Drug Interactions of Anticoagulants (Part 2)

Drug Interactions of Heparin:

More Presentations from Naina Mohamed, PhD

©   Heparin is used to treat and prevent Deep Vein Thrombosis (DVT), Pulmonary Embolism (PE) and Arterial Thromboembolism.

©   Heparin is also used in the treatment of Myocardial Infarction (Heart Attack) and Unstable Angina.

©   Regular blood monitoring of Partial Thromboplastin Time (aPTT) (Time taken by blood plasma to clot) is recommended to check the effectiveness and safety of Heparin.

©   Concomitant use of Heparin and Telavancin or Oritavancin is Contraindicated due to artificial prolongation of activated Partial Thromboplastin Time (aPTT) test results.

©   Drugs increasing the risk of Heparin associated bleeding, include…

·      Enoxaparin

·      Dalteparin

·      Bivalirudin

·      Danaparoid

·      Rivaroxaban

·      Apixaban

·      Dabigatran

ª    Drugs increasing Anticoagulants associated bleeding risk, include…

·      NSAIDs (Ibuprofen, Diclofenac, Naproxen, etc)

·      Selective serotonin reuptake inhibitors (SSRIs) (Fluvoxamine, Paroxetine, Vortioxetine,  Escitalopram, Sertraline, Nefazodone, vilazodone)

·      Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) (Venlafaxine, Desvenlafaxine, Duloxetine, Milnacipran, Levomilnacipran, Sibutramine)

·      Fibrinolytics (Alteplase, Retaplase, Tenecteplase, Streptokinase, Urokinase)

·      Antiplatelet agents (Aspirin, Clopidogrel, Ticagrelor, etc)

·      Fenofibrate

·      Orlistat

·      Alprostadil (Prostaglandin E1)

·      Ginkgo

·      Garlic

·      Papaya

·      Chamomile (Matricaria chamomilla)

·      Ginger

·      Fenugreek

·      Anise

·      Clove oil

·      Asafetida

·      Capsaicin

·      Evening primrose oil

·      Licorice

·      Celery

©   Drug interactions can result in significant morbidity and mortality and thus minimizing the risk for drug interactions should be a goal in drug therapy.

©   The patients with clotting disorders should bring a list of all of the drugs they are taking including prescription drugs, over-the-counter drugs, and any supplements, herbal or otherwise, during their visit to the doctor or pharmacist.

©   The risk of adverse effects could be reduced by healthcare professionals through the screening, education, and follow up on suspected drug interactions.

©   If possible, the patients are recommended to fill all their prescriptions at one pharmacy.

©   Pharmacists can play a crucial role in identifying possible drug interactions by asking patients on Anticoagulants about their herbal and other alternative medicine product use.

Drug Interactions of Anticoagulants (Part 1)

Drug Interactions of Warfarin:

 More Presenttions from Dr.Naina Mohamed Pakkir Maideen

ª    Warfarin is used to treat patients with Deep Vein Thrombosis (DVT) or Pulmonary Embolism.

ª    Warfarin is also used to prevent thrombosis in high risk patients with Atrial Fibrillation, Heart attack and knee or hip surgeries.

ª    Warfarin can cause serious interactions with many commonly used medicines and it also can interact with certain foods.

ª    Regular blood monitoring of INR (International Normalized Ratio) is recommended to check for effectiveness and safety.

ª    Mechanism of Action of Warfarin:

ª    Drugs increasing the risk of Warfarin associated bleeding, include…

·      Tamoxifen

·      Simvastatin

·      Amiodarone

·      Enoxaparin

·      Danaparoid

·      Antiplatelet agents (Aspirin, Clopidogrel, etc)

·      Penicillins (Amoxicillin, Cloxacillin, Ticarcillin, Methicillin, etc)

·      Cephalosporins (Cefixime, Cefepime, Ceftazidime, etc)

·      Macrolide Antibiotics (Azithromycin, Clarithromycin, Roxithromycin, etc)

·      Fluoroquinolones (Ciprofloxacin, Levofloxacin, Moxifloxacin, etc)

·      Sulphonamides (Sulfamethoxazole, Sulfisoxazole, etc)

·      Azole Antifungals (Fluconazole, Ketoconazole, Posaconazole, Miconazole, Itraconazole, etc)

·      Chemotherapeutic Agents (Cyclophosphamide, Methotrexate, Doxorubicin)

·       Fish oil (Omega 3 Fatty Acids) supplements

·      Pomegranate

·      Alcohol

    Prothrombine time/INR should be monitored closely and frequently while using listed drugs along with Warfarin. Patients should be educated to report any signs of bleeding.

ª    Habits reducing Warfarin efficacy, include…

·      Vitamin K rich Foods (Kale, Spinach, Brussels sprouts, Collard greens, Mustard greens, etc)

·      St.John's Wort

·      Green tea

·      Tobacco smoking

        Large changes in dietary consumption of foods high in vitamin K or Green Tea should be avoided. Close monitoring of warfarin therapy is recommended when there is a change in smoking status of patients.

ª    Drugs increasing Anticoagulants associated bleeding risk, include…

·      NSAIDs (Ibuprofen, Diclofenac, Naproxen, etc)

·      Selective serotonin reuptake inhibitors (SSRIs) (Fluvoxamine, Paroxetine, Vortioxetine,  Escitalopram, Sertraline, Nefazodone, vilazodone)

·      Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) (Venlafaxine, Desvenlafaxine, Duloxetine, Milnacipran, Levomilnacipran, Sibutramine)

·      Ginkgo

·      Garlic

·      Papaya

·      Chamomile (Matricaria chamomilla)

ª    TIPS for Warfarin Patients:

·      Limit the intake of Vitamin K rich foods kale, collards, broccoli, spinach and other green leafy vegetables.

·      Do not double the dose to compensate a missed one.

·      Do not forget to discuss with your surgeon or dentist about the regular use of Warfarin prior to any surgery.

·      Contact your doctor if you develop severe diarrhea, an infection or a fever.

·      Seek immediate medical advice if there is signs of bleeding such as blood in your stools or urine, nose-bleeds, bleeding gums, excessive menstrual bleeding or excessive bruising.

·      Be careful with knives and try to minimize the risk of falling.

·      Always adhere to the prescribed dosage schedule.

·      Wear or carry an identification stating that You are on Warfarin.

·      Stick with the same brand of warfarin to maintain INR levels stable.

ª    Drug interactions can result in significant morbidity and mortality and thus minimizing the risk for drug interactions should be a goal in drug therapy.

ª    The patients with clotting disorders should bring a list of all of the drugs they are taking including prescription drugs, over-the-counter drugs, and any supplements, herbal or otherwise, during their visit to the doctor or pharmacist.

ª    The risk of adverse effects could be reduced by healthcare professionals through the screening, education, and follow up on suspected drug interactions.

ª    If possible, the patients are recommended to fill all their prescriptions at one pharmacy.

ª    Pharmacists can play a crucial role in identifying possible drug interactions by asking Warfarin patients about their herbal and other alternative medicine product use.