Warfarin with Cisplatin Interaction Details
Brand Names Associated with Warfarin
- Coumadin®
- Jantoven®
- Warfarin
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 07, 2023
Interaction Effect
Increased INR
Interaction Summary
Concomitant use of CISplatin together with warfarin may result in increased INR and risk of bleeding. Two case reports have described elevations in INR following addition of CISplatin in patients previously stable on warfarin. Monitor INR when starting, stopping, or changing the dose of the concomitant drug in patients receiving warfarin therapy .
Severity
Moderate
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Concurrent use of CISplatin and warfarin may result in increased INR. Monitor INR when starting, stopping, or changing the dose of the concomitant drug in patients receiving warfarin therapy .
Mechanism Of Interaction
Unknown
Literature Reports
A) Increased INR without bleeding was reported on day 3 of 2 consecutive cycles of irinotecan and CISplatin therapy in a 50-year-old woman with ovarian carcinoma and DVT. The patient was diagnosed with ovarian cancer, DVT of the femoral and internal iliac veins, cerebellar thrombosis, bilateral kidney thrombosis, and DIC and treated with warfarin, continuous heparin, neoadjuvant paclitaxel plus CARBOplatin, and surgery. Concomitant medications included warfarin 3.25 mg/day (goal INR 2 to 2.5) and aspirin 100 mg/day with the chemotherapy regimen of irinotecan 60 mg/m(2) on days 1, 8, and 15 plus CISplatin 60 mg/m(2) on day 1 repeated every 4 weeks and the supportive agents of granisetron, dexamethasone, and aprepitant began. On day 3 of irinotecan plus CISplatin, INR increased from 2.12 to 3.43; warfarin was held for 1 dose and no bleeding was reported. A similar increase of INR occurred on day 3 during the second chemotherapy cycle. The patient reported mild nausea and anorexia with a 30% reduction of food intake for a few days after CISplatin dosing .
B) A 43-year-old woman with recurrent peritoneal and liver metastasis of uterine cervical adenocarcinoma experienced an increased INR without bleeding around day 3 during 3 consecutive cycles of irinotecan and CISplatin therapy. Concomitant medication included warfarin 2 mg/day (goal INR 1.2 to 1.5) when the chemotherapy regimen of irinotecan 60 mg/(m)2 on days 1, 8, and 15 plus CISplatin 60 mg/(m)2 on day 1 repeated every 4 weeks and the supportive agents of granisetron, dexamethasone, and aprepitant began. On day 3 of the second cycle of irinotecan plus CISplatin, INR increased from 1.3 to 1.77; warfarin was continued without change and INR remained elevated at 1.88 on day 8, and INR returned to within goal range by day 15 of the chemotherapy cycle. A similar increase of INR occurred during the third and fourth chemotherapy cycles. The patient reported mild nausea and anorexia with a 20% reduction of food intake for a few days after each CISplatin dose .
Warfarin Overview
-
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.
Return To Our Drug Interaction Homepage
Feedback, Question Or Comment About This Information?
Ask Dr. Brian Staiger, PharmD, our medical editor, directly! He's always more than happy to assist.
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.