Warfarin Institute of America
DEDICATED TO YOUR HEALTH SINCE 2000
What interaction, if any, is a concern with warfarin and corticosteroids? Is there a difference between oral & inhaled corticosteroids and their effect on warfarin? - Tracy
Corticosteroids have long been known to have a possible interaction with warfarin1. The cause of this interaction has not been clearly determined but it is thought that the corticosteroids change the metabolism of warfarin1. Though corticosteroids can cause a patient’s INR to go either up or down2, it is most common to see an increase in INR1,3. Due to this unpredictable reaction, a patient’s INR should be monitored closely when any corticosteroid treatment is started1.
All information regarding the combined use of warfarin and corticosteroids that I found involved oral corticosteroid use. Though some references report the same interaction warning for Advair® use while taking warfarin4, others report no known interaction2. Because Advair® delivers the corticosteroid directly to the lungs there is very little systemic absorption of the drug. Only about 18% of the inhaled dose reaches the blood circulation2. Based on this information I believe that using Advair® while on warfarin is unlikely to cause any problems significant enough to avoid the combined use, but that a patient should be aware of the possibility. More frequent INR monitoring may be useful to ensure that the INR remains within the therapeutic range but may not be absolutely necessary in all people.
References:
1. Hazlewood KA. Fugate SE. Harrison DL. Effect of oral corticosteroids on chronic warfarin therapy. [Comparative Study. Journal Article] Annals of Pharmacotherapy. 40(12):2101-6, 2006 Dec.
2. Lexi-Comp, Inc. (Lexi-InteractTM ). Lexi-Comp, Inc.; June 28, 2007.
3. Stading JA. Effects of prednisone on the International Normalized Ratio. [Case Reports. Journal Article] American Journal of Health-System Pharmacy. 63(23):2354-6, 2006 Dec 1.
4. Gold Standard, Inc (accessed on June 28, 2007). Clinical Pharmacology, Drug Interactions Report for Healthcare Professionals. URL:http://clinicalpharmacology.com
©2007 Christine Boberick
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