Warfarin Institute of America
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OFLOXACIN INTERACTIONS WITH WARFARIN
This drug is not as popular as it once was, but its use is primarily for urinary tract infections. This is an easy area to have bleeding occur and the risk of bleeding increases with this type of infection and high INRs. Therefore, this is worthy of consideration.
It is theorized that taking ofloxacin causes bacteria in the intestinal tract to be killed if the drug is not completely absorbed. These bacteria produce vitamin K. Vitamin K works against warfarin. Therefore, starting ofloxacin and continuing warfarin at the same dose has been reported to cause an increase in the INR. In a case reported by Baciewicz et al., the patient had bleeding only five days after the ofloxacin was started. Therefore, it would seem prudent to check the INR about three days after ofloxacin is started. If the use is to be longer than ten days, it would seem advisable to check the INR again in about one week.
Also remember that if the warfarin dose is lowered during ofloxacin therapy, it will probably need to be raised again about three to seven days after the ofloxacin is stopped.
Reference:
Baciewicz AM et al. Interaction of Ofloxacin and Warfarin.Ann Intern Med 1993;119:1223.
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Last updated November 14, 2004