Difficulties in anticoagulation management during coadministration of warfarin and rifampin.

Abstract:

:The clinical significance of rifampin's induction of warfarin metabolism is well documented, but no published studies or case reports have quantified this interaction with respect to the international normalized ratio (INR). A patient receiving concomitant rifampin and warfarin to treat a mycobacterial infection and intraventricular thrombus, respectively, underwent routine INR testing at a pharmacist-managed anticoagulation clinic to assess his anticoagulation regimen. A 233% increase in warfarin dosage over 4 months proved insufficient to attain a therapeutic INR during long-term rifampin therapy More aggressive titration of the warfarin dosage was needed. In addition, a gradual 70% reduction in warfarin dosage over 4-5 weeks was necessary to maintain a therapeutic INR after rifampin discontinuation, demonstrating the clinically significant offset of this drug interaction. Extensive changes in warfarin dosage are required to attain and maintain a therapeutic INR during the initiation, maintenance, and discontinuation of rifampin.

journal_name

Pharmacotherapy

journal_title

Pharmacotherapy

authors

Lee CR,Thrasher KA

doi

10.1592/phco.21.15.1240.33897

subject

Has Abstract

pub_date

2001-10-01 00:00:00

pages

1240-6

issue

10

eissn

0277-0008

issn

1875-9114

journal_volume

21

pub_type

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