A case study: amiodarone enhanced warfarin anticoagulation effects for post heart value replacement

QIAN Jiao; WANG Zhuo; CAO Ailin

doi:10.3969/j.issn.1006-0111.2015.06.023

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Objective To explore the role of clinical pharmacists in analyzing and dealing with abnormal INR value fluctuations caused by the drug interaction of warfarin and amiodarone in a post heart valve replacement patient. Methods By comparing interactions between warfarin and other drugs, we investigated the drugs the patient was using, found the cause of unusual INR value fluctuations, and regulated warfarin dosage in time. After that, we intensified the monitoring of coagulation function and offered detailed pharmaceutical care to the patient. In addition, we studied the possible reasons for the phenomenon from the following aspects such as the drug action mechanisms of warfarin and amiodarone;the interaction mechanisms of the two drugs;the correlation of anticoagulation effects of warfarin, the dosage and concentration of combined use of these two drugs. Results The reason for unusal INR value fluctuations was identified as the drug interaction between warfarin and amiodarone. Amiodarone can enhance the anticoagulant effects of warfarin, increase the risk of bleeding. By stoping warfarin for 3 days, INR value was restored to the target range. Then we continued the anticoagulant therapy, and the condition of the patient was controlled steadily, and he was discharged smoothly. Conclusion Clinical pharmacists can help doctors find out problems related to drug therapy in time by providing effective pharmaceutical care to patients, so doctors may adjust the treatment in time. When using the drugs interacted with warfarin, we have to consider the those drug effects on anticoagulant therapy. In order to adjust regimens in time, we must understand the pharmacology and pharmacokinetics of the drugs we used at the same time;as well, we must intensify monitoring. Therefore, we can improve the safety and rationality of clinical medication, and also can provide better pharmaceutical care for patients.

A case study: amiodarone enhanced warfarin anticoagulation effects for post heart value replacement

Department of Pharmacy, Changhai Hospital Affiliated to Second Military Medical University, Shanghai 200433, China

Received Date: 2013-10-12

Rev Recd Date: 2014-07-01

Key words:

Abstract: Objective To explore the role of clinical pharmacists in analyzing and dealing with abnormal INR value fluctuations caused by the drug interaction of warfarin and amiodarone in a post heart valve replacement patient. Methods By comparing interactions between warfarin and other drugs, we investigated the drugs the patient was using, found the cause of unusual INR value fluctuations, and regulated warfarin dosage in time. After that, we intensified the monitoring of coagulation function and offered detailed pharmaceutical care to the patient. In addition, we studied the possible reasons for the phenomenon from the following aspects such as the drug action mechanisms of warfarin and amiodarone;the interaction mechanisms of the two drugs;the correlation of anticoagulation effects of warfarin, the dosage and concentration of combined use of these two drugs. Results The reason for unusal INR value fluctuations was identified as the drug interaction between warfarin and amiodarone. Amiodarone can enhance the anticoagulant effects of warfarin, increase the risk of bleeding. By stoping warfarin for 3 days, INR value was restored to the target range. Then we continued the anticoagulant therapy, and the condition of the patient was controlled steadily, and he was discharged smoothly. Conclusion Clinical pharmacists can help doctors find out problems related to drug therapy in time by providing effective pharmaceutical care to patients, so doctors may adjust the treatment in time. When using the drugs interacted with warfarin, we have to consider the those drug effects on anticoagulant therapy. In order to adjust regimens in time, we must understand the pharmacology and pharmacokinetics of the drugs we used at the same time;as well, we must intensify monitoring. Therefore, we can improve the safety and rationality of clinical medication, and also can provide better pharmaceutical care for patients.

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Reference (11)

[1]	Watt AH, Stephens MR, Buss DC, et al. Amiodarone reduces plasma warfarin clearance in man[J]. Br J Clin Pharmacol, 1985, 20(6): 707.
[2]	Cheung B,Lam FM,Kumana CR.Insidiously evolving, occult drug interaction involving warfarin and amiodarone[J]. BMJ, l996, 312(7023): 107.
[3]	Sanoski CA, Bauman JL. Clinical observations with the amiodarone/warfarin interaction[J]. Chest, 2002, 121(1): 19.
[4]	Breckenridce A, Orme M. Kinetics of warfarin absorption in man[J].Clin Pharmacol Ther, 1973, 14(6): 955.
[5]	Breckenridce A, Orme M, Wesseling H, et a1. Pharmacokinetics and pharmacodynamics of the enantiomers of warfarin in man[J]. Clin Pharmacol Ther, 1974, 15(4): 424.
[6]	岳林峰.抗凝药物华法林的安全应用[J].药学与临床研究,2009, 17(5): 397.
[7]	Habib G,Nashashibi M,Khateeb A,et al.Excessive prolongation of prothrombin time among patients treated with warfarin and admitted to the emergency room[J].Eur J Intern Med, 2009, 19: 129.
[8]	Heimark LD, Wienkers L, Kunze K, et al. The mechanism of the interaction between amiodarone and warfarin in humans[J]. Clin Pharmacol Ther, 1992, 51(4): 398.
[9]	Ohyama K, Nakajima M, Suzuki M, et al. Inhibitory effects of amiodarone and its N-deethylated metabolite on human cytochrome P450 activities: prediction of (in vivo) drug interactions[J]. Br J clin Pharmacol, 2000, 49(3): 244.
[10]	谢爽,刘红,娄莹,等. 胺碘酮对心脏瓣膜置换患者华法林初始服药1周内抗凝效果的研究[J].中国药学杂志, 2010, 45(8): 593.
[11]	Walter A, Alexander SG, Ann W, et al. Oral anticoagulant therapy : antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J].Chest, 2012, 141: e44S.

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A case study: amiodarone enhanced warfarin anticoagulation effects for post heart value replacement

doi: 10.3969/j.issn.1006-0111.2015.06.023

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通讯作者: 陈斌, [email protected]

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