Warfarin with Chitosan Interaction Details
Brand Names Associated with Warfarin
- Coumadin®
- Jantoven®
- Warfarin
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 07, 2023
Interaction Effect
INR elevation
Interaction Summary
Concomitant use of chitosan products and warfarin may result in increased warfarin anticoagulant effects. Profound INR elevation occurred in an elderly man previously stable on warfarin, after repeated self-dosing with recommended dosing of a chitosan product. Patients should be advised to avoid chitosan products while receiving warfarin therapy.
Severity
Moderate
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Avoid concomitant use of chitosan in patients receiving warfarin as this may result in elevated INR values and potentiation of warfarin's anticoagulation effects.
Mechanism Of Interaction
Unknown
Literature Reports
A) A case report described elevations in INR in an 83-year-old male following concurrent use of chitosan and warfarin. The patient, who had chronic atrial fibrillation complicated by left atrial thrombus formation, was maintained at a therapeutic INR (between 2 and 3) with warfarin 2.5 mg/day for a year prior to his beginning self-treatment with a chitosan product (1200 mg twice daily). One month after starting chitosan, the patient's INR went out of range (between 8 and 10). The warfarin dosage was reduced to 1.25 mg/day but the INR remained above target range. Subsequently, the patient was hospitalized for evaluation, given 20 mg of parenteral vitamin K, and the chitosan was discontinued. His INR returned to 1.63 two days later and the patient was discharged in stable condition. Against medical advice, the patient restarted chitosan the following month and the INR increased to 4.47 to 5.6 over the next 3 months. When the chitosan was again discontinued, the INR remained stable. Impaired vitamin K absorption, resulting from binding of chitosan to lipids, was postulated as a mechanism for this interaction .
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.