Opinions and research priorities

Bussey, Henry I.; Tapson, Victor F.; Cannon, Richard O.; Nolan, Paul E.; Gage, Brian F.; Penzak, Scott R.; Spinler, Sarah A.; Smet, Peter De; Wittkowsky, Ann K.; Lee, Alison Pataky; Ernst, Edzard; Marder, Victor J.

doi:10.1016/j.thromres.2005.05.030

Cited by 7 publications

(5 citation statements)

References 37 publications

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“…20 A modified drug interaction probability scale for assessing anticoagulant drug interactions has been described, and the interaction was also rated as probable on this scale. 21…”

Section: Discussionmentioning

confidence: 99%

Probable Elevation in International Normalized Ratio from Cranberry Juice

Welch

Forster

2007

Journal of Pharmacy Technology

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WWW.JPHARMTECHNOL.COMSeveral health benefits of cranberries have been proposed, from urinary tract infection prophylaxis, possibly related to an anti-adhesion mechanism of bacteria in the bladder, to a cardioprotective effect by inhibiting lowdensity lipoprotein (LDL) oxidation and inducing LDL receptor expression. 1-3 The growing interest in alternative therapies, including phytonutrients, may lead to concomitant use of cranberry juice or products in patients receiving warfarin.Close monitoring of patients who consume cranberry juice is recommended based on warnings of its possible interaction with warfarin. 4-8 We report a case of an elevated international normalized ratio (INR) believed to be caused by consumption of cranberry juice.

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“…20 A modified drug interaction probability scale for assessing anticoagulant drug interactions has been described, and the interaction was also rated as probable on this scale. 21…”

Section: Discussionmentioning

confidence: 99%

Probable Elevation in International Normalized Ratio from Cranberry Juice

Welch

Forster

2007

Journal of Pharmacy Technology

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“…This drug interaction was scored as possible on the Naranjo adverse drug reaction probability scale 11 and on a modified Naranjo scale tailored for assessing anticoagulant drug interactions. 12 Three opinions published in response to this case report questioned its validity and the subsequent warnings issued in the United Kingdom to limit the consumption of cranberry juice in patients receiving warfarin. [13][14][15] One author questioned why any amount of cranberry juice was considered safe, whereas the second author commented that the patient' s poor dietary intake (vitamin K deficiency) most likely contributed to the supratherapeutic INR.…”

Section: Literature Reviewmentioning

confidence: 99%

“…16 Unlike the previous case, the absence of any apparent confounding factors in this report strengthens the evidence supporting an interaction. On both the Naranjo scale 11 and the Naranjo scale modified for anticoagulants, 12 this interaction was rated as probable.…”

Section: Literature Reviewmentioning

confidence: 99%

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Interaction Between Warfarin and Cranberry Juice

2006

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Warfarin is extensively used for anticoagulation to a target international normalized ratio of 2.0-3.0 for most indications or 2.5-3.5 for high-risk indications; however, many drugs and dietary supplements induce fluctuations in the international normalized ratio. Such fluctuations may lead to therapeutic failure or bleeding complications. Cranberry juice is increasingly used for the prevention and adjunctive treatment of urinary tract infections. The United Kingdom's Committee on Safety of Medicines has alerted clinicians to a potential interaction between warfarin and cranberry juice and has advised that patients avoid their concurrent use. Review and analysis of the literature revealed that ingestion of large volumes of cranberry juice destabilize warfarin therapy. Small amounts of juice are not expected to cause such an interaction. Clinicians should be aware of this potential interaction and monitor and counsel patients accordingly.

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“…The drug interactions between omeprazole and warfarin as well as glyburide and warfarin had already been accounted for prior to the start of HDK, thus implicating ketoconazole in the potentiation of the warfarin effect. The Naranjo, the modified Naranjo adverse drug reaction probability scales, and the Holbrook criteria all revealed a probable adverse reaction of an increased anticoagulant effect associated with HDK [8, 10, 11]. …”

Section: Discussionmentioning

confidence: 99%

Enhanced Interaction between Warfarin and High-Dose Ketoconazole: A Case Report

Jackevicius

Ton

2009

Case Reports in Medicine

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This case describes the increased anticoagulation effect associated with the use of high-dose ketoconazole. A 59-year-old man treated with warfarin for aortic valve replacement was prescribed high-dose ketoconazole and hydrocortisone for the treatment of prostate cancer. Despite lowering the warfarin dosage by 35% during the start of high dose ketoconazole, an additional dose reduction was required subsequently when the INR rose from 2.62 to 3.82 within nine days. After a total dose reduction of 43%, the INR returned to therapeutic range within two weeks. The Naranjo probability scale revealed a probable adverse reaction of increased anticoagulant effect associated with high dose ketoconazole. Due to the inhibition of warfarin metabolism by ketoconazole, patients taking high dose ketoconazole concomitantly with warfarin may need their warfarin dosage reduced by more than is currently recommended, as well as receive more frequent INR monitoring to avoid over anticoagulation.

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Opinions and research priorities

Cited by 7 publications

References 37 publications

Probable Elevation in International Normalized Ratio from Cranberry Juice

Probable Elevation in International Normalized Ratio from Cranberry Juice

Interaction Between Warfarin and Cranberry Juice

Enhanced Interaction between Warfarin and High-Dose Ketoconazole: A Case Report

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