Bosentan and Warfarin Interaction

2003 ◽  
Vol 37 (7-8) ◽  
pp. 1028-1031 ◽  
Author(s):  
Lisa M Murphey ◽  
Elizabeth H Hood
Keyword(s):  
Primary Pulmonary Hypertension ◽  
African American Woman ◽  
American Woman ◽  
Warfarin Dose ◽  
International Normalized Ratio ◽  
Over The Counter ◽  
Herbal Products ◽  
Case Summary ◽  
History Of ◽  
Clinically Significant

OBJECTIVE: To report a case of decreased international normalized ratio (INR) in a patient receiving warfarin and bosentan. CASE SUMMARY: A 35-year-old African American woman with a history of primary pulmonary hypertension managed with warfarin, diltiazem, and hydrochlorothiazide was initiated on bosentan therapy. The patient's INR had been stable and within therapeutic range (goal 2.0–3.0) for the previous 3 months with warfarin 27.5 mg/wk, but became subtherapeutic after 10 days of bosentan therapy. Addition of over-the-counter medications, herbal products, vitamins, or dietary changes was denied. The INR remained subtherapeutic for 5 weeks despite weekly warfarin dose increases. After these 5 weeks of dosage increases, the INR became supratherapeutic for 3 weeks, resulting in a subsequent dosage decrease. The resultant warfarin dose required to maintain a therapeutic INR was 45 mg/wk, a 63.6% dosage increase after the initiation of bosentan. DISCUSSION: This case shows that a clinically significant interaction between bosentan and warfarin may exist. An objective causality assessment revealed that the interaction was probable. Although the possibility of this interaction has been noted, no previously documented occurrence of this interaction has been identified. CONCLUSIONS: Bosentan may significantly decrease the anticoagulant properties of warfarin. The INR should be monitored more frequently when bosentan is initiated, adjusted, or discontinued in patients taking warfarin.

scholarly journals A Case of a Laryngeal MALT Lymphoma in a Patient with a History of Gastric MALT

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Mark Ashamalla ◽  
Marita S. Teng ◽  
Joshua Brody ◽  
Elizabeth Demicco ◽  
Rahul Parikh ◽  
...  
Keyword(s):  
African American ◽  
Malt Lymphoma ◽  
African American Woman ◽  
American Woman ◽  
Complete Response ◽  
Gastric Malt Lymphoma ◽  
Rare Presentation ◽  
Original Diagnosis ◽  
History Of ◽  
Previously Treated

We are reporting a case of a 62-year-old African American woman with a history of gastric MALT lymphoma successfully treated with radiation who presented with a laryngeal MALT lymphoma 4 years after her original diagnosis. She received definitive radiation with a complete response. The case presented is unique for the rare presentation of a MALT lymphoma in the larynx, especially in light of the patient’s previously treated gastric MALT lymphoma years ago.

Inductive Effect of a Ritonavir-Containing Hepatitis C Treatment Regimen on Warfarin in a Patient—A Case Report

2018 ◽  
Vol 32 (4) ◽  
pp. 470-473 ◽  
Author(s):  
Audrey C. Rosene ◽  
Jaymee L. Gaspar
Keyword(s):  
Hepatitis C ◽  
Treatment Regimen ◽  
Case Reports ◽  
Warfarin Dose ◽  
International Normalized Ratio ◽  
Close Monitoring ◽  
Anticoagulation Management ◽  
Hepatitis C Treatment ◽  
History Of ◽  
Repeated Use

The warfarin management strategy for a mechanical mitral valve patient initiated on a ritonavir-based hepatitis C treatment regimen is described. A 62-year-old male with a past medical history of hepatitis C genotype 1a and stable warfarin dose history was initiated on a concomitant Viekira Pak® (VP) regimen containing ritonavir. Prior to initiation of the VP for hepatitis C treatment, the patient was stable on a warfarin dose of 40 mg/wk for 5 months. During treatment with VP, the patient experienced a markedly decreased international normalized ratio (INR) and warfarin requirements ultimately increased 125% from baseline (90 mg/wk). Effective anticoagulation management throughout and surrounding the treatment period for hepatitis C involved frequent warfarin dose adjustments, including preemptive changes, close monitoring, and repeated use of enoxaparin to ensure adequate thrombotic prophylaxis. This is believed to be the first reported case describing the management of warfarin in a patient with hepatitis C who received VP and required a drastically increased weekly warfarin dose. The possible mechanisms suggestive of this interaction and similar case reports in the literature are discussed.

Subcutaneous Phaeohyphomycosis Caused by Cladophialophora bantiana

2005 ◽  
Vol 129 (6) ◽  
pp. 794-797
Author(s):  
Sean M. Hussey ◽  
Rita Gander ◽  
Paul Southern ◽  
Mai P. Hoang
Keyword(s):  
Lupus Erythematosus ◽  
Clinical Symptoms ◽  
African American Woman ◽  
American Woman ◽  
Systemic Lupus ◽  
History Of ◽  
Skin Nodules ◽  
Subcutaneous Phaeohyphomycosis ◽  
Purulent Drainage

Abstract Primary subcutaneous phaeohyphomycosis can rarely be caused by Cladophialophora bantiana, and we present the histologic and culture findings of such a case. A 32-year-old African American woman with systemic lupus erythematosus presented with a 2-year history of multiple, recurrent, tender, and ulcerated skin nodules with purulent drainage on her upper back. Histologic sections of the excision demonstrated features of phaeohyphomycosis. Culture findings were characteristic of C bantiana. Of interest, at age 10 she had sustained traumatic implantation of wood splinters into this area during a tornado, yet clinical symptoms of a subcutaneous infection did not manifest until she developed lupus erythematosus at age 27. Our case highlights the role of trauma and immunosuppression in the pathogenesis of subcutaneous phaeohyphomycosis.

Warfarin dose adjustment required after cannabidiol initiation and titration

2020 ◽  
Vol 77 (22) ◽  
pp. 1846-1851
Author(s):  
Josh Cortopassi
Keyword(s):  
Case Report ◽  
Interaction Potential ◽  
Significant Interaction ◽  
Dose Adjustment ◽  
Intractable Epilepsy ◽  
Warfarin Dose ◽  
International Normalized Ratio ◽  
Dose Titration ◽  
Published Report ◽  
Clinically Significant

Abstract Purpose A case of a possible interaction between cannabidiol and warfarin is presented along with a brief overview of cytochrome enzymes involved in these drugs’ metabolism. Summary A 46-year-old male taking warfarin for treatment of a deep venous thrombosis was initiated on a Food and Drug Administration (FDA)–approved cannabidiol product (Epidiolex, Greenwich Biosciences) for intractable epilepsy. The patient’s International Normalized Ratio (INR) was monitored closely during cannabidiol initiation and dose titration. The patient required a nearly 20% warfarin dose reduction to maintain an INR within the goal range after starting therapy with cannabidiol. There is 1 other case report describing a clinically significant interaction between cannabidiol (specifically Epidiolex) and warfarin in a patient receiving warfarin who was enrolled in a study involving the initiation and titration of cannabidiol; that patient developed a supratherapeutic INR of 6.86 and required a 30% reduction in the weekly warfarin dose to reachieve the goal INR. Conclusion A previously published report suggesting an interaction between cannabidiol and warfarin is supported by this case report. INR should be monitored frequently in patients taking warfarin who begin to take FDA-approved cannabidiol. Additional studies should be performed to clarify the interaction potential of cannabidiol and warfarin.

Interaction between Warfarin and Trazodone

2000 ◽  
Vol 34 (6) ◽  
pp. 734-736 ◽  
Author(s):  
Nancy L Small ◽  
Kathy A Giamonna
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
International Normalized Ratio ◽  
Potential Interaction ◽  
Case Summary ◽  
Subsequent Decrease ◽  
Clinically Significant ◽  
Few Data ◽  
Time To Onset ◽  
Potentially Clinically Significant

BACKGROUND: It is well known that there are many drug interactions involving warfarin. However, few data have been supplied to guide clinicians concerning the interaction between trazodone and warfarin. CASE SUMMARY: Three clinically significant cases of suspected trazodone and warfarin interactions were identified in a retrospective chart review based on changes in the prothrombin time (PT) and international normalized ratio (INR) that were not explained by other factors. In each of the cases, the INR changed by ≥1.0 after the initiation or discontinuation of trazodone. In the patients who started trazodone, a subsequent decrease in the PT and INR resulted; conversely, the PT and INR increased in the patient who stopped trazodone therapy. Although none of the patients experienced adverse effects due to the marked changes in PT and INR, the warfarin dosages had to be adjusted accordingly on initiation and discontinuation of trazodone. DISCUSSION: These cases show that there is a potentially clinically significant interaction between trazodone and warfarin. The time to onset of the interaction is variable; the mechanism behind it is not known, but it may involve substrate or protein-binding competition. CONCLUSIONS: The use of trazodone on an as-needed basis for sleep is strongly discouraged in patients who are receiving warfarin, due to the difficulty of achieving a therapeutic PT and INR. Until more is known, patients and clinicians should be educated about this potential interaction and monitor for changes in the anticoagulant effects when trazodone is initiated or stopped.

Clinically Significant Diuretic-Induced Glucose Intolerance

1988 ◽  
Vol 22 (12) ◽  
pp. 969-972 ◽  
Author(s):  
N. Kathryn Lowder ◽  
Henry I. Bussey ◽  
Nancy J. Sugarek
Keyword(s):  
Blood Glucose ◽  
Glucose Intolerance ◽  
Mexican Americans ◽  
Mexican American ◽  
Blood Glucose Concentration ◽  
Fasting Blood Glucose ◽  
American Woman ◽  
History Of ◽  
Clinically Significant

Diuretic-induced glucose intolerance is cited frequently as a problem of only limited clinical significance. In certain populations, such as Mexican-Americans, this effect may be much more dramatic. A 50-year-old obese Mexican-American woman presented with a three-month history of increased thirst and frequent urination. A fasting blood glucose concentration of 365 mg/dL prompted initiation of chlorpropamide therapy. A review of her medical history revealed that a thiazide diuretic was started six months previously. A reduction in thiazide dose and potassium supplementation together with chlorpropamide therapy controlled the patient's blood glucose. Subsequently, all three medications were discontinued, and the patient remained normoglycemic during a full year of follow-up. The temporal relationship between symptomatic diabetes and hydrochlorothiazide therapy incriminates the diuretic as the most probable cause.

Mild elevations of international normalized ratio at hospital Day 1 and risk of expansion in warfarin-associated subdural hematomas

2013 ◽  
Vol 119 (4) ◽  
pp. 1050-1057 ◽  
Author(s):  
Marie Roguski ◽  
Kyle Wu ◽  
Ron I. Riesenburger ◽  
Julian K. Wu
Keyword(s):  
Volume Overload ◽  
Neurological Status ◽  
International Normalized Ratio ◽  
Fresh Frozen Plasma ◽  
Increased Risk ◽  
Fresh Frozen ◽  
History Of ◽  
Clinically Significant ◽  
Frozen Plasma ◽  
Increases In Risk

Object A primary goal in the treatment of patients with warfarin-associated subdural hematoma (SDH) is reversal of coagulopathy with fresh-frozen plasma. Achieving the traditional target international normalized ratio (INR) of 1.3 is often difficult and may expose patients to risks of volume overload and of thromboembolic complications. This retrospective study evaluates the risk of mild elevations of INR from 1.31 to 1.69 at 24 hours after admission in patients presenting with warfarin-associated SDH. Methods Sixty-nine patients with warfarin-associated SDH and 197 patients with non–warfarin-associated SDH treated at a single institution between January 2005 and January 2012 were retrospectively identified. Charts were reviewed for patient age, history of trauma, associated injuries, neurological status at presentation, size and chronicity of SDH, associated midline shift, INR at admission and at hospital Day 1 (HD1), concomitant aspirin or Plavix use, platelet count, and medical comorbidities. Patients were stratified according to use of warfarin and by INR at HD1 (INR 0.8–1.3, 1.31–1.69, 1.7–1.99, and ≥ 2). The groups were evaluated for differences the in rate of radiographic expansion of SDH and in the rate of clinically significant SDH expansion resulting in death, unplanned procedure, and/or readmission. Results There was no difference in the rate of radiographic versus clinically significant expansion of SDH between patients not on warfarin and those on warfarin (no warfarin: 22.3% vs 20.3%, p = 0.866; warfarin: 10.7% vs 11.6%, p = 0.825), but the rate of medical complications was significantly higher in the warfarin subgroup (13.3% for patients who did not receive warfarin vs 26.1% for those who did; p = 0.023). For warfarin-associated SDH, there was no difference in the rate of radiographic versus clinically significant expansion between patients reversed to HD1 INRs of 0.8–1.3 and 1.31–1.69 (HD1 INR 0.8–1.3: 22.5% vs 20%, p = 1; HD1 INR 1.31–1.69: 15% vs 10%, p = 0.71). Conclusions Mild INR elevations of 1.31–1.69 in warfarin-associated SDH are not associated with a markedly increased risk of radiographic or clinically significant expansion of SDH. Larger prospective studies are needed to determine if subtherapeutic INR elevations at HD1 are associated with smaller increases in risk of SDH expansion.

scholarly journals Bipallidal Lesions in a COVID-19 Patient: A Case Report and Brief Review of Literature

2020 ◽  
Author(s):  
Sudhat Ashok ◽  
Kalyan Shastri ◽  
L. Beryl Guterman ◽  
Lee R. Guterman
Keyword(s):  
Brain Injury ◽  
African American Woman ◽  
Central Nervous System Involvement ◽  
American Woman ◽  
Ischemic Brain Injury ◽  
Ischemic Brain ◽  
Hyperintense Signal ◽  
History Of ◽  
Hypoxic Ischemic Brain Injury ◽  
Bilateral Lung

Abstract BackgroundAltered mentation in COVID-19 patients can be a function of any number of metabolic abnormalities associated with the infection. Here we present the case of an encephalopathic COVID-19 patient with bilateral globus pallidus lesions. While imaging abnormalities involving basal ganglia have been reported in encephalitis caused by neuroinvasive flaviviruses, the bipallidal lesions noted here likely resulted from hypoxic-ischemic brain injury.Case PresentationA 51-year-old African American woman was found unresponsive at home by her fiancé. She had been complaining of shortness of breath and cough for three days. She is a former smoker with past medical history of hypertension, nephropathy, and bipolar disorder. Upon examination, she was alert but nonverbal, following commands inconsistently, and unable to move extremities against gravity. After several minutes, she was able to state her name but kept repeating it in response to all questions. Chest radiograph revealed bilateral lung infiltrates. CT of the head showed hypodensities in bilateral globus pallidi. A non-contrast MRI of the brain showed symmetric restricted diffusion and FLAIR hyperintense signal changes in bilateral globus pallidi. Abnormal SWI signal seen in bilateral globus pallidi likely represents mineralization or hemosiderin. There were no striatal or thalamic lesions. Major intracranial arteries were widely patent.The patient later tested positive for 2019-nCoV using real-time PCR assay, and was transferred to our COVID-19 designated hospital campus. Thereafter, she had waxing and waning mentation. Repeat CT imaging 11 days after the first scan demonstrated resolution of the bipallidal hypodensities. The patient was recently discharged to a subacute rehab facility but is still experiencing confusion.ConclusionsAs we come across neurological manifestations of COVID-19, we believe neuroimaging is likely to play an important role in establishing if central nervous system involvement is invariably due to indirect mechanisms such as metabolic or hypoxic-ischemic brain injury or if direct neuroinvasive disease is a possibility, as with certain viruses.

scholarly journals Rhopressa-induced corneal edema: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Matthew J. Chu ◽  
Michael Song ◽  
Trisa Palmares ◽  
Alice Song ◽  
Julia Song
Keyword(s):  
African American Woman ◽  
Open Angle Glaucoma ◽  
Case Reports ◽  
American Woman ◽  
Corneal Edema ◽  
Common Side Effect ◽  
Conjunctival Hyperemia ◽  
Rock Inhibitor ◽  
Unique Case ◽  
History Of

Abstract Background Rhopressa (netarsudil) has recently been added to the arsenal of treatment for open-angle glaucoma. It is an effective norepinephrine transporter and Rho-associated protein kinase (ROCK) inhibitor used to decrease intraocular pressure (IOP), with the most common side effect being conjunctival hyperemia. Case presentation We report a unique case of Rhopressa-induced corneal edema in a 79-year-old African-American woman, which resolved after discontinuation. She had a history of smoking one cigarette per day and did not consume alcohol. She had no history of corneal edema or uveitis. Conclusions Previous case reports have documented patients with Rhopressa-induced corneal edema; however, they have all had a preexisting history of corneal edema or uveitis. We believe that this is a unique case of Rhopressa-induced corneal edema in a relatively healthy eye. While Rhopressa is effective in managing glaucoma, there may be effects of treatment that are still unknown. We will discuss clinical findings of our case, along with a review of previous literature on Rhopressa and novel ROCK inhibitors. We hope that we can add to the existing body of literature and invite further investigation of Rhopressa and ROCK inhibitors and their effects on the cornea.

scholarly journals Descendants of Celia and Robert Newsom Speak

Genealogy ◽  
2020 ◽  
Vol 4 (2) ◽  
pp. 49 ◽  
Author(s):  
Traci Wilson-Kleekamp
Keyword(s):  
African American ◽  
Family History ◽  
Oral History ◽  
African American Woman ◽  
Family Relations ◽  
American Woman ◽  
Black Feminist Thought ◽  
Black Feminist ◽  
Black And White ◽  
History Of

This paper deploys narrative inquiry and analysis to capture the oral history of two families’ intergenerational memory of an African American woman named Celia who was hanged in 1855 for killing her owner Robert Newsom. It is the first scholarly investigation into the intergenerational memory of both black and white descendants of Robert Newsom, and the first to be conducted utilizing the theory of critical family history. Through the paradigm of Black Feminist Thought, the paper analyzes the power imbalances embedded in the narrative about family relations, especially those that conjure race, gender roles and class produced through oral history.

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