Fenofibrate with Phenprocoumon Interaction Details
Brand Names Associated with Fenofibrate
- Antara®
- Fenofibrate
- Fenoglide®
- Lipidil®
- Lipofen®
- TriCor®
- Triglide®
- Trilipix®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 15, 2023
Interaction Effect
An increased risk of bleeding
Interaction Summary
Fenofibrate may potentiate the anticoagulant effects of coumarin anticoagulants resulting in prolongation of the Prothrombin Time/International Normalized Ratio (PT/INR). The dosage of the anticoagulants should be reduced to maintain the PT/INR at the desired level to prevent bleeding complications. Frequent PT/INR determinations are advisable until it has been definitely determined that the PT/INR has stabilized. Monitor for both immediate- and delayed-onset bleeding with concomitant use of warfarin and fibrates .
Severity
Major
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
Fenofibrate may potentiate the anticoagulant effects of coumarin anticoagulants resulting in prolongation of the Prothrombin Time/International Normalized Ratio (PT/INR). The dosage of the anticoagulants should be reduced to maintain the PT/INR at the desired level to prevent bleeding complications. Frequent PT/INR determinations are advisable until it has been definitely determined that the PT/INR has stabilized. Monitor for both immediate- and delayed-onset bleeding with concomitant use of warfarin and fibrates .
Mechanism Of Interaction
Additive effects on anticoagulation
Literature Reports
A) Coadministration of warfarin with gemfibrozil compared to warfarin with pravastatin was associated with a 79% increased risk of a composite of gastrointestinal bleeding (GIB) or intracranial hemorrhage (ICH) within the first 30 days of concomitant use (adjusted HR, 1.79; 1.36 to 2.35) in a propensity score-adjusted cohort study of users of warfarin and antihyperlipidemics (N=236,691; median age, 71 years; 63% women). The associated increased risk with gemfibrozil was most pronounced within the first 10 days of concomitant use (adjusted HR, 2.09; 1.35 to 3.24). Additionally, coadministration of warfarin with fenofibrate products was associated with an 80% increased risk of GIB/ICH during the second month of coadministration (days 30 to 59; adjusted HR, 1.8; 1.2 to 2.7); there was no significant difference in risk within the first 30 days of concomitant use. Antihyperlipidemics studied were fenofibrate (including fenofibric acid), gemfibrozil, or a statin (ie, atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin or simvastatin). Warfarin and individual statins (including pravastatin) did not show an increased risk of GIB/ICH .
Fenofibrate Overview
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Fenofibrate is used with a low-fat diet, exercise, and sometimes with other medications to reduce the amounts of fatty substances such as cholesterol and triglycerides in the blood and to increase the amount of HDL (high-density lipoprotein; a type of fatty substance that decreases the risk of heart disease) in the blood. Build-up of cholesterol and fats along the walls of the arteries (a process known as atherosclerosis) decreases the blood flow and, therefore, the oxygen supply to the heart, brain, and other parts of the body. This increases the risk of heart disease, angina (chest pain), strokes, and heart attacks. Although fenofibrate decreases the levels of fatty substances in the blood, it has not been shown to decrease the risk of heart attacks or strokes. Fenofibrate is in a class of medications called antilipemic agents. It works by speeding the natural processes that remove cholesterol from the body.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.