Oral Anticoagulants

Anticoagulants increase the risk of bleeding if administered prior to, during, or after Alteplase therapy.

Concomitant use may increase prolongation of prothrombin time and abnormal INR. Monitoring and dose adjustments may be necessary.

Abnormal prolongation of prothrombin time and increased INR reported. Monitoring and dose adjustments of anticoagulants may be necessary.

Increased risk of bleeding. Aspirin can displace warfarin from protein binding sites, prolonging prothrombin time and bleeding time.

Increased risk of bleeding. Aspirin can displace warfarin from protein binding, prolonging prothrombin and bleeding time. Aspirin increases anticoagulant activity of heparin.

Bicalutamide can displace coumarin anticoagulants from protein binding sites. PT/INR should be closely monitored and anticoagulant dose adjustment may be necessary.

Potentiation of anticoagulant effect; Prothrombin time, INR, or other anticoagulation tests should be closely monitored.

Aspirin enhances effects causing bleeding by inhibiting prothrombin formation and displacing anticoagulants from plasma protein binding sites.

Concomitant use may increase the risk of bleeding. Avoid concomitant use when possible and monitor closely for bleeding.

Increased prothrombin time, with or without clinical bleeding, has been reported when cefixime is administered concomitantly with anticoagulants.

Chenodiol hepatotoxicity can affect coumarin pharmacodynamics, causing unexpected prolongation of prothrombin time and hemorrhages. Careful monitoring required.

Potentiate CNS-depressant action of clonazepam.

Dexamethasone may reduce the response to anticoagulants. Frequently monitor coagulation indices to maintain the desired anticoagulant effect.

Methylphenidate may inhibit the metabolism of coumarin anticoagulants. Downward dose adjustments may be required and coagulation times should be monitored.

Vitamin K1 in soybean oil component may counteract anticoagulant activity. Monitor laboratory parameters for anticoagulant activity.

Increased anticoagulant effects when used concomitantly with erythromycin, potentially more pronounced in elderly patients.

Increased anticoagulant effects have been reported with concomitant use, particularly in elderly patients.

Androgens may decrease anticoagulant requirements; patients require close monitoring, especially when androgens are started or stopped.

Simvastatin prolongs INR. Achieve stable INR before starting therapy and monitor frequently upon initiation or dose changes.

Potentiation of coumarin anticoagulant effects with prolongation of PT/INR. Dosage reduction and frequent PT/INR monitoring recommended to prevent bleeding complications.

Fibrates may potentiate coumarin anticoagulant effects with prolongation of PT/INR. Reduce anticoagulant dosage and monitor PT/INR frequently to prevent bleeding complications.

Coumarins may potentiate the hypoglycemic action of glyburide. Close observation for hypoglycemia required.

Concomitant use with indomethacin has been associated with bleeding in post-marketing experience. Monitor prothrombin time closely.

Thyroid hormones increase catabolism of vitamin K-dependent clotting factors, impairing compensatory synthesis. Patients may require reduced anticoagulant dosage when starting thyroid replacement.

Levothyroxine increases response to oral anticoagulant therapy. Decrease in anticoagulant dose may be warranted with correction of hypothyroidism or dose increases. Closely monitor coagulation tests.

Levothyroxine increases the response to oral anticoagulant therapy. Decrease in anticoagulant dose may be warranted with correction of hypothyroidism. Prothrombin time should be closely monitored.

Thyroid hormones increase catabolism of vitamin K-dependent clotting factors, impairing compensatory increases in clotting factor synthesis. Patients stabilized on oral anticoagulants starting thyroid replacement may require reduction in anticoagulant dosage.

Produces increased CNS-depressant effects including respiratory depression and sedation.

Highly protein-bound drug that may increase methotrexate plasma concentrations, increasing risk of severe adverse reactions and potentially reducing clinical effectiveness.

Highly protein-bound oral anticoagulants may increase methotrexate plasma concentrations, increasing risk of severe adverse reactions.

C-17 substituted derivatives of testosterone decrease anticoagulant requirements. Close monitoring required, especially when androgens are started or stopped.

Metronidazole potentiates the anticoagulant effect of oral coumarin anticoagulants, resulting in prolongation of prothrombin time. Prothrombin time and INR should be carefully monitored.

Prolonged anticoagulant effects reported with oral metronidazole co-administration, resulting in prothrombin time prolongation.

Nintedanib is a VEGFR inhibitor that may increase bleeding risk. Monitor patients on full anticoagulation therapy closely and adjust treatment as necessary.

Prolonged prothrombin time and INR occasionally associated with hemorrhage reported in patients receiving oxaliplatin with fluorouracil/leucovorin. Increase monitoring frequency.

Bleeding has been reported in patients treated with pentoxifylline with or without concomitant anticoagulants.

Combination prolongs INR. Achieve stable INR prior to starting rosuvastatin and monitor frequently upon initiation or alteration of therapy.

Rosuvastatin significantly prolongs INR in patients receiving coumarin anticoagulants. Monitor INR frequently until stable.

Salicylate competes for serum albumin binding, increasing bleeding risk in patients on oral anticoagulants.

Salicylate competition for serum albumin binding increases bleeding risk.

Salicylates given concomitantly with anticoagulant drugs may predispose to systemic bleeding.

SEYSARA may depress plasma prothrombin activity, increasing bleeding risk. Decrease anticoagulant dosage as appropriate.

Concomitant use prolongs INR. Achieve stable INR prior to starting simvastatin and monitor INR frequently during therapy initiation or changes.

Significant increase in anticoagulant effect may occur; careful monitoring of prothrombin time is recommended.

Produces additive CNS-depressant effects when co-administered with temazepam.

May decrease anticoagulant requirement; patients require close monitoring especially when androgens are started or stopped.

Thyroid hormones increase catabolism of vitamin K-dependent clotting factors, impairing compensatory increases in clotting factor synthesis. Patients stabilized on oral anticoagulants starting thyroid replacement require close monitoring and likely need anticoagulant dose reduction.

Thyroid hormones increase catabolism of vitamin K-dependent clotting factors, impairing compensatory increases in clotting factor synthesis. Patients may require reduction in anticoagulant dosage.

Tinidazole may enhance the effect of coumarin anticoagulants, resulting in prolongation of prothrombin time. Dosage adjustment may be needed during tinidazole co-administration and up to 8 days after discontinuation.

Concomitant use increases the risk of bleeding.

Concomitant use increases the risk of bleeding.

Concomitant use may potentiate bleeding risk. Monitor closely for bleeding.

High doses of folic acid may result in decreased serum levels of anticonvulsant drugs.

Anticonvulsants may increase the catabolism of cholecalciferol. Additional vitamin D supplementation should be considered.

Coadministration produces additive CNS depressant effects. Carefully consider pharmacology of agents to be employed.

Amoxicillin may cause abnormal prolongation of prothrombin time (increased INR) in patients receiving oral anticoagulants. Monitoring and dose adjustments may be necessary.

Increased risk of methemoglobinemia when concurrently exposed to anticonvulsants.

Variable effects on blood coagulation have been reported very rarely in patients receiving oral anticoagulants with chlordiazepoxide. Monitor patients closely.

Ciprofloxacin may increase anticoagulant effect and INR; monitor prothrombin time.

Concomitant use may potentiate risk of bleeding.

Concomitant use may potentiate risk of bleeding. Inform patients of increased bleeding risk.

XIAFLEX should be used with caution in patients receiving concomitant anticoagulants (except for low-dose aspirin) due to increased risk of bleeding.

Both increased and decreased warfarin effects have been reported in patients receiving warfarin and cyclophosphamide.

Use of FRAGMIN with oral anticoagulants may increase the risk of bleeding.

May increase formation of dapsone hydroxylamine, a metabolite associated with hemolysis. Monitor for hemolytic reactions.

May increase formation of dapsone hydroxylamine, a metabolite associated with hemolysis.

Tetracyclines depress plasma prothrombin activity; patients on anticoagulant therapy may require downward adjustment of anticoagulant dosage.

Tetracyclines depress plasma prothrombin activity; patients may require downward adjustment of anticoagulant dosage.

May potentiate or be potentiated by diazepam action. Careful consideration should be given when combining.

Diazoxide is highly bound to serum proteins and may displace coumarin, resulting in higher blood levels of coumarin.

Diazoxide may displace coumarin from protein binding, affecting blood levels. Monitor INR and adjust coumarin dosage as needed.

Disulfiram may prolong prothrombin time. Dosage adjustment may be necessary when beginning or stopping disulfiram.

Tetracyclines depress plasma prothrombin activity; patients on anticoagulant therapy may require downward adjustment of anticoagulant dosage.

Tetracyclines depress plasma prothrombin activity; anticoagulant dosage may require downward adjustment.

Epoprostenol has the potential to increase the risk of bleeding when used concomitantly with anticoagulants, though clinical trials showed no evidence of increased bleeding.

Tetracyclines depress plasma prothrombin activity; patients on anticoagulant therapy may require downward adjustment of anticoagulant dosage.

May potentiate the action of estazolam; careful consideration of CNS effects needed.

Prolonged bleeding time reported in patients taking anticoagulants with oral omega-3 fatty acids. Periodic monitoring of bleeding time recommended.

Decreased prothrombin time response. Monitor prothrombin levels and adjust anticoagulant dosage accordingly.

Produces additive CNS depressant effects. Downward dose adjustment may be necessary.

May potentiate hypoglycemic action of glyburide; patient should be closely observed for hypoglycemia.

Highly protein-bound drugs that may increase glucose-lowering effect of glimepiride, increasing susceptibility to hypoglycemia.

Coumarins may potentiate hypoglycemic action of glipizide. Patient should be observed closely for hypoglycemia when initiated or withdrawn.

Coumarins may potentiate the hypoglycemic action of glipizide. Patient should be observed closely for hypoglycemia.

May potentiate hypoglycemic action of glyburide; monitor for hypoglycemia.

Variable effect with reports of both enhanced and diminished anticoagulant effects when given concurrently with corticosteroids. Coagulation indices should be monitored.

Omega-3 fatty acids may prolong bleeding time. Monitor patients for bleeding when icosapent ethyl is used concomitantly with anticoagulants.

Omega-3 fatty acids may prolong bleeding time. Monitor patients for bleeding when used concomitantly with anticoagulants.

Methohexital may influence the metabolism of anticoagulants.

Methylphenidate may inhibit metabolism of coumarin anticoagulants. Downward dose adjustments may be required and coagulation times should be monitored.

Methylphenidate may inhibit metabolism of coumarin anticoagulants; downward dose adjustment may be required and coagulation times should be monitored.

Effect is variable with reports of both enhanced and diminished anticoagulant effects; coagulation indices should be monitored.

Increased risk of methemoglobinemia when concurrently exposed.

Metolazone may affect hypoprothrombinemic response to anticoagulants; dosage adjustments may be necessary.

May affect the results of the metyrapone test. Consider withdrawing if possible before testing.

Tetracyclines depress plasma prothrombin activity; patients may require downward adjustment of anticoagulant dosage.

Tetracyclines depress plasma prothrombin activity; patients may require downward adjustment of anticoagulant dosage.

Tetracyclines decrease plasma prothrombin activity; patients on anticoagulant therapy may require downward adjustment of anticoagulant dosage.

Morphine may increase the anticoagulant activity of coumarin and other anticoagulants.

Oral neomycin sulfate may enhance anticoagulant effect of coumarin by decreasing vitamin K availability.

Rare reports of increased prothrombin time in patients taking coumarin anticoagulants with nifedipine, though relationship uncertain.

Natural Vitamin K1 content in olive and soybean oils may counteract the anticoagulant activity of coumarin derivatives.

Tetracyclines depress plasma prothrombin activity; patients may require downward adjustment of anticoagulant dosage.

Omega-3-acid ethyl esters may prolong bleeding time. Patients receiving both should be monitored periodically.

Omega-3-acid ethyl esters may prolong bleeding time. Patients taking concomitant anticoagulants should be monitored periodically.

Phenobarbital may decrease the effect of anticoagulants, necessitating larger doses for optimal effect. Dose adjustment may be needed when phenobarbital is discontinued.

Monitor coagulation parameters in patients receiving piperacillin and tazobactam with oral anticoagulants.

Prednisone may enhance or diminish anticoagulant effects variably; coagulation indices should be monitored to maintain desired anticoagulant effect.

Produces additive CNS depressant effects. Downward dose adjustment may be necessary.

No data available on concomitant use. Consider risks and benefits; concomitant use was not allowed in clinical studies.

Chronic use may reduce activity and duration of rocuronium bromide effect, requiring higher infusion rates.

Prolongation of PT and elevation of INR observed similar to warfarin. Monitor PT and INR more frequently when co-administered with romidepsin.

Concurrent use may potentiate the risk of bleeding.

Somatropin may alter clearance of anticonvulsants metabolized by CYP450 liver enzymes; careful monitoring is advised.

Soybean oil contains vitamin K1 which can counteract anticoagulant activity of coumarin and coumarin derivatives. Monitor laboratory parameters.

Sulfonamides may increase the effect of oral anticoagulants, probably by displacement from plasma albumin binding sites.

GH may alter clearance of anticonvulsants metabolized by CYP450 liver enzymes; monitor for potential interactions.

Changes in anticoagulant activity may occur with androgens. More frequent monitoring of INR and prothrombin time is recommended, especially at initiation and termination of therapy.

Androgens may increase sensitivity to oral anticoagulants, requiring dosage reduction to maintain therapeutic hypoprothrombinemia.

Androgens may change anticoagulant activity. More frequent monitoring of INR and prothrombin time is recommended, especially at initiation and termination of therapy.

Androgens may alter anticoagulant activity. Frequent monitoring of INR and prothrombin time is necessary, especially at initiation and termination of therapy.

Tetracyclines depress plasma prothrombin activity; patients may require downward adjustment of anticoagulant dosage.

The effect of oral anticoagulants may be decreased when used concurrently with hydrochlorothiazide; dosage adjustments may be necessary.

Concomitant use may potentiate the risk of bleeding. Monitor patients closely for bleeding when initiating or discontinuing venlafaxine.

Concomitant use may potentiate bleeding risk. Closely monitor for bleeding when initiating or discontinuing venlafaxine.

Concurrent use may potentiate bleeding risk. Monitor INR carefully for warfarin.

High doses of folic acid may result in decreased serum levels of anticonvulsant drugs.

High doses of folic acid may result in decreased serum levels of anticonvulsant drugs.

Prolongation of prothrombin time (PT) and International Normalized Ratio (INR) observed with concomitant use. Monitor PT and INR frequently.

No changes in degree of anticoagulation observed when guanfacine administered with oral anticoagulants at 1-2 mg/day for 4 weeks.

No changes in anticoagulation observed when guanfacine 1-2 mg/day was given to patients stabilized on oral anticoagulants for 4 weeks.