Moxifloxacin—Warfarin Interaction: A Series of Five Case Reports

2005 ◽  
Vol 39 (2) ◽  
pp. 361-364 ◽  
Author(s):  
Dean HT Elbe ◽  
Sandra W Chang
Keyword(s):  
Drug Interaction ◽  
Warfarin Therapy ◽  
Healthcare Professionals ◽  
Case Reports ◽  
Potential Interaction ◽  
Warfarin Interaction ◽  
Probability Scale ◽  
Product Monograph ◽  
Clinically Significant ◽  
Age Range

OBJECTIVE: To report 5 cases of a moxifloxacin—warfarin drug interaction, all resulting in elevated international normalized ratios (INRs) and clinically significant hemorrhage in one case. CASE SUMMARIES: Between January 2002 and January 2004, 4 men and 1 woman (age range 63–92 y) were retrospectively identified as having significantly elevated INR results shortly after being prescribed moxifloxacin with concomitant warfarin therapy. DISCUSSION: This is the second series of case reports describing an interaction between warfarin and moxifloxacin. The current moxifloxacin product monograph indicates this drug has no significant effect on the pharmacokinetics of R- or S-warfarin or the prothrombin time (INR). A moxifloxacin—warfarin interaction probably led to prolonged hospitalization in 2 cases and significant gastrointestinal hemorrhage in one case. In 3 of the 5 cases, a moxifloxacin—warfarin interaction was assessed as probable, and in the remaining 2 cases, a moxifloxacin—warfarin interaction was assessed as possible by use of the Naranjo probability scale. CONCLUSIONS: Healthcare professionals should consider moxifloxacin for the potential to interact with warfarin. Routine, frequent INR monitoring for patients previously stabilized on warfarin during initiation and discontinuation of moxifloxacin may help detect this potential interaction.

Capecitabine–Warfarin Interaction

2005 ◽  
Vol 39 (9) ◽  
pp. 1546-1551 ◽  
Author(s):  
Laurel M Janney ◽  
Nancee V Waterbury
Keyword(s):  
Warfarin Therapy ◽  
Case Reports ◽  
Package Insert ◽  
Warfarin Dose ◽  
Stage Iv ◽  
Warfarin Interaction ◽  
Weekly Dose ◽  
Close Monitoring ◽  
Metastatic Colon Cancer ◽  
Pharmacodynamic Interaction

OBJECTIVE: To report a case of concomitant warfarin therapy with consecutive cycles of capecitabine therapy, providing time of onset, magnitude, and assessment of the interaction. CASE SUMMARY: A 59-year-old man receiving chronic warfarin therapy for a mechanical mitral valve replacement was diagnosed with stage IV metastatic colon cancer. He was started on capecitabine/irinotecan after his cancer progressed with fluorouracil/leucovorin and the FOLFOX 6 regimen (oxaliplatin, leucovorin, and continuous fluorouracil infusion). He received 3 consecutive cycles of capecitabine/irinotecan with concomitant oral anticoagulation and, with each cycle, the warfarin dose was reduced. Over the course of these 3 cycles, the total weekly dose of warfarin was reduced by >85%. DISCUSSION: The capecitabine–warfarin interaction is clinically significant, requiring a black box warning in the package insert. The mechanism of action for the interaction is not clear, but may be related to down-regulation of CYP2C9 by capecitabine or its metabolites or a pharmacodynamic interaction with warfarin. A common response to this interaction, as discussed in previously published case reports, is the discontinuation of warfarin, capecitabine, or both. In this case, the Naranjo probability scale indicates a highly probable drug interaction between warfarin and capecitabine. CONCLUSIONS: As more patients require anticoagulation, and as chemotherapy agents such as capecitabine become available, the likelihood for these drug interactions increases. In our patient, close monitoring of therapy allowed successful use of warfarin and capecitabine.

Macrolide Drug Interactions: An Update

2000 ◽  
Vol 34 (4) ◽  
pp. 495-513 ◽  
Author(s):  
Manjunath P Pai ◽  
Danielle M Graci ◽  
Guy W Amsden
Keyword(s):  
Cytochrome P450 ◽  
Drug Interaction ◽  
Drug Interactions ◽  
Case Reports ◽  
Data Extraction ◽  
Depth Information ◽  
Cytochrome P450 Enzyme ◽  
Medline Search ◽  
P450 Enzyme ◽  
Clinically Significant

OBJECTIVE: To describe the current drug interaction profiles for the commonly used macrolides in the US and Europe, and to comment on the clinical impact of these interactions. DATA SOURCES: A MEDLINE search (1975–1998) was performed to identify all pertinent studies, review articles, and case reports. When appropriate information was not available in the literature, data were obtained from the product manufacturers. STUDY SELECTION: All available data were reviewed to provide an unbiased account of possible drug interactions. DATA EXTRACTION: Data for some of the interactions were not available from the literature, but were available from abstracts or company-supplied materials. Although the data were not always explicit, the best attempt was made to deliver pertinent information that clinical practitioners would need to formulate practice opinions. When more in-depth information was supplied in the form of a review or study report, a thorough explanation of pertinent methodology was supplied. DATA SYNTHESIS: Several clinically significant drug interactions have been identified since the approval of erythromycin. These interactions usually were related to the inhibition of the cytochrome P450 enzyme systems, which are responsible for the metabolism of many drugs. The decreased metabolism by the macrolides has in some instances resulted in potentially severe adverse events. The development and marketing of newer macrolides are hoped to improve the drug interaction profile associated with this class. However, this has produced variable success. Some of the newer macrolides demonstrated an interaction profile similar to that of erythromycin; others have shown improved profiles. The most success in avoiding drug interactions related to the inhibition of cytochrome P450 has been through the development of the azalide subclass, of which azithromycin is the first and only to be marketed. Azithromycin has not been demonstrated to inhibit the cytochrome P450 system in studies using a human liver microsome model, and to date has produced none of the classic drug interactions characteristic of the macrolides. CONCLUSIONS: Most of the available data regarding macrolide drug interactions are from studies in healthy volunteers and case reports. These data suggest that clarithromycin appears to have an interaction profile similar to that of erythromycin. Given this similarity, it is important to consider the interaction profile of clarithromycin when using erythromycin. This is especially necessary as funds for further studies of a medication available in generic form (e.g., erythromycin) are limited. Azithromycin has produced few clinically significant interactions with any agent cleared through the cytochrome P450 enzyme system. Although the available data are promising, the final test should come from studies conducted in patients who are taking potentially interacting compounds on a chronic basis.

Macrolides Versus Azalides: A Drug Interaction Update

1995 ◽  
Vol 29 (9) ◽  
pp. 906-917 ◽  
Author(s):  
Guy W Amsden
Keyword(s):  
Drug Interaction ◽  
Drug Interactions ◽  
Case Reports ◽  
Data Extraction ◽  
Membered Ring ◽  
Depth Information ◽  
Variable Effect ◽  
Study Selection ◽  
Variable Success ◽  
Clinically Significant

Objective: To describe the current drug interaction profiles for all approved and investigational macrolide and azalide antimicrobials, and to comment on the clinical impact of these interactions when appropriate. Data Sources: MEDLINE was searched to identify all pertinent studies, review articles, and case reports from 1975 to 1995. When appropriate information was not available in the literature, data were obtained from the product manufacturers. Study Selection: All available data were reviewed to give an unbiased account of possible drug interactions. Data Extraction: Data for some of the interactions were not available from the literature, but were available from abstracts or from company-supplied materials. Although the data were not always entirely explicative, the best attempt was made to deliver the pertinent information that clinical practitioners would need to formulate practice opinions. When more in-depth information was supplied in the form of a review or study report, a thorough explanation of pertinent methodology was supplied. Data Synthesis: Since the introduction of erythromycin into clinical practice, there have been several clinically significant drug interactions identified throughout the literature associated with this drug. These interactions have been caused mostly by inhibition of the CYP3A subclass of hepatic enzymes, thereby decreasing the metabolism of any other agent given concurrently that is also cleared through this mechanism. With the development and marketing of several new macrolides, it was hoped that the drug interaction profile associated with this class would improve. This has been met with variable success. Although some of the extensions of the 14-membered ring macrolides have shown an incidence of interactions equal to that of erythromycin, others have shown improved profiles. In contrast, the 16-membered ring macrolides have demonstrated a much improved, though not absent, interaction profile. The most success in avoiding drug interactions through structure modification has been accomplished with the development of the azalide class, of which azithromycin is the first to be approved for marketing. This agent has to date produced none of the classic drug interactions that most macrolides have demonstrated in patient care. Conclusions: The introduction of new 14- and 16-membered ring macrolides appears to have had a variable effect in modifying the incidence of drug interactions associated with this class. Azithromycin, a member of the new azalide class, has to date produced fewer clinically significant interactions than other azalides with any agent that is cleared through the CYP3A system. Overall, the available data are promising, and the final test should come from conducting studies in patients who are taking potentially interacting compounds on a chronic basis, as most available data are from trials in healthy volunteers.

scholarly journals Herb–Drug Interactions: Worlds Intersect with the Patient at the Center

Medicines ◽  
2021 ◽  
Vol 8 (8) ◽  
pp. 44
Author(s):  
Mary Beth Babos ◽  
Michelle Heinan ◽  
Linda Redmond ◽  
Fareeha Moiz ◽  
Joao Victor Souza-Peres ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Case Report ◽  
Drug Interactions ◽  
Clinical Studies ◽  
Drug Information ◽  
Case Reports ◽  
Full Information ◽  
Information Need ◽  
Herbal Products ◽  
Reduce Risk

This review examines three bodies of literature related to herb–drug interactions: case reports, clinical studies, evaluations found in six drug interaction checking resources. The aim of the study is to examine the congruity of resources and to assess the degree to which case reports signal for further study. A qualitative review of case reports seeks to determine needs and perspectives of case report authors. Methods: Systematic search of Medline identified clinical studies and case reports of interacting herb–drug combinations. Interacting herb–drug pairs were searched in six drug interaction resources. Case reports were analyzed qualitatively for completeness and to identify underlying themes. Results: Ninety-nine case-report documents detailed 107 cases. Sixty-five clinical studies evaluated 93 mechanisms of interaction relevant to herbs reported in case studies, involving 30 different herbal products; 52.7% of these investigations offered evidence supporting reported reactions. Cohen’s kappa found no agreement between any interaction checker and case report corpus. Case reports often lacked full information. Need for further information, attitudes about herbs and herb use, and strategies to reduce risk from interaction were three primary themes in the case report corpus. Conclusions: Reliable herb–drug information is needed, including open and respectful discussion with patients.

Inhibition of Hepatic Microsomal Drug Metabolism by the Hydrazines Ro 4-4602, MK 486, and Procarbazine Hydrochloride

1972 ◽  
Vol 50 (7) ◽  
pp. 721-724 ◽  
Author(s):  
Norman R. Bade ◽  
Stuart M. MacLeod ◽  
Kenneth W. Renton
Keyword(s):  
Drug Interaction ◽  
Drug Metabolism ◽  
Sleeping Time ◽  
Hydrazine Derivatives ◽  
Significant Drug Interaction ◽  
Microsomal Drug Metabolism ◽  
Clinically Significant ◽  
Hepatic Biotransformation

Preliminary experiments were undertaken to examine the effect of three hydrazine derivatives, viz. Ro 4-4602, MK 486, and procarbazine hydrochloride, on hepatic microsomal drug metabolism in rats. All three compounds when given as pretreatment significantly prolonged pentobarbital sleeping time. In vitro, the hepatic microsomal N-demethylation of aminopyrine was inhibited. It is concluded that all three drugs are possible sources of clinically significant drug interaction when administered in combination with other agents which undergo hepatic biotransformation.

scholarly journals Warfarin-Rifampin Drug Interaction in a Pediatric Patient

2017 ◽  
Vol 22 (5) ◽  
pp. 375-377 ◽  
Author(s):  
Michael Poon ◽  
Brady S. Moffett ◽  
Donald L. Yee
Keyword(s):  
Drug Interaction ◽  
Pediatric Patient ◽  
Warfarin Therapy ◽  
Pediatric Patients ◽  
Extreme Case ◽  
Inhibitory Effect ◽  
Adult Patients

Rifampin has been documented to significantly attenuate the effect of warfarin in adult patients. No data have been presented on the use of rifampin and warfarin in a pediatric patient. We report an extreme case of increased warfarin metabolism in a pediatric patient who was concomitantly receiving rifampin, despite receiving other medications that significantly decrease warfarin metabolism. The inhibitory effect of rifampin on warfarin therapy may be amplified in pediatric patients.

scholarly journals Analysis of Health Insurance Big Data for Early Detection of Disabilities: Algorithm Development and Validation (Preprint)

2020 ◽  
Author(s):  
Seung-Hyun Jeong ◽  
Tae Rim Lee ◽  
Jung Bae Kang ◽  
Mun-Taek Choi
Keyword(s):  
Big Data ◽  
Health Insurance ◽  
Early Detection ◽  
Developmental Delays ◽  
Brain Lesion ◽  
Detection Model ◽  
Clinical Diagnoses ◽  
Significant Performance ◽  
Clinically Significant ◽  
Age Range

BACKGROUND Early detection of childhood developmental delays is very important for the treatment of disabilities. OBJECTIVE To investigate the possibility of detecting childhood developmental delays leading to disabilities before clinical registration by analyzing big data from a health insurance database. METHODS In this study, the data from children, individuals aged up to 13 years (n=2412), from the Sample Cohort 2.0 DB of the Korea National Health Insurance Service were organized by age range. Using 6 categories (having no disability, having a physical disability, having a brain lesion, having a visual impairment, having a hearing impairment, and having other conditions), features were selected in the order of importance with a tree-based model. We used multiple classification algorithms to find the best model for each age range. The earliest age range with clinically significant performance showed the age at which conditions can be detected early. RESULTS The disability detection model showed that it was possible to detect disabilities with significant accuracy even at the age of 4 years, about a year earlier than the mean diagnostic age of 4.99 years. CONCLUSIONS Using big data analysis, we discovered the possibility of detecting disabilities earlier than clinical diagnoses, which would allow us to take appropriate action to prevent disabilities.

scholarly journals Burden of caregivers of patients with frontotemporal lobar degeneration – a scoping review

2019 ◽  
pp. 1-21 ◽  
Author(s):  
Tina Karnatz ◽  
Jessica Monsees ◽  
Diana Wucherer ◽  
Bernhard Michalowsky ◽  
Ina Zwingmann ◽  
...  
Keyword(s):  
Caregiver Burden ◽  
Scoping Review ◽  
Frontotemporal Lobar Degeneration ◽  
Healthcare Professionals ◽  
Web Of Science ◽  
Case Reports ◽  
Behavior Changes ◽  
Behavioral Disturbances ◽  
Young Onset Dementia ◽  
And Behavior

ABSTRACT Background: Frontotemporal lobar degeneration (FTLD) is the second-most common cause of young-onset dementia. Personality and behavior changes lead to high caregiver stress and burden, but little support is available. Our aim is to present the evidence on the characteristics, challenges and unmet needs of caregivers as well as on possible interventions. Methods: We conducted a scoping review on caregiver burden using PubMed, Web of Science and ScienceDirect. A total of 69 articles were considered eligible and were analyzed in the present study. Results: Through the analysis of 69 empirical articles, our results show that caregivers of patients with FTLD are often younger in age, have children and find behavioral disturbances to be the most burdensome. Nine studies assessed the needs of and support for caregivers. Ten studies compared the burden in different forms of FTLD, 19 compared FTLD to other types of dementia, and one compared the caregiver burden between two countries. Eight studies reported on interventions for caregivers or interventions taking burden into account. One study assessed the support structure for caregivers of FTLD patients. Five case reports, eight research overviews and three reviews addressed specific needs and challenges. Conclusions: Further research should reproduce and validate efficacious interventions and focus on underage children of FTLD patients and findings from non-Western countries. Additionally, support structures for FTLD caregivers should be assessed and extended. Awareness both in the wider population and among healthcare professionals is an urgent need for the future.

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