Fluconazole and coumadin

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  1. ridex Guest

    Fluconazole and coumadin


    Absorption: Well absorbed from the GI tract after oral administration. Distribution: Crosses the placenta but does not enter breast milk. Metabolism and Excretion: Metabolized by the liver. TIME/ACTION PROFILE (effects on coagulation tests) PO: (Adults) 2–5 mg/day for 2–4 days; then adjust daily dose by results of INR. Initiate therapy with lower doses in geriatric or debilitated patients or in Asian patients or those with CYP2C9*2 and/or CYP2C9*3 alleles or VKORC1 AA genotype. PO: (Children 1 mo): Initial loading dose– 0.2 mg/kg (maximum dose: 10 mg) for 2–4 days then adjust daily dose by results of INR, use 0.1 mg/kg if liver dysfunction is present. Tablets: 1 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg, 10 mg Cost: Generic: 1 mg $10.83/100, 2 mg $10.83/100, 2.5 mg $10.83/100, 3 mg $10.83/100, 4 mg $10.83/100, 5 mg $8.52/100, 6 mg $10.64/100, 7.5 mg $10.83/100, 10 mg $10.83/100Lab Test Considerations: Monitor PT, INR and other clotting factors frequently during therapy; monitor more frequently in patients with renal impairment. Therapeutic PT ranges 1.3–1.5 times greater than control; however, the INR, a standardized system that provides a common basis for communicating and interpreting PT results, is usually referenced. An INR of 2.5–3.5 is recommended for patients at very high risk of embolization (for example, patients with mitral valve replacement and ventricular hypertrophy). Heparin may affect the PT/INR; draw blood for PT/INR in patients receiving both heparin and warfarin at least 5 hr after the IV bolus dose, 4 hr after cessation of IV infusion, or 24 hr after subcut heparin injection. Asian patients and those who carry the CYP2C9*2 allele and/or the CYP2C9*3 allele, or those with VKORC1 AA genotype may require more frequent monitoring and lower doses. Toxicity Overdose: Withholding 1 or more doses of warfarin is usually sufficient if INR is excessively elevated or if minor bleeding occurs. A 44-year-old man experienced worsening vision and floaters in both eyes for 1 month. His medical history included alcoholism and pancreatitis. He had been admitted to another hospital for parenteral hyperalimentation via a central line, complicated by a deep venous thrombosis of his internal jugular vein requiring anticoagulation with warfarin. His visual acuity without correction was 20/400 OD and counting fingers at 3 ft OS. Slitlamp examination revealed mild anterior chamber cells and anterior vitritis in both eyes. Funduscopic examination revealed vitreous haze and multiple fluffy cotton-ball chorioretinal opacities predominantly in the left eye (Figure 1). A diagnosis of bilateral Candida endophthalmitis was made.

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    Fluconazole is a triazole antifungal agent reported to have a low affinity for human cytochrome P-450, and thus would not be expected to interact with drugs metabolized through the cytochrome P. Fluconazole should be administered with caution to patients with renal dysfunction. Fluconazole is a potent CYP2C9 inhibitor and a moderate CYP3A4 inhibitor. Fluconazole treated-patients who are concomitantly treated with drugs with a narrow therapeutic window metabolized through CYP2C9 and CYP3A4 should be monitored. Warfarin's primary metabolic pathway involves the cytochrome P450 2C9 isoform, and fluconazole is a strong inhibitor of this enzyme. Avoidance of fluconazole in patients on warfarin is advisable—unless the dose of warfarin is empirically reduced and the INR is closely monitored.

    Although commonly used to treat blood clots, warfarin (Coumadin, Jantoven) can have dangerous side effects or interactions that can place you at risk of bleeding. Here are precautions to take to avoid warfarin side effects. If you've been prescribed warfarin (Coumadin, Jantoven) to prevent blood clots, you probably already know that this powerful drug can save your life if you are at risk of or previously had blood clots. But you may not realize how serious warfarin side effects can be. Warfarin, especially if taken incorrectly, increases your risk of dangerous bleeding. Warfarin side effects can also include interactions with some foods, prescription medicines and over-the-counter supplements. When you take warfarin, your blood won't clot as easily. A large number of drugs are introduced every year, and new interactions between medications are increasingly reported. Consequently, it is no longer practical for physicians to rely on memory alone to avoid potential drug interactions. Multiple drug regimens carry the risk of adverse interactions. Precipitant drugs modify the object drug's absorption, distribution, metabolism, excretion or actual clinical effect. Nonsteroidal anti-inflammatory drugs, antibiotics and, in particular, rifampin are common precipitant drugs prescribed in primary care practice. Drugs with a narrow therapeutic range or low therapeutic index are more likely to be the objects for serious drug interactions. Object drugs in common use include warfarin, fluoroquinolones, antiepileptic drugs, oral contraceptives, cisapride and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors.

    Fluconazole and coumadin

    Clinically Significant Drug Interactions - American Family Physician, Fluconazole -

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  6. ATIENTS WHO TAKE WARFARIN Coumadin. Amiodarone, fluconazole, metronidazole, trimethoprim-. can be used instead of brand-name Coumadin.

    • Practical tips for warfarin dosing and monitoring - Cleveland Clinic.
    • Bleeding interaction between fluconazole and warfarin - The..
    • Fluconazole and Warfarin interaction Treato.

    Common Questions and Answers about Fluconazole and warfarin diflucan Common reasons for coumadin use are in atrial fibrillation to reduce the risk of stroke, in persons with clotting disorders, in persons with mechanical heart valves, and sometimes in people with severe heart failure. Fluconazole oral and warfarin oral. fluconazole oral and warfarin oral. fluconazole oral increases levels of warfarin oral by decreasing metabolism. Dec 11, 2018. I have just used diflucan 150mg as a self medication for my yeast. certain other medications Coumadin, oral blood-sugar-lowering medicines.

     
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