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J Clin Psychopharmacol. Richard W. Sloan, M. Hospital and clinical associate professor in family and community medicine at the Milton S. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.

Contact afpserv aafp. Want to use this article elsewhere? Get Permissions. Read the Issue. Sign Up Now. Previous: Management of Bacterial Endocarditis. Next: Update on Colorectal Cancer. Mar 15, Issue. Clinically Significant Drug Interactions. A large number of drugs are introduced every year, and new interactions between medications are increasingly reported. Carbamazepine Tegretol plus cimetidine Tagamet , erythromycin, clarithromycin or fluconazole Diflucan Increased carbamazepine levels Generally within 1 week Monitor carbamazepine levels.

Phenytoin Dilantin plus cimetidine, erythromycin, clarithromycin or fluconazole Increased phenytoin levels Generally within 1 week Monitor phenytoin levels. Phenobarbital plus cimetidine, erythromycin, clarithromycin or fluconazole Increased phenobarbital levels Generally within 1 week Clinical significance has not been established. Monitor phenobarbital levels.

Phenytoin plus rifampin Rifadin Decreased phenytoin levels Generally within 1 week Clinical significance has not been established. Monitor phenytoin levels. Phenobarbital plus rifampin Decreased phenobarbital levels Generally within 1 week Monitor phenobarbital levels.

Carbamazepine plus rifampin Decreased carbamazepine levels Generally within 1 week Clinical significance has not been established. Monitor carbamazepine levels. Oral contraceptive pills plus rifampin Decreased effectiveness of oral contraception Any time Avoid if possible.

Oral contraceptive pills plus antibiotics Decreased effectiveness of oral contraception Any time Avoid if possible. Oral contraceptive pills plus troglitazone Rezulin Decreased effectiveness of oral contraception Any time Have the patient take an oral contraceptive pill with a higher estrogen content or recommend alternative method of contraception. Cisapride Propulsid plus erythromycin, clarithromycin, fluconazole, itraconazole Sporanox , ketoconazole Nizoral , nefazodone Serzone , indinavir Crixivan or ritonavir Norvir Prolongation of QT interval along with arrhythmias secondary to inhibited cisapride metabolism Generally within 1 week Avoid.

Consider whether metoclopromide therapy is appropriate for the patient. Sildenafil Viagra plus nitrates Dramatic hypotension Soon after taking sildenafil Absolute contraindication. Sildenafil plus cimetidine, erythromycin, itraconazole or ketoconazole Increased sildenafil levels Any time Initiate sildenafil at a mg dose. SSRI plus tricyclic antidepressant Increased tricyclic antidepressant level Any time Monitor for anticholinergic excess and consider lower dosage of tricyclic antidepressant.

SSRI plus tramadol Ultram Increased potential for seizures; serotonin syndrome Any time Monitor the patient for signs and symptoms of serotonin syndrome.

SSRI plus St. John's wort Serotonin syndrome Any time Avoid. New Rochelle, NY Telephone: , Fax: E-mail: custserv themedicalletter. Cephalexin and clindamycin, which have minimal interactions with warfarin, are considered low-risk antibiotics, said the researchers.

Their study involved military veterans treated in the Veterans Affairs healthcare system who were prescribed uninterrupted warfarin therapy for more than 30 days between October and September Thirty-six of the 8, patients who received low-risk antibiotics suffered serious bleeding events compared with 93 of the 14, patients who received high-risk antibiotics.

The researchers noted infections alone might cause elevations in INR. They also pointed out that although all patients in the study received antibiotics for infection, only those receiving high-risk medications were at increased risk for bleeding events, which suggests the antibiotic-warfarin interaction is a critical risk factor. Antibiotics, one of the most frequently utilized classes of mediations, have potentially life-threatening interactions with warfarin, one of the most commonly used blood thinners, commented Dr.

Infections are one of the most common reasons patients are admitted to hospitals, pointed out Dr. Serious bleeding events due to warfarin and antibiotic co-prescription in a cohort of veterens. Am J Med. Sign in. Annals of Long-Term Care. First Report Managed Care. Integrated Healthcare Executive. Pharmacy Learning Network. Veterans Health Today. For Advertisers.

Editorial Description. Publishing Staff. Expert Insights. Interactive Features. AMCP Nexus Talking Therapeutics. Drug Recalls. Tetracycline [prescribing information].

Unasyn [prescribing information]. PL Detail-Document. Antimicrobial drug interactions and warfarin. August Drug interactions involving warfarin: practice tool and practical management tips.

Can Pharm J. Emily Seamans, PharmD Candidate. Related Topics. Antibiotics in the same class have similar effects on INR: Cephalosporins may increase INR by inhibiting production of vitamin K-dependent clotting factors. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians evidence-based clinical practice guidelines Chest ; 6 Suppl SS. Otolaryngol Head Neck Surg ; 1 Suppl : Clin Infect Dis ;S Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women.

Clin Infect Dis ; Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Lamb E. Top prescription drugs of