Near-fatal bleeding, senna, and the opposite of lettuce

Kittisupamongkol, Weekitt; Nilaratanakul, Voraphoj; Kulwichit, Wanla

doi:10.1016/s0140-6736(08)60347-5

Cited by 5 publications

(3 citation statements)

References 4 publications

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“…Constipation is a common problem in hospitalised elderly patients [41]. Senna increases bowel motility thereby potentially decreasing the absorption of vitamin K and resulting in elevated INR values [42]. In patients newly started on warfarin, senna use may lead to exaggerated anticoagulation and early bleeding complications despite close INR monitoring during the hospital admission.…”

Section: Discussionmentioning

confidence: 99%

Frailty and Co-Prescribing of Potentially Interacting Drugs in New Users of Warfarin

et al. 2020

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Background Warfarin is underutilised in frail older people because of the fear of bleeding complications. Drug interactions are an independent bleeding risk factor. However, the extent to which potential drug interactions are taken into account at warfarin therapy initiation in frail patients is not known. Objective The objective of this study was to investigate the use of potentially interacting drugs increasing the bleeding risk before and after warfarin initiation in frail and non-frail patients. Methods We conducted an observational study including inpatients aged ≥ 60 years initiated on warfarin in a tertiary hospital in Adelaide, South Australia. Frailty status was assessed with the Reported Edmonton Frail Scale. Medication charts were reviewed before and after warfarin initiation. Results In total, 151 patients (102 non-frail and 49 frail) were included. Before warfarin initiation, the use of clopidogrel and acetaminophen was more common in frail patients compared with non-frail patients (25.5% vs 10.2%, p = 0.0135, 63.8% vs 35.7% p = 0.0014, respectively). The use of non-steroidal anti-inflammatory drugs, 9.2% in non-frail patients and 6.4% in frail patients before warfarin initiation, was completely stopped after warfarin initiation in both groups. The use of antiplatelet drugs decreased from 56.1% in non-frail patients and 66.0 % in frail patients to 12.2% and 14.9%, respectively. Instead, the use of drugs affecting the metabolism of warfarin or vitamin K increased in both groups. No statistically significant difference was seen in the exposure to interacting drugs between study groups after warfarin initiation. Acetaminophen, senna glycosides and cytochrome P450 2C9 inhibiting drugs were the most common interacting drugs at discharge used in 49.0%, 18.4% and 20.4% of non-frail patients and 53.2%, 29.8% and 19.1% of frail patients, respectively. Conclusions The overall frequency of potential drug interactions was moderate and frail patients were not exposed to warfarin drug interactions more often than non-frail patients. Further studies in larger study populations are required to verify these results.

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Section: Discussionmentioning

confidence: 99%

Frailty and Co-Prescribing of Potentially Interacting Drugs in New Users of Warfarin

et al. 2020

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“…In our experience, patients who are stable on warfarin and fall ill tend to have an increase in their INR. Case reports have also demonstrated elevated INRs and near fatal bleeding in conjunction with diarrhoea [16–18]. A case‐control study associated an increase in elevated INRs in patients on warfarin with decreased intake of vitamin K and diarrhoea [19].…”

Section: Discussionmentioning

confidence: 99%

Effect of high‐dose cranberry juice on the pharmacodynamics of warfarin in patients

Mellen

Ford

Rindone

2010

Brit J Clinical Pharma

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WHAT IS ALREADY KNOWN ABOUT THIS SUBJECTCase reports suggest an association between cranberry juice and potentiation of warfarin. Studies using 240 ml of cranberry juice daily demonstrated no interaction. It is unknown if higher amounts of cranberry juice will interact with warfarin. WHAT THIS STUDY ADDSCranberry juice at 240 ml twice daily does not alter the pharmacodynamics of warfarin. AIMTo determine if high-dose cranberry juice (240 ml twice daily) alters the pharmacodynamic action of warfarin. METHODSTen male patients taking stable doses of warfarin were given cranberry juice at 240 ml twice daily for 7 days. Prothrombin times were drawn at baseline and days 2, 6 and 8 after administration of the juice. Prothrombin times were averaged for each day and mean times were compared from each study day to baseline using repeated measures ANOVA. RESULTSThere was no statistical difference between mean prothrombin time at baseline and any day tested during juice administration. CONCLUSIONSCranberry juice (240 ml twice daily for 1 week) did not alter the pharmacodynamics of warfarin in patients.

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“…Concomitant use of stimulant laxatives with diuretics, cardiac glycosides and licorice is contraindicated due to hypokalemic effects, especially with long term use of these laxatives [27,178,304,308,309]. Senna can potentially interfere with antiplatelet and anticoagulant activity by causing excessive bleeding [310]. There is one case report of a possible interaction of aloe and sevoflurane, in which a 35 year old female patient undergoing surgery for hemangioma experienced perioperative bleeding [311].…”

Section: Stimulant Laxativesmentioning

confidence: 99%

Interactions with Drugs and Dietary Supplements Used For Weight Loss

Jordan¹

2013

Drug Discovery

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Near-fatal bleeding, senna, and the opposite of lettuce

Cited by 5 publications

References 4 publications

Frailty and Co-Prescribing of Potentially Interacting Drugs in New Users of Warfarin

Frailty and Co-Prescribing of Potentially Interacting Drugs in New Users of Warfarin

Effect of high‐dose cranberry juice on the pharmacodynamics of warfarin in patients

Interactions with Drugs and Dietary Supplements Used For Weight Loss

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