A Warfarin-Piroxicam Drug Interaction

Rhodes, Richard S.; Rhodes, Pamela J.; Klein, Catherine; Sintek, Charles D.

doi:10.1177/106002808501900711

Cited by 20 publications

(4 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Non-selective non-steroidal anti-inflammatory drugs, through their effects on cyclo-oxygenase I, inhibit platelet aggregation, reducing clot formation. These agents are contraindicated in patients taking other anti-platelet drugs such as dipyridamole (PersantineÒ), ticlodipine (TiclidÒ), anagrelide (AgrylinÒ), clopidogrel (PlavixÒ), and celostazol (PletalÒ) or anticoagulants such as warfarin (CoumadinÒ), anissindione (MiradonÒ), or dicumarol, because of the risk of increased bleeding (44,54,55,60). Non-selective non-steroidal antiinflammatory drugs should be used cautiously in patients taking aspirin or other salicylates because those medications also inhibit platelet aggregation and therefore reduce clot formation.…”

Section: Non-selective Non-steroidal Anti-inflammatory Drugsmentioning

confidence: 99%

Drug interactions important for periodontal therapy

Sims

Sims²

2007

Periodontology 2000

View full text Add to dashboard Cite

Section: Non-selective Non-steroidal Anti-inflammatory Drugsmentioning

confidence: 99%

Drug interactions important for periodontal therapy

Sims

Sims²

2007

Periodontology 2000

View full text Add to dashboard Cite

“…It can also cause gastrointestinal ulceration, hemorrhage, and inhibition of platelet aggregation 19,69,70 . Of the other non-steroidal anti-inflammatory drugs, flurbiprofen 71 , meclofenamate sodium 72 73,74 , piroxicam 75 , sulindac 76,77 , tiaprofenic acid 78 , tolmetin sodium 79 may potentiate the anticoagulant effect. In many cases the result of concomitant therapy was an increased prothrombin time which may or may not be clinically significant; in other cases haemorrhage occurred.…”

Section: Drugs Affecting Haemostasismentioning

confidence: 99%

Interactions of Warfarin

Rehulková¹

2001

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

View full text Add to dashboard Cite

In this article, the author reviews and updates the basis of interactions with warfarin, illustrated with appropriate examples. The interactions with drugs, medicinal herbs and foods are summarised. 28Cholestyramine binds vitamin K in the gut, thus preventing its absorption 18 . It also decreases the absorption and may interrupt the enterohepatic recirculation of warfarin, resulting in a reduced anticoagulant effect 19,20 .Colestipol does not affect the absorption of warfarin. When colestipol is administered with warfarin, no depressant effects on blood levels are seen 21 . Drugs affecting receptor sensitivityEstrogens increase the synthesis of various clotting factors and may thus reduce the effect of anticoagulants 22, 23 . Oral contraceptives increase clotting factor concentrations and inhibit warfarin metabolism. The net effect depends on balance between these factors. Oral contraceptives are generally contraindicated in most patients taking warfarin since they are trombogenic 1, 24 .Steroids with anabolic or androgenic properties, such as oxymetholone 25, 26, 27 , stanozolol 28, 29 and danazol 30, 31, 32 , may potentiate the action of warfarin allegedly by reducing clotting factor synthesis. The 17-alpha-alkylated steroids appear to be more likely to induce this reaction than the non-substituted steroids 25, 26, 27, 33 . However, there has been a report of topically applied testosterone, which does not have 17-alpha-alkyl substituent, enhancing warfarin 34 .Diuretics may antagonise the action of warfarin by two pharmacodynamic mechanisms 18 : (a) patients in cardiac failure have impaired clotting factor synthesis due to hepatic congestion -correction of this state leads to increased clotting factor synthesis; (b) diuretics also reduce the plasma volume producing an increased concentration of clotting factors which may alter the anticoagulant effect of warfarin 35 . Chlorthalidone 36 and spironolactone 35 have both been associated with a reduction of warfarin activity probably as a consequence of diuresis concentrating the circulating clotting factors. Bumetanide, furosemide and thiazides appear to have no effect on warfarin 23 .Certain cephalosporines, such as cefotetan, cefamandole, cefoperazone, or moxalactam may cause marked hypoprothrombinemia and/or prolonged bleeding time at concurrent use with warfarin 38, 39, 40, 41 . The main mechanism of interaction consists in decreasing synthesis of vitamin K-dependent clotting factors.Clofibrate may potentiate warfarin action, probably by altering receptor sensitivity 23, 37 . Although clofibrate displaces warfarin from albumin binding sites this does not appear to be a principal mechanism of the interaction 42 .Drugs altering thyroid function may affect anticoagulant control, since rates of synthesis and degradation of clotting factors are dependent on thyroid function 7 . Thyroid compounds do enhance the activity of oral anticoagulants by increased metabolism of clotting factors 12 . Dextrothyroxine increases the anticoagulant effect of warfarin ...

show abstract

“…The assay was adapted from Some well-documented case reports have described an increase of the anticoagulant activity of warfarin or Fitos et al [20 ]. Aliquots (50 ml ) of the sample were injected onto a Chiral-AGP (ChromTech AB, acenocoumarol during coadministration with piroxicam [17][18][19] …”

Section: Introductionmentioning

confidence: 99%

“…Fitos et al [20 ]. Aliquots (50 ml ) of the sample were injected onto a Chiral-AGP (ChromTech AB, acenocoumarol during coadministration with piroxicam [17][18][19], but the interaction was never investigated at Hägersten, Sweden) h.p.l.c. column (100×4 mm i.d., 5 mm) protected by a Chiral-AGP precolumn the pharmacokinetic level.…”

Section: Introductionmentioning

confidence: 99%

Stereoselective interaction between piroxicam and acenocoumarol

Bonnabry

Desmeules

Rudaz

et al. 1996

Brit J Clinical Pharma

View full text Add to dashboard Cite

1 An open-label study was performed to assess the effect of piroxicam on the pharmacokinetics of acenocoumarol enantiomers. 2 Eight healthy male volunteers received an oral dose of 4 mg rac-acenocoumarol on days 1 and 8, plus 40 mg piroxicam orally 2 h before the anticoagulant on day 8. R-and S-acenocoumarol, piroxicam and their metabolites were measured in plasma over a 24 h interval. : +19.9% ( 42.0), and CL/F: −9.8% ( 20.5). V/F remained unchanged for both enantiomers. 4 Piroxicam plasma AUC( 0, 24 h) correlated closely with R-and Sacenocoumarol AUCs on day 1 (r=0.901, P<0.005 and r=0.797, P<0.05, respectively), as well as with the difference of AUC between days 1 and 8 for R-acenocoumarol (r=0.903, P<0.001) and S-acenocoumarol (r=0.711, P<0.05). 5 Piroxicam markedly reduced acenocoumarol enantiomer clearance, with a greater effect on the more active R-isomer. This interaction, which occurs in addition to the well documented pharmacodynamic one (effect on platelets), is expected to result in increased anticoagulant effect.

show abstract

A Warfarin-Piroxicam Drug Interaction

Cited by 20 publications

References 22 publications

Drug interactions important for periodontal therapy

Drug interactions important for periodontal therapy

Interactions of Warfarin

Stereoselective interaction between piroxicam and acenocoumarol

Contact Info

Product

Resources

About