increased Inhibition ofWarfarin
Metabolism
4 4
paclitaxel increased UnexplainedMechanisms
1 0
phenytoina decreased Induction orInhibition of
WarfarinMetabolism
2 3
prasugrel no effect IncreasedBleeding
Risk
0 0
primidone decreased Induction ofWarfarin
Metabolism
1 2
progestins increased UnexplainedMechanisms
4 4
propafenone increased Inhibition ofWarfarin
4 3
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Warfarin drug interactionsPublished on Anticoagulation Services(https://depts.washington.edu/anticoag/home)
Metabolismpropoxyphe
neincreased Unexplained
Mechanisms4 3
propranolol increased UnexplainedMechanisms
4 4
propylthiouracil
decreased ReducedCatabolismof Clotting
Factors
1 3
ProteaseInhibitors
decreased UnexplainedMechanisms
4 3
quinidine increased Inhibition ofWarfarin
Metabolism
1 3
quinine increased Inhibition ofWarfarin
Metabolism
1 0
reserpine increased UnexplainedMechanisms
0 4
ribavirin decreased UnexplainedMechanisms
4 3
Rifamycins decreased Induction ofWarfarin
Metabolism
2 2
rofecoxib increased Inhibition ofWarfarin
Metabolism
1 4
simethicone decreased ReducedAbsorptionof Warfarin
0 4
simvastatin increased Inhibition ofWarfarin
Metabolism
1 4
spironolactone
decreased Hemoconcentration of
ClottingFactors
5 4
SSRIs increased Inhibition ofWarfarin
Metabolism
4 3
sucralfate decreased ReducedAbsorptionof Warfarin
5 3
SulfaAntibiotics
increased Inhibition ofWarfarin
Metabolism
1 3
Sulfinpyrazone
increased Inhibition ofWarfarin
Metabolism
1 2
tamoxifen increased UnexplainedMechanisms
4 0
telithromycin
increased Inhibition ofWarfarin
Metabolism
1 4
temafloxacin
increased Inhibition ofWarfarin
Metabolism
1 4
terbinafine decreased Induction ofWarfarin
4 0
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Warfarin drug interactionsPublished on Anticoagulation Services(https://depts.washington.edu/anticoag/home)
Metabolismtestosterone increased Unexplained
Mechanisms4 0
Tetracyclines
increased ImpairedVitamin KProduction
by Gut Flora
1 3
ThiazideDiuretics
decreased Hemoconcentration of
ClottingFactors
5 4
Thrombolytics
increased Additive AnticoagulantResponse
1 0
ThyroidHormones
increased IncreasedCatabolismof Clotting
Factors
1 3
tolterodine increased UnexplainedMechanisms
4 4
tramadol increased UnexplainedMechanisms
2 0
trazodone decreased UnexplainedMechanisms
2 4
trastuzumab increased UnexplainedMechanisms
4 0
vitamin E increased DecreasedSynthesis of
ClottingFactors
1 3
vitamin K decreased IncreasedClotting
Factor Synthesis/Activity
2 3
zafirlukast increased Inhibition ofWarfarin
Metabolism
0 3
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