#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Interactions between glucocorticoids and warfarin in chronic inflammatory (autoimmune) diseases


Authors: L. Hromádková;  J. Vlček
Authors‘ workplace: Katedra sociální a klinické farmacie Farmaceutické fakulty UK Hradec Králové, vedoucí prof. RNDr. Jiří Vlček, CSc.
Published in: Vnitř Lék 2012; 58(5): 354-356
Category: Reviews

Overview

Glucocorticosteroids are still very important part of the treatment of chronic inflammatory disorders. Their use is often accompanied by unpleasant adverse effects, problems associated with withdrawal during their long-term use and interactions with conco­mitantly administered drugs. One of the important interactions that may often occur in clinical practice is interaction with warfarin. Despite the fact that as glucocorticosteroids so warfarin are used for many years and seem to be completely known, their co-administration is still accompanied by uncertainties. The interaction may have pharmacodynamic or pharmacokinetic character and both types result in increased risk of bleeding. The pharmacodynamic interaction can be expected to increase a risk of gastrointestinal bleeding to which a gastrotoxicity of glucocorticosteroids contributes. A pharmacokinetic interaction is considered to influence a hepatic metabolism of warfarin and to increase its availability. The exact mechanism is still not fully understood. Manifestations of both types of interactions are taken up with a delay. Co-administration requires increased attention and close monitoring of international normalized ratio. At higher doses of glucocorticosteroids proton pump inhibitors are also effective in prevention of gastrotoxicity.

Key words:
glucocorticosteroids – warfarin – interaction – rheumatology – autoimmune disorders


Sources

1. Product information. Medrol (methylprednisolone). Pfizer Inc., Prague, Czech Republic, November 2009.

2. Carson JL, Strom BL, Schinnar R et al. The low risk of upper gastrointestinal bleeding in pa­tients dispensed corticosteroids. Am J Med 1991; 91: 223–228.

3. Hazlewood KA, Fugate SE, Harrison DL. Effect of oral corticosteroids on chronic warfarin therapy. Ann Pharmacother 2006; 40: 2101–2106.

4. Kaufman M. Treatment of multiple sclerosis with high-dose corticosteroids may prolong the prothrombin time to dangerous levels in patients taking warfarin. Mult Scler 1997; 3: 248–249.

5. Costedoat-Chalumeau N, Amoura Z, Aymard G et al. Potentiation of vitamin K antagonists by high-dose intravenous methylprednisolone. Ann Intern Med 2000; 132: 631–635.

6. Bai XB, Liu CX. Overview of major CYP450 isoforms and “Cocktail Approach”. Asian J Drug Metabolism Pharmacokinetics 2005; 5: 257–264.

7. Sharif Z. Pharmacokinetics, metabolism, and drug interactions of atypical antipsychotics in special population. J Clin Psychiatry 2003; 5 (Suppl 6): 22–25.

8. DRUGDEX® System [intranet database]. Version 5.1. Greenwood Village, Colo: Thomson Reuters (Healthcare) Inc.

Labels
Diabetology Endocrinology Internal medicine
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#