Sucralfate with Warfarin Interaction Details
Brand Names Associated with Sucralfate
- Carafate®
- Sucralfate
Brand Names Associated with Warfarin
- Coumadin®
- Jantoven®
- Warfarin
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 25, 2023
Interaction Effect
Decreased warfarin effectiveness
Interaction Summary
Although two studies did not demonstrate an interaction between sucralfate and warfarin, a few case reports suggest that some patients may be at risk for this interaction .
Severity
Moderate
Onset
Delayed
Evidence
Probable
How To Manage Interaction
In patients receiving oral anticoagulant therapy with warfarin, the prothrombin time ratio or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with sucralfate, and should be reassessed periodically during concurrent therapy. Adjustments of the warfarin dose may be necessary in order to maintain the desired level of anticoagulation.
Mechanism Of Interaction
Decreased warfarin absorption
Literature Reports
A) A possible interaction between warfarin and sucralfate resulting in subtherapeutic prothrombin times was reported . Withdrawal of sucralfate resulted in warfarin concentrations and prothrombin times returning to adequate levels. The temporal relationship suggests an interaction between warfarin and sucralfate in the GI tract, but further studies are required to evaluate the significance of this interaction .
B) Subtherapeutic prothrombin times were reported four days after warfarin 5 mg daily when administered four hours after sucralfate. The patient was also receiving indomethacin. Despite minimal phytonadione intake and an increase in the warfarin dosage to 17.5 mg daily, prothrombin times failed to rise. When sucralfate and indomethacin were discontinued, and the warfarin dose was decreased to 10 mg daily, therapeutic prothrombin times of greater than 1.5 times control were achieved within two days. The authors suggest that sucralfate may absorb warfarin and decrease its bioavailability during initiation of warfarin therapy .
C) Subtherapeutic levels of digoxin, quinidine, and warfarin occurred in a 71-year-old patient, even though the administration of sucralfate was separated by two hours from the other agents. Following hospitalization, sucralfate was administered four hours apart from the remainder of the therapeutic regimen and was subsequently discontinued; digoxin and quinidine levels returned to therapeutic levels and the prothrombin time improved. Clinicians should be aware that sucralfate may reduce the bioavailability of other drugs, even if the administration times are staggered .
D) No significant interaction between sucralfate and warfarin was reported after simultaneous oral administration in 8 patients in a prospective crossover study . A prospective study also reported no significant difference in PT, PTT, or warfarin plasma levels in patients chronically ingesting warfarin and sucralfate .
Sucralfate Overview
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Sucralfate is used to treat and prevent the return of duodenal ulcers (ulcers located in first part of the small intestine). Treatment with other medications, such as antibiotics, may also be necessary to treat and prevent the return of ulcers caused by a certain type of bacteria (H. pylori) Sucralfate is in a class of medications called protectants. It sticks to damaged ulcer tissue and protects against acid and enzymes so healing can occur.
Warfarin Overview
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Warfarin is used to prevent blood clots from forming or growing larger in your blood and blood vessels. It is prescribed for people with certain types of irregular heartbeat, people with prosthetic (replacement or mechanical) heart valves, and people who have suffered a heart attack. Warfarin is also used to treat or prevent venous thrombosis (swelling and blood clot in a vein) and pulmonary embolism (a blood clot in the lung). Warfarin is in a class of medications called anticoagulants ('blood thinners'). It works by decreasing the clotting ability of the blood.
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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.