Effects of changing the timing of warfarin administration in combination with fluconazole on prolongation of the PT-INR: a case report
Abstract Background Fluconazole (FLCZ) inhibits cytochrome P450 (CYP) 2C9, 2C19, and 3A4 and has a drug-drug interaction that potentiates the effects of warfarin and prolong the prothrombin time-international normalized ratio (PT-INR). Although a drug-drug interaction have been reported between FLCZ...
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| Format: | Article |
| Language: | English |
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BMC
2023-04-01
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| Series: | Journal of Pharmaceutical Health Care and Sciences |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40780-023-00279-w |
| _version_ | 1797853645907165184 |
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| author | Hayato Akamatsu Hiroo Nakagawa Ichiro Matsumaru Junya Hashizume Hitomi Harasawa Yukinobu Kodama Takashi Miura Kaname Ohyama |
| author_facet | Hayato Akamatsu Hiroo Nakagawa Ichiro Matsumaru Junya Hashizume Hitomi Harasawa Yukinobu Kodama Takashi Miura Kaname Ohyama |
| author_sort | Hayato Akamatsu |
| collection | DOAJ |
| description | Abstract Background Fluconazole (FLCZ) inhibits cytochrome P450 (CYP) 2C9, 2C19, and 3A4 and has a drug-drug interaction that potentiates the effects of warfarin and prolong the prothrombin time-international normalized ratio (PT-INR). Although a drug-drug interaction have been reported between FLCZ and warfarin, the effects of the timing of their administration on this interaction have not yet been investigated. Case presentation A female patient in her 30s with Marfan syndrome had undergone the Bentall procedure with a mechanical valve and total arch replacement for acute aortic dissection Stanford A type and rupture of the ascending aorta. Warfarin was administered to prevent thromboembolism. She was hospitalized 1 year ago for graft infection caused by Candida albicans, and treatment with FLCZ was initiated. She received FLCZ 200 mg once a day in the morning and warfarin 1.75 mg once a day in the evening, and the PT-INR remained stable at approximately 2.0 and within the therapeutic range. However, 42 days after changing the timing of administration of warfarin from evening to morning, the PT-INR was prolonged by approximately 3-fold to 6.25. The PT-INR then decreased to the previous level by changing the timing of administration of warfarin from morning to evening. Conclusions The timing of administration of FLCZ and warfarin may affect the magnitude of drug-drug interaction. |
| first_indexed | 2024-04-09T19:54:02Z |
| format | Article |
| id | doaj.art-49217e61f0364a39ac3252d608d4a5ee |
| institution | Directory Open Access Journal |
| issn | 2055-0294 |
| language | English |
| last_indexed | 2024-04-09T19:54:02Z |
| publishDate | 2023-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Pharmaceutical Health Care and Sciences |
| spelling | doaj.art-49217e61f0364a39ac3252d608d4a5ee2023-04-03T05:34:44ZengBMCJournal of Pharmaceutical Health Care and Sciences2055-02942023-04-01911410.1186/s40780-023-00279-wEffects of changing the timing of warfarin administration in combination with fluconazole on prolongation of the PT-INR: a case reportHayato Akamatsu0Hiroo Nakagawa1Ichiro Matsumaru2Junya Hashizume3Hitomi Harasawa4Yukinobu Kodama5Takashi Miura6Kaname Ohyama7Department of Hospital Pharmacy, Nagasaki University HospitalDepartment of Hospital Pharmacy, Nagasaki University HospitalDepartment of Cardiovascular Surgery, Nagasaki University HospitalDepartment of Hospital Pharmacy, Nagasaki University HospitalDepartment of Hospital Pharmacy, Nagasaki University HospitalDepartment of Hospital Pharmacy, Nagasaki University HospitalDepartment of Cardiovascular Surgery, Nagasaki University HospitalDepartment of Hospital Pharmacy, Nagasaki University HospitalAbstract Background Fluconazole (FLCZ) inhibits cytochrome P450 (CYP) 2C9, 2C19, and 3A4 and has a drug-drug interaction that potentiates the effects of warfarin and prolong the prothrombin time-international normalized ratio (PT-INR). Although a drug-drug interaction have been reported between FLCZ and warfarin, the effects of the timing of their administration on this interaction have not yet been investigated. Case presentation A female patient in her 30s with Marfan syndrome had undergone the Bentall procedure with a mechanical valve and total arch replacement for acute aortic dissection Stanford A type and rupture of the ascending aorta. Warfarin was administered to prevent thromboembolism. She was hospitalized 1 year ago for graft infection caused by Candida albicans, and treatment with FLCZ was initiated. She received FLCZ 200 mg once a day in the morning and warfarin 1.75 mg once a day in the evening, and the PT-INR remained stable at approximately 2.0 and within the therapeutic range. However, 42 days after changing the timing of administration of warfarin from evening to morning, the PT-INR was prolonged by approximately 3-fold to 6.25. The PT-INR then decreased to the previous level by changing the timing of administration of warfarin from morning to evening. Conclusions The timing of administration of FLCZ and warfarin may affect the magnitude of drug-drug interaction.https://doi.org/10.1186/s40780-023-00279-wFluconazoleWarfarinPT-INRDrug-drug interactionTiming of administration |
| spellingShingle | Hayato Akamatsu Hiroo Nakagawa Ichiro Matsumaru Junya Hashizume Hitomi Harasawa Yukinobu Kodama Takashi Miura Kaname Ohyama Effects of changing the timing of warfarin administration in combination with fluconazole on prolongation of the PT-INR: a case report Journal of Pharmaceutical Health Care and Sciences Fluconazole Warfarin PT-INR Drug-drug interaction Timing of administration |
| title | Effects of changing the timing of warfarin administration in combination with fluconazole on prolongation of the PT-INR: a case report |
| title_full | Effects of changing the timing of warfarin administration in combination with fluconazole on prolongation of the PT-INR: a case report |
| title_fullStr | Effects of changing the timing of warfarin administration in combination with fluconazole on prolongation of the PT-INR: a case report |
| title_full_unstemmed | Effects of changing the timing of warfarin administration in combination with fluconazole on prolongation of the PT-INR: a case report |
| title_short | Effects of changing the timing of warfarin administration in combination with fluconazole on prolongation of the PT-INR: a case report |
| title_sort | effects of changing the timing of warfarin administration in combination with fluconazole on prolongation of the pt inr a case report |
| topic | Fluconazole Warfarin PT-INR Drug-drug interaction Timing of administration |
| url | https://doi.org/10.1186/s40780-023-00279-w |
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