Warfarin Institute of America
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FLUVOXAMINE INTERACTION WITH WARFARIN
Brand Name: Luvox
The package insert for Luvox (fluvoxamine) states that adding warfarin to the medications of a patient taking warfarin can almost double the blood level of warfarin. Therefore, a high international normalized ratio (INR) can result. This increased activity of warfarin can be prolonged, particularly in the elderly.
Yap and Low reported that the INR became elevated on an 80-year-old woman who was on warfarin and started fluvoxamine. Her INR was elevated within one week. Six days later warfarin was re-started and her INR became elevated again. The high INR persisted for two weeks after the fluvoxamine was stopped.
Limke et al. report on another such an occurrence. A 79-year-old woman was started on fluvoxamine while taking warfarin. Her INR became elevated and persisted for seven days. The authors note that warfarin and fluvoxamine are metabolized by the same liver enzymes. Also fluvoxamine is metabolized to eleven different metabolites which may contribute to its prolonged effect on warfarin. The authors conclude that closely monitoring of patients with this combination of medications is necessary.
References:
Yap KB, Low ST. Interaction of fluvoxamine with warfarin in an elderly woman. Singapore Med J. 1999;40:480-482.
Limke KK et al. Fluvoxamine interaction with warfarin. Ann Pharmacother 2002;36:1890-1892.
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Last updated November 7, 2004