Warfarin with Carboplatin Interaction Details
Brand Names Associated with Warfarin
- Coumadin®
- Jantoven®
- Warfarin
Brand Names Associated with Carboplatin
- Carboplatin Injection
- CBDCA
- Paraplatin®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 07, 2023
Interaction Effect
Increased risk for elevated INR and subsequent bleeding
Interaction Summary
An elevated INR, trace guaiac-positive black stools, and bruising at the site of blood draws occurred 16 days after a cycle of CARBOplatin and etoposide were reported in a male on warfarin. Monitor the INR (international normalized ratio) closely and monitor for signs of bleeding when warfarin is used concomitantly with etoposide and CARBOplatin. Warfarin dosage may require adjustment to maintain the desired level of anticoagulation.
Severity
Major
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Monitor the INR (international normalized ratio) closely and monitor for signs of bleeding when warfarin is used concomitantly with etoposide and CARBOplatin. Warfarin dosage may require adjustment to maintain the desired level of anticoagulation.
Mechanism Of Interaction
Unknown
Literature Reports
A) A 74-year-old male stabilized on warfarin for atrial fibrillation had an elevated INR of 12.6, a decreased hemoglobin, and experienced trace guaiac-positive black stools and bruising at the site of blood draws 16 days after a cycle of CARBOplatin and etoposide. His INR (1.15 to 2.11) had been stable for 8 months while on warfarin 5 mg every other day alternating with 7.5 mg every other day. He subsequently required CARBOplatin 180 mg/m(2) IV on day 1 plus etoposide 150 mg/m(2) IV on days 1 to 3 for secondary mediastinal metastases. His baseline INR was 2.11, hemoglobin 12.6 g/dL, and platelets 228 x 10(3)/mm(3). On his follow-up visit, 11 days post-chemotherapy, there was no evidence of bleeding or symptoms of nausea, vomiting, fever, or chills. An INR at the time was not measured but his hemoglobin was 11.1 g/dL. On post-chemotherapy day 16, the patient was admitted to the hospital with fever, diarrhea, nausea, and vomiting. His INR was 12.6, hemoglobin 10.5 g/dL, and platelets 348 x 10(3)/mm(3). He had trace guaiac-positive black watery stools and bruises at the site of blood draws. Warfarin was stopped for 2 days and he was administered phytonadione IV and fresh frozen plasma. Due to suspected gastrointestinal bleeding, decreased hemoglobin, and his history of cardiac and pulmonary disease, packed red blood cells were administered. All subsequent INRs were below 2. The patient refused further chemotherapy .
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.
Carboplatin Overview
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Carboplatin is used alone or in combination with other medications to treat cancer of the ovaries (cancer that begins in the female reproductive organs where eggs are formed) that has spread to other parts of the body, not improved, or that has worsened after treatment with other medications or radiation therapy. Carboplatin is in a class of medications known as platinum-containing compounds. It works by stopping or slowing the growth of cancer cells.
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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.