TITLE

Elevated International Normalized Ratio associated with concurrent use of ophthalmic erythromycin and warfarin

AUTHOR(S)
Parker, Debra L.; Hoffmann, Teresa Kay; Tucker, Mary Ann; Gerschutz, Gregory P.; Malone, Patrick M.
PUB. DATE
January 2010
SOURCE
American Journal of Health-System Pharmacy;1/1/2010, Vol. 67 Issue 1, p38
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Purpose. The case of a patient whose International Normalized Ratio (INR) increased with concurrent use of ophthalmic erythromycin and warfarin is reported. Summary. A 77-year-old Caucasian woman began therapy with warfarin for thromboembolism prophylaxis secondary to atrial fibrillation (target INR, 2-3). Warfarin was prescribed by her cardiologist, and care was established with clinical pharmacists in an anticoagulation clinic. She was receiving a weekly maintenance dosage of 14 mg. She had a history of atrial fibrillation, hyperlipidemia, osteoarthritis, hypothyroidism, coronary artery disease, myocardial infarction, congestive heart failure, and breast cancer. In addition to warfarin, the patient had been receiving alprazolam, carvedilol, furosemide, levothyroxine sodium, lisinopril, nitroglycerin, potassium chloride, propoxyphene hydrochloride- acetaminophen, simvastatin, and trazodone. After receiving warfarin at the same weekly dosage for over four months, the patient's ophthalmologist prescribed erythromycin ophthalmic ointment for chronic bacterial conjunctivitis. Three weeks later, her INR was found to be 8.5. A total of four warfarin doses were withheld, and her weekly maintenance dosage of warfarin was subsequently decreased to 12 mg. Five weeks later, her INR was 1.5, and it was determined that the erythromycin ophthalmic ointment had been discontinued five days prior. Her weekly maintenance dosage of warfarin was increased to 16 mg. Rechallenge with erythromycin five days before her next INR measurement resulted in an INR of 4.2. A new weekly maintenance dosage of 13 mg was established, and her subsequent INRs were within normal range. Conclusion. An increase in INR values was reported after initiation of ophthalmic erythromycin in a patient receiving warfarin and recurred upon rechallenge with ophthalmic erythromycin.
ACCESSION #
47426495

 

Related Articles

  • ERYTHROMYCINS. GRIFFITH, H. WINTER // Complete Guide to Prescription & Nonprescription Drugs 2012;2010, p364 

    The article presents information on erythromycins, an antibacterial and antiacne agent, including its dosage, usage, adverse reactions, side effects, precautions when administering, and possible interaction with other drugs.

  • Effect of multiple-dose erythromycin on everolimus pharmacokinetics. Kovarik, J. M.; Beyer, D.; Bizot, M. N.; Jiang, Q.; Shenouda, M.; Schmouder, R. L. // European Journal of Clinical Pharmacology;Mar2005, Vol. 61 Issue 1, p35 

    We sought to quantify the influence of the CYP3A inhibitor erythromycin on the pharmacokinetics of everolimus, a CYP3A substrate. This was a two-period, single-sequence, crossover study in 16 healthy subjects. In period 1, subjects received the reference treatment of a single 2-mg dose of...

  • Fourth-generation fluoroquinolones: becoming a standard for cataract surgery? Guttman, Cheryl // Ophthalmology Times;5/15/2005, Vol. 30 Issue 10, p45 

    Discusses the perioperative use of a topical fourth-generation fluoroquinolones for chemoprophylaxis in cataract surgery. Studies that demonstrated the need for fourth-generation fluoroquinolones and their activity against ocular pathogens; Design of the fourth-generation fluoroquinolones. ...

  • Chloromycetin.  // Royal Society of Medicine: Medicines;2002, p151 

    The article provides information on the antibacterial Chloromycetin. It is a proprietary, prescription-only preparation of the broad-spectrum antibacterial and antibiotic chloramphenicol, used for bacterial infections in the eye. It is available as an eye ointment and eye-drops.

  • Beyond Compliance: Getting the Drops In. Robin, Alan L. // Review of Ophthalmology;Feb2010, Vol. 17 Issue 2, p70 

    The article offers information on the importance of proper administration of eye medications. It cites a study where 139 patients with hypertension and glaucoma with self-administered eyedrops were recorded on how they use eye medications. It reveals that 20% of compliant patients was not able...

  • DECONGESTANTS (Ophthalmic). Griffith, H. Winter // Complete Guide to Prescription & Nonprescription Drugs 2012;2009, p306 

    The article presents information on ophthalmic decongestancs, including dosage, usage, adverse reactions, side effects, precautions, and possible interaction with other drugs.

  • ANTIBACTERIALS (Ophthalmic). GRIFFITH, H. WINTER // Complete Guide to Prescription & Nonprescription Drugs 2012;2010, p66 

    The article presents information on ophthalmic antibacterials, a drug developed to treat corneal ulcers and help overcome eye infections, including its dosage, usage, adverse reactions, side effects, precautions when administering, and possible interaction with other drugs.

  • ANTIBACTERIALS (Ophthalmic). Griffits, H. Winter // Complete Guide to Prescription & Nonprescription Drugs 2012;2009, p68 

    The article presents information on ophthalmic antibacterials, including dosage, usage, adverse reactions, side effects, precautions, and possible interaction with other drugs.

  • Comparative Review of Topical Ophthalmic Antibacterial Preparations. Robert, P-Y.; Adenis, J-P. // Drugs;Jan2001, Vol. 61 Issue 2, p175 

    The choice of an antibacterial is based on considerations of pharmacodynamic, pharmacokinetic and bacteriological characteristics, risk of selecting resistant mutants, and cost. In this article we review 16 commercially available ophthalmic antibacterial preparations. Fusidic acid and bacitracin...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics