Warfarin Institute of America
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FLUOROURACIL INTERACTIONS WITH WARFARIN
There has been some controversy over whether or not this interaction actually occurs. I believe it does (I've seen it once).
(For those of you who have linked from the capecitabine page, the rest of this applies to that drug also.)
Kolesar et al reported on five patients who took this combination. The patients required about a 44% reduction in their warfarin dose after 5-FU was added. One patient suffered a major internal bleeding episode on this combination. The maximum INR observed was 23.7. The authors recommend weekly monitoring of the INR for all patients on 5-FU or capecitabine.
Masci et al reported that they found this happening in patients taking minidose warfarin and the FOLOX chemotherapy regimen.
References:
Kolesar et al. Warfarin - 5-FU interaction -- a consecutive case series. Pharmacotherapy 1999;19:1445-1449.
Masci G et al. Minidose warfarin prophylaxis for catheter-associated
thrombosis in cancer patients: can it be safely associated with
fluorouracil-based chemotherapy? J Clin Oncol. 2003;21:736-9.
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Last updated November 7, 2004