Evidence of a clinically significant interaction between warfarin and intravesical gemcitabine

Kurtzhalts, Kari; Gee, Megan E.; Feuz, Lindsey; Krajewski, Kristin C.

doi:10.2146/ajhp150425

Cited by 3 publications

(3 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…80 Gemcitabine also interacts with warfarin, and even intrabladder instillation of gemicitabine can cause an elevated INR in patients taking warfarin. 81,82…”

Section: Vitamin K Antagonist: Warfarinmentioning

confidence: 99%

“…Several chemotherapeutic agents interact with warfarin. [78][79][80][81][82][83][84] Two fluoropyrimidines in particular have been widely reported to interact with warfarin: fluorouracil and capecitabine. 78,80 Fluorouracil increases INR and the risk of bleeding via many mechanisms, including inhibition of CYP2C9, direct injury to the gastrointestinal tract, or alteration of gastrointestinal flora; experts recommend decreasing the dose of warfarin prophylactically by 20% to 70%.…”

Section: Cancer Chemotherapymentioning

confidence: 99%

“…80 Gemcitabine also interacts with warfarin, and even intrabladder instillation of gemicitabine can cause an elevated INR in patients taking warfarin. 81,82 Paclitaxel can potentiate warfarin anticoagulation by displacing it from protein-binding sites. 84 Enzalutamide, a strong inducer of CYP2C9, enhances clearance of warfarin and the INR should be monitored closely during its initiation and following discontinuation.…”

Section: Cancer Chemotherapymentioning

confidence: 99%

See 2 more Smart Citations

Drug Interactions Affecting Oral Anticoagulant Use

Mar

Gopinathannair

Gengler

et al. 2022

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

Oral anticoagulants (OACs) are medications commonly used in patients with atrial fibrillation and other cardiovascular conditions. Both warfarin and direct oral anticoagulants are susceptible to drug-drug interactions (DDIs). DDIs are an important cause of adverse drug reactions and exact a large toll on the health care system. DDI for warfarin mainly involve moderate to strong inhibitors/inducers of cytochrome P450 (CYP) 2C9, which is responsible for the elimination of the more potent S-isomer of warfarin. However, inhibitor/inducers of CYP3A4 and CYP1A2 may also cause DDI with warfarin. Recognition of these precipitating agents along with increased frequency of monitoring when these agents are initiated or discontinued will minimize the impact of warfarin DDI. Direct oral anticoagulants are mainly affected by medications strongly affecting the permeability glycoprotein (P-gp), and to a lesser extent, strong CYP3A4 inhibitors/inducers. Dabigatran and edoxaban are affected by P-gp modulation. Strong inducers of CYP3A4 or P-gp should be avoided in all patients taking direct oral anticoagulant unless previously proven to be otherwise safe. Simultaneous strong CYP3A4 and P-gp inhibitors should be avoided in patients taking apixaban and rivaroxaban. Concomitant antiplatelet/anticoagulant use confers additive risk for bleeding, but their combination is unavoidable in many cases. Minimizing duration of concomitant anticoagulant/antiplatelet therapy as indicated by evidence-based clinical guidelines is the best way to reduce the risk of bleeding.

show abstract

“…80 Gemcitabine also interacts with warfarin, and even intrabladder instillation of gemicitabine can cause an elevated INR in patients taking warfarin. 81,82…”

Section: Vitamin K Antagonist: Warfarinmentioning

confidence: 99%