Clinical Observations With the Amiodarone/Warfarin Interaction

Sanoski, Cynthia A.; Bauman, Jerry L.

doi:10.1378/chest.121.1.19

Cited by 94 publications

(80 citation statements)

References 20 publications

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“…In fact, the warfarin dose had to be modified. 24,[27][28][29] Considering the therapeutic tools available to healthcare professionals, physicians and pharmacists in particular need to be alert regarding detection of clinically significant drug-drug interactions. Cahill 11 reported that, because of the close links between physicians and pharmacists, teamwork for revision and intervention within the context of drug-drug interactions is required.…”

Section: Discussionmentioning

confidence: 99%

Frequency of potential interactions between drugs in medical prescriptions in a city in southern Brazil

Bleich¹,

Bleich

Chiamulera

et al. 2009

Sao Paulo Med. J.

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CONTEXT AND OBJECTIVE: Drug interactions form part of current clinical practice and they affect between 3 and 5% of polypharmacy patients. The aim of this study was to identify the frequency of potential drug-drug interactions in prescriptions for adult and elderly patients. METHODS: Stratified cluster sampling, proportional to the total number of homes in the housing project, was used. The sample consisted of 95 homes and 96 male or female patients aged 19 or over, with medical prescriptions for at least two pharmaceutical drugs. Interactions were identified using DrugDigest, Medscape and Micromedex softwares. TYPE OF STUDY AND SETTING: RESULTS:Most of the patients were female (69.8%), married (59.4%) and in the age group of 60 years or over (56.3%), with an income less than or equal to three minimum monthly salaries (81.3%) and less than eight years of schooling (69.8%); 90.6% of the patients were living with another person.The total number of pharmaceutical drugs was 406 (average of 4.2 medications per patient). The drugs most prescribed were antihypertensives (47.5%).The frequency of drug interactions was 66.6%. Among the 154 potential drug interactions, 4.6% were classified as major, 65.6% as moderate and 20.1% as minor. CONCLUSION:The high frequency of drug prescriptions with a potential for differentiated interactions indicates a situation that has so far been little explored, albeit a reality in household surveys.RESUMO CONTEXTO E OBJETIVO: As interações medicamentosas fazem parte da prática corrente na clínica médica e a sua incidência oscila entre 3% e 5% nos pacientes fazendo uso da polifarmácia. O objetivo do estudo foi identificar a frequência de interações droga-droga potenciais em prescrições de pacientes adultos e idosos. MÉTODO: A amostra foi por conglomerado e estratificada, proporcional ao total de residências no conjunto habitacional, constituída de 95 residências, com 96 pacientes de 19 anos ou mais, sexo feminino e masculino, com prescrição de no mínimo duas especialidades farmacêuticas. As interações foram identificadas de acordo com os softwares DrugDigest, Medscape, Micromedex. TIPO DE ESTUDO E LOCAL: RESULTADOS:A maioria dos pacientes pertencia ao gênero feminino (69,8%), em situação conjugal casada (59,4%), com renda menor ou igual a três salários mínimos (81,3%), faixa etária 60 anos ou mais (56,3%) e 8 anos ou menos de estudo (69,8%) com 90,6% dos pacientes moravam com mais outra pessoa. O total de especialidades farmacêuticas foi de 406, correspondendo a uma média de 4,2 medicamentos por paciente. Os fármacos mais prescritos foram os anti-hipertensivos (47,5%). A frequência de interações medicamentosas foi de 66,6%. Dentre as 154 interações medicamentosas potenciais, 4,6% foram classificadas como maior e 65,6% como moderada e 20,1% como menor.CONCLUSÃO: A alta frequência de prescrições de drogas com potencial de interações diferenciado indica uma situação ainda pouco explorada, mas real em pesquisa domiciliar.

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Section: Discussionmentioning

confidence: 99%

Frequency of potential interactions between drugs in medical prescriptions in a city in southern Brazil

Bleich¹,

Bleich

Chiamulera

et al. 2009

Sao Paulo Med. J.

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“…7 Studies have reported increased anticoagulant effects of warfarin in patients treated simultaneously with amiodarone. [8][9][10][11] Other studies have indicated that interactions are commonly observed at 1 week after administration of these drugs and may increase potentially up to 6 weeks, although significant clinical effects of these interactions were not seen in a number of studies. 7,12 Drug interaction studies selecting patients in a real-life setting are scarce, and most studies to date are characterized by a small sample size.…”

Section: What This Study Addsmentioning

confidence: 99%

Simultaneous Use of Amiodarone Influences Warfarin Maintenance Dose but Is Not Associated with Adverse Events

Santos¹,

Soares

Strunz³

et al. 2014

JMCP

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“…As amiodarone has a very long half-life (20-100 days), close INR monitoring is required several weeks after the interruption of the treatment. Amiodarone induces a broad range of adverse events, and is involved in complex drug interactions, especially with VKAs [9]. Amiodarone strongly inhibits several CYPs, including CYP2C9, CYP1A2, and CYP3A4, thereby decreasing warfarin clearance and potentiating warfarin pharmacodynamic effects, resulting in increased anticoagulation [9].…”

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confidence: 99%

“…Amiodarone induces a broad range of adverse events, and is involved in complex drug interactions, especially with VKAs [9]. Amiodarone strongly inhibits several CYPs, including CYP2C9, CYP1A2, and CYP3A4, thereby decreasing warfarin clearance and potentiating warfarin pharmacodynamic effects, resulting in increased anticoagulation [9]. The warfarin-amiodarone interaction is considered to be clinically relevant, as it can lead to overanticoagulation when amiodarone is added to warfarin, thus potentially increasing the risk of hemorrhagic complications [10,11].…”

mentioning

confidence: 99%

“…The warfarin-amiodarone interaction is considered to be clinically relevant, as it can lead to overanticoagulation when amiodarone is added to warfarin, thus potentially increasing the risk of hemorrhagic complications [10,11]. In adults receiving standard warfarin doses, a decrease of~25% in the dose is required when amiodarone 100 mg dailyis started [9]. Conversely, amiodarone withdrawal can lead to under-anticoagulation, and therefore to an increased risk of thrombosis.…”

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confidence: 99%

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Genetic resistance to warfarin therapy masked by amiodarone in a 2-year-old girl with mitral valve replacement

Moreau

Bajolle

Siguret

et al. 2013

Journal of Thrombosis and Haemostasis

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To cite this article: Moreau C, Bajolle F, Siguret V, Loriot M-A, Bonnet D. Genetic resistance to warfarin therapy masked by amiodarone in a 2-year-old girl with mitral valve replacement. J Thromb Haemost 2013; 11: 555-7.A 2.2-year-old Moroccan girl (11 kg; body surface area, 0.50 m 2 ) underwent mitral valve replacement for congenital mitral stenosis. Two days later, she received amiodarone for atrial arrhythmia; the dose was 500 mg m À2 daily for 7 days, and then 250 mg m À2 daily (Fig. 1).Nine days after surgery, she was started on a standard warfarin regimen for children (0.2 mg kg À1

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Clinical Observations With the Amiodarone/Warfarin Interaction

Cited by 94 publications

References 20 publications

Frequency of potential interactions between drugs in medical prescriptions in a city in southern Brazil

Frequency of potential interactions between drugs in medical prescriptions in a city in southern Brazil

Simultaneous Use of Amiodarone Influences Warfarin Maintenance Dose but Is Not Associated with Adverse Events

Genetic resistance to warfarin therapy masked by amiodarone in a 2-year-old girl with mitral valve replacement

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