Warfarin With Fluoroquinolones, Sulfonamides, or Azole Antifungals: Interactions and the Risk of Hospitalization for Gastrointestinal Bleeding
2008; Wiley; Volume: 84; Issue: 5 Linguagem: Inglês
10.1038/clpt.2008.150
ISSN1532-6535
AutoresHedi Schelleman, WB Bilker, CM Brensinger, Xu Han, SE Kimmel, Sean Hennessy,
Tópico(s)Antibiotics Pharmacokinetics and Efficacy
ResumoThe aim of this study was to determine whether a potential pharmacokinetic interaction between warfarin and orally administered anti-infectives increases the risk of hospitalization for gastrointestinal (GI) bleeding in warfarin users. We conducted a nested case–control and case–crossover study using US Medicaid data. Logistic regression was used to determine the association between GI bleeding and prior use of ciprofloxacin, levofloxacin, gatifloxacin, co-trimoxazole, or fluconazole vs. no exposure and also vs. use of cephalexin, which would not be expected to interact with warfarin. All of the anti-infectives examined were associated with elevated odds ratios (ORs) when compared to no exposure to these drugs. With cephalexin data as the reference, the ORs for co-trimoxazole (OR: 1.68 (95% confidence interval (CI): 1.21–2.33) in the prior 6–10 days) and fluconazole (OR: 2.09 (95% CI: 1.34–3.26) in the prior 11–15 days) were significantly elevated. Warfarin users who had received an anti-infective agent showed a substantially increased risk of GI bleeding. However, a drug–drug interaction with warfarin was evident only for co-trimoxazole and fluconazole. Clinical Pharmacology & Therapeutics (2008); 84, 5, 581–588 doi:10.1038/clpt.2008.150
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