Warfarin with Cyclosporine Interaction Details
Brand Names Associated with Warfarin
- Coumadin®
- Jantoven®
- Warfarin
Brand Names Associated with Cyclosporine
- Cyclosporine
- Gengraf®
- Neoral®
- Sandimmune® Capsules
- Sandimmune® Oral Solution
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 07, 2023
Interaction Effect
Decreased anticoagulant and cycloSPORINE effectiveness
Interaction Summary
There have been reports published that indicate a reduction in the anticoagulant activity of warfarin when cycloSPORINE are used concurrently.
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 cycloSPORINE, 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
Unknown
Literature Reports
A) Concomitant administration of cycloSPORINE and warfarin was reported to result in significant reductions in cyclosporine serum concentrations and loss of therapeutic activity in a patient with pure erythrocyte aplasia . Increasing the dose of cycloSPORINE resulted in a decrease in the activity of warfarin, as evidenced by an increase in prothrombin activity, from 17% of control to 64%, necessitating increased doses of warfarin. This case report suggests that each drug interfered with the activity of the other. However, the patient was also taking phenobarbital, which is capable of reducing the activity of both warfarin and cycloSPORINE, and it is unclear if a true interaction between the 2 agents exists. More studies are required to fully evaluate this interaction.
B) An interaction between cycloSPORINE and warfarin leading to a decrease in International Normalized Ratio (INR) has been reported . A 65-year-old female diagnosed with angioimmunoblastic T-cell lymphoma was given cycloSPORINE while receiving warfarin for venous thromboembolism. During six courses of standard CHOP regimen the patient developed a deep venous thrombosis (DVT) of her left leg. The DVT regressed when low molecular weight heparin was administered for 2 months. Long-term warfarin therapy was initiated after a CT san of the abdomen demonstrated an asymptomatic vena cava thrombosis which spread from the iliac bifurcation to the renal veins. CycloSPORINE therapy was initiated after a lymphoma relapse to control the malignant T-cell proliferation. INR subsequently decreased about 40% after the beginning of cycloSPORINE therapy. A larger dose of warfarin had to be administered (from 18.75 to 27.5 mg/week). After the increase in warfarin dose, cycloSPORINE blood levels remained within the therapeutic range, and the INR values became stable with the same warfarin dose. When warfarin was discontinued, cycloSPORINE blood levels remained unchanged.
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.
Cyclosporine Overview
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Cyclosporine and cyclosporine (modified) are used with other medications to prevent transplant rejection (attack of the transplanted organ by the immune system of the person who received the organ) in people who have received kidney, liver, and heart transplants. Cyclosporine (modified) is also used alone or with methotrexate (Rheumatrex) to treat the symptoms of rheumatoid arthritis (arthritis caused by swelling of the lining of the joints) in patients whose symptoms were not relieved by methotrexate alone. Cyclosporine (modified) is also used to treat psoriasis (a skin disease in which red, scaly patches form on some areas of the body) in certain patients who have not been helped by other treatments. Cyclosporine and cyclosporine (modified) are in a class of medications called immunosuppressants. They work by decreasing the activity of the immune system.
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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.