Warfarin Institute of America
DEDICATED TO YOUR HEALTH SINCE 2000
CLINDAMYCIN INTERACTION WITH WARFARIN (Coumadin, Jantoven)
Brand Name: Cleocin
There is some question as to whether or not this interaction occurs. There are some reports prior to 1980, but back then warfarin (Coumadin, Jantoven) was managed much differently from the way it is today. However, I have had an exchange of e-mails with Mary Aubertin, DMD from the University of Texas Health Sciences Center in San Antonio. She had a patient who experienced prolonged bleeding when prescribed clindamycin before and after some dental work. The following is that exchange.
Dr. Aubertin: I have had a woman premedicated
with clindamycin for a prosthetic heart
valve for the surgical procedure of crown lengthening of a maxillary
canine (buccal flap, removal of about 2mm of crestal bone). Her INR
was 2.7.
She was given a prescription for clindamycin 150 mg q6h for one week
post-op. She continued to ooze blood from one of the incision lines
for the better part of the next week. She had bleeding off and on,
which stopped at home with pressure and/or a tea bag placed on the site.
She was seen 2 weeks post op and found to have freely bleeding granulation
tissue in one of the incision lines. Curetting that away appeared to
cure the bleeding problem. INRs were ordered subsequent to the
surgery, which were normal. The patient also drank hot coffee very
frequently. One oral surgery resident I talked with said he had
found an obscure internet reference which reported that clindamycin also
interacts with coumadin, but I'm not sure of the mechanism.
Mr. Lodwick: I do not know of any
interactions with references but here are my
thoughts. warfarin (Coumadin, Jantoven) is a slow-acting drug because it inhibits the
production of vitamin K dependent clotting factors. It does nothing
with the ones already circulating in the body. These factors have a
half-life of about three days. Therefore, it is probably 36 hours
before anything noticeable will happen. Even if you assume that they
may raise the INR
when given with warfarin (Coumadin, Jantoven), it should happen only after the healing process
from an out-patient dental procedure is well under way. The
likelihood of an adverse bleeding event is probably the result of both the
magnitude of the INR and the time spent above the range. If an
antibiotic did raise the INR, even to double the therapeutic range (to 6
or 7) it should only stay there for about one day. I see patients
every week in this range who have no problems.
SEE A CATALOG OF PUBLICATIONS AVAILABLE FROM LODWICK CREATIONS, LLC.
LEARN HOW YOU CAN BECOME LISTED ON THE HONOR ROLL OF SUPPORTERS AND TAKE ADVANTAGE OF THE BENEFITS
REQUEST A MEDICATION CONSULTATION
Back to interactions list Home
© 2000-2006 Lodwick Creations, LLC
Contact Mr. Lodwick at: allodwick@earthlink.net
Last modified May 7, 2006