Can i take digoxin with warfarin

How can clinicians use this information? To prescribe safely, there are 3 choices: one is to never prescribe or allow another medicine to be given with warfarin.

This is clearly impractical for most patients requiring warfarin. The third option is to group the majority of offending interacting drugs into easier-to-remember families or therapeutic groups, as we have done in Table 3. New oral anticoagulants may soon be available but have not demonstrated superior long-term efficacy, safety, or drug interaction profile compared with warfarin.

While the drug interaction literature is generally of poor quality, relatively consistent reporting of interactions between warfarin and certain commonly used drugs and drug families mainly anti-infective agents, lipid-lowering drugs, NSAIDs including COX-2 selective NSAIDs, selective serotonin reuptake inhibitors, amiodarone, omeprazole, fluorouracil, and cimetidine is cause for concern. In patients who are starting therapy with one of these medicines, consideration should be given to using an alternative medication with less potential for warfarin interactions eg, rabeprazole instead of omeprazole and acetaminophen instead of NSAIDs.

More frequent INR testing during the 2 weeks of the onset or discontinuation of treatment with other medications is advisable. Finally, we recommend the use of more rigorous methods to examine warfarin interactions in patients eg, RCTs, N of 1 crossover studies, or large health database analyses. Correspondence: Anne M. Our website uses cookies to enhance your experience.

By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy Continue. Table 1. View Large Download. Chest ; suppl S- S[published correction appears in Chest. Oral anticoagulants: mechanism of action clinical effectiveness and optimal therapeutic range. Engelsen JNielsen JDHansen KE Effect of coenzyme Q10 and ginkgo biloba on warfarin dosage in patients on long-term warfarin treatment: a randomized double-blind, placebo-controlled cross-over trial.

Effect of ciprofloxacin on the pharmacokinetics and pharmacodynamics of warfarin. Lambert JCormier J Potential interaction between warfarin and boldo-fenugreek. Dingemanse JMeyerhoff CSchadrack J Effect of the catechol-O-methyltransferase inhibitor entacapone on the steady-state pharmacokinetics and pharmacodynamics of warfarin.

Monterrey-Rodriguez J Interaction between warfarin and mango fruit [letter]. Marinella MA Mesalamine and warfarin therapy resulting in decreased warfarin effect. Schulman S Inhibition of warfarin activity by ribavirin. Mallikaarjun SBramer SL Effect of cilostazol on the pharmacokinetics and pharmacodynamics of warfarin. Eprosartan does not affect the pharmacodynamics of warfarin.

Ragueneau-Majlessi ILevy RHMeyerhoff C Lack of effect of repeated administration of levetiracetam on the pharmacodynamic and pharmacokinetic profiles of warfarin. Losartan does not affect the pharmacokinetics and pharmacodynamics of warfarin.

Heinig RKitchin NRolan P Disposition of a single dose of warfarin in healthy individuals after pretreatment with metrifonate. Arzneimittelforschung ; 46 PubMed Google Scholar. Moexipril does not alter the pharmacokinetics or pharmacodynamics of warfarin. Effect of montelukast on the pharmacokinetics and pharmacodynamics of warfarin in healthy volunteers. Anderson DMShelley SCrick NBuraglio M No effect of the novel antidiabetic agent nateglinide on the pharmacokinetics and anticoagulant properties of warfarin in healthy volunteers.

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Pharmacotherapy ; PubMed Google Scholar. Guerret MFrancheteau PHuber M Evaluation of effects of terbinafine on single oral dose pharmacokinetics and anticoagulant actions of warfarin in healthy volunteers. Newshan GTsang P Ritonavir and warfarin interaction. Need of more frequent international normalized ratio monitoring in elderly patients on long-term anticoagulant therapy after influenza vaccination.

Drug Investig ; Google Scholar Crossref. The mechanism of the interaction between amiodarone and warfarin in humans. Mechanism of warfarin potentiation by amiodarone: dose and concentration-dependent inhibition of warfarin elimination. O'Reilly RA Comparative interaction of cimetidine and ranitidine with racemic warfarin in man. Cimetidine: interaction with oral anticoagulants in man.

Effect of two cimetidine regimens on prothrombin time and warfarin pharmacokinetics during long-term warfarin therapy. Clin Pharm ; [published correction appears in Clin Pharm. Pharmacotherapy ; Google Scholar. Clin Pharmacol Ther ;51piii- 52 Google Scholar. O'Reilly RA The stereoselective interaction of warfarin and metronidazole in man.

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Breckenridge AOrme M Clinical implications of enzyme induction. O'Reilly RA Interaction of sodium warfarin and rifampin: studies in man. O'Reilly RA Lack of effect of fortified wine ingested during fasting and anticoagulant therapy. O'Reilly RA Lack of effect of mealtime wine on the hypoprothrombinemia of oral anticoagulants.

Lack of interaction between famotidine and warfarin. Udall JA Warfarin interactions with chloral hydrate and glutethimide. O'Reilly RA Dynamic interaction between disulfiram and separated enantiomorphs of racemic warfarin. Carabino JWang F International normalized ratio fluctuation with warfarin-fluorouracil therapy [letter]. Bartle WR Grapefruit juice might still be factor in warfarin response [letter].

Levine MSheppard I Biphasic interaction of phenytoin with warfarin. Koch-Weser J Quinidine-induced hypoprothrombinemic hemorrhage in patients on chronic warfarin therapy. Gaw AWosornu D Simvastatin during warfarin therapy in hyperlipoproteinaemia [letter]. Westfall LK An unrecognized cause of warfarin resistance [letter]. Danos EA Apparent potentiation of warfarin activity by tetracycline.

Rosado MF Thrombosis of a prosthetic aortic valve disclosing a hazardous interaction between warfarin and a commercial ginseng product. Cambria-Kiely JA Effect of soy milk on warfarin efficacy. Schulman SHenriksson K Interaction of ibuprofen and warfarin on primary haemostasis. Mieszczak CWinther K Lack of interaction of ketoprofen with warfarin. Antila SJarvinen AHonkanen TLehtonen L Pharmacokinetic and pharmacodynamic interactions between the novel calcium sensitiser levosimendan and warfarin.

Malacarne PMaestri A Possible interactions between antiblastic agents and warfarin inducing prothrombin time abnormalities [letter]. Yue QJansson K Herbal drug curbicin and anticoagulant effect with and without warfarin: possibly related to the vitamin E component [letter].

Booth CD Drug interaction between danazol and warfarin. Pharm J ; Google Scholar. Sylven CAnderson P Evidence that disopyramide does not interact with warfarin. Ahmad S Lovastatin: warfarin interaction. Lim VPande I Leflunomide can potentiate the anticoagulant effect of warfarin. A natural element found in grapefruit latches onto the intestinal enzyme called CYP3A4, which alters the breakdown of the calcium channel blockers, possibly resulting in excessively high blood levels of the drug, along with an increased risk of serious side effects.

This effect dissipates slowly. One study indicated that one third of the impact on CYP3A4 from grapefruit juice was still evident a full 24 hours later. The interaction between grapefruit and calcium channel blockers is strongest, for example, with felodipine Plendil , nicardipine Cardene , and nisoldipine Sular and weaker with amlodipine Norvasc , diltiazem Cardizem , and nifedipine Adalat.

Tangelos, a cross between a tangerine and grapefruitlike pomelo and Seville oranges, a bitter citrus fruit used to make marmalades, can have the same deleterious effects as grapefruit on both statins and calcium channel blockers.

Erectile Dysfunction Drugs and Grapefruit Although unproven, evidence points to the likely fact that grapefruit juice gives a boost to blood levels of erectile dysfunction drugs such as sildenafil Viagra.

This may seem like a boon to some men, but it could trigger headaches symptomatic of fatal or near fatal conditions, flushing, or low blood pressure. Antibiotics and Dairy Products Dairy products such as milk, yogurt, and cheese can delay or prevent the absorption of antibiotics such as tetracyclines and ciprofloxacin Cipro. This occurs because the calcium in such foods binds to the antibiotics in the stomach and upper small intestine to form an insoluble compound.

To avoid problems, Zive recommends taking an antibiotic one hour before or two hours after a meal. MAOIs and Tyramine-Containing Foods Monoamine oxidase inhibitors are an older type of antidepressant still prescribed, albeit less frequently, due to their serious side effects. Antithyroid drugs work by preventing iodine absorption in the stomach. She is cautious about taking any other drug that might affect her warfarin levels.

I take digoxin, amiodarone, frusemide, isosorbide mononitrate, spironolactone, lisinopril and warfarin. And iron because of the warfarin and because I'm still bleeding in the gut somewhere, in the colon, and they can't do anything about it. I'm on a very high dose of iron to keep my haemoglobin up. Not really, I've not really noticed any side-effects other than those. But I do, if I go to the chemist for anything, then I always tell them what drugs I'm on and they're pretty good. You know, they sort of look it up in a book.

And I won't take anything unless, if it interferes with warfarin, then I don't take it, you know, I've had a period of not being able to sleep and I thought I'd try Valerian, the complementary medicine, and I found that that interfered with warfarin.

It's a bit of a balance actually, the whole rigmarole of the drugs, but you know, as I say, it's just second nature to me, I just take them. In fact my husband brings my coffee up in the morning and before I even lift it I've got my pills out, you know. Mahendra had to stay in hospital before and after his ICD was fitted where his warfarin was replaced by heparin before having surgery.

So you went into hospital before the ICD was fitted? And they changed your warfarin for heparin. They had to put me on heparin. Can we talk about it because that is a very specific case. So how long before did you go into hospital? They called me a week before that, you know. They put me on heparin to make sure that the levels dropped before they can insert this defibrillator, you see.

And then you had to stay. Mahendra explained the monitoring that followed his surgery to put him back on warfarin. Do you remember how soon after the ICD was fitted you went back on to warfarin? They had to put me slowly back to warfarin because soon as the operation was done from next day they had to check the INR and according to what levels my INR then they had to give me that much warfarin, you know, those levels, like 5mg or 6mg to go back to normal, you know, what my targets are, you know 3.

So soon as it was up to 3.