So Gregory J. Hughes, PharmD, and colleagues searched the databases for PubMed —November and International Pharmaceutical Abstracts —November to review the literature addressing acetaminophen-warfarin interactions and the possible mechanisms.
The authors noted that both case reports and prospective studies indicate an effect on INR values. Recommendations regarding the management of patients taking both drugs are not strong because no studies examining outcomes, such as major bleeding, exist. It may be prudent to monitor the INR more frequently if a patient who was previously stable on a dose of warfarin begins taking scheduled acetaminophen. Finally, in otherwise unexplained INR variability, this interaction could be considered a contributing factor.
Effect of acetaminophen on international normalized ratio in patients receiving warfarin therapy. Paracetamol: a haemorrhagic risk factor in patients on warfarin. Br J Clin Pharmacol. Interaction between paracetamol and warfarin in patients: a double-blind, placebo-controlled, randomized study.
Interaction between acetaminophen and warfarin in adults receiving long-term oral anticoagulants: a randomized controlled trial. Eur J Clin Pharmacol. No significant changes in drug intake, clinical status, diet, or lifestyle were noted. Changes in INR of this magnitude with the addition of another drug during stable anticoagulation therapy suggest a drug interaction. The lack of an increase in warfarin plasma concentration associated with the increased INR suggests a possible pharmacodynamic mechanism for this interaction.
Potentiation of anticoagulant effect of warfarin by acetaminophen Tylenol [abstract]. Clin Res. Anticoagulant, thrombolytic, and antiplatelet drugs. The effect of vitamin K on warfarin-induced anticoagulation. J Intern Med. Kempin SJ. Warfarin resistance caused by broccoli. On the influence of vitamin K-rich vegetables and wine on the effectiveness of warfarin treatment.
Acta Med Scand. Anticoagulation instability with life-threatening complication after dietary modification. Postgrad Med J. Epidemiology in Medicine. The influence of fasting and stress on the response of rats to warfarin. J Pharmacol Exp Ther. The influence of fasting on the disposition of warfarin in rats. Black JA.
Diarrhoea, vitamin K, and warfarin. Increased rate of clearance of drugs from the circulation of alcoholics. Am J Med Sci. O'Reilly RA. Lack of effect of fortified wine ingested during fasting and anticoagulant therapy. Ahlbom A, Norell S. Introduction to Modern Epidemiology. Rogers AS. Unintended drug effects: identification and attribution.
Pharmacoepidemiology: An Introduction. In: Bennett DR, ed. Drug Evaluations Annual Chicago, Ill. American Medical Association; Caron J, Libersa C. The coumarins warfarin and other coumarin congeners. In: Dukes MNG, ed. Stockley IH. Anticoagulants and paracetamol. Oxford, England. Blackwell Scientific Publications; Anticoagulants systemic. Bleeding during acetylsalicylic acid and anticoagulant therapy in patients with reduced platelet reactivity after aortic valve replacement.
Am Heart J. Schulman S, Henriksson K. Interaction of ibuprofen and warfarin on primary haemostasis. Br J Rheumatol. Concurrent use of nonsteroidal anti-inflammatory drugs and oral anticoagulants places elderly persons at high risk for hemorrhagic peptic ulcer disease. Cole P, MacMahon B. Atttributable risk percent in case-control studies. Br J Prev Soc Med.
National patterns of warfarin use in atrial fibrillation. See More About Anticoagulation. Save Preferences. Privacy Policy Terms of Use. This Issue. Citations View Metrics. Twitter Facebook More LinkedIn. Original Contribution. Elaine M. Skates, PhD ; et al Mary A. Sheehan, RN ; Daniel E. Singer, MD. Identification of Study Patients.
Sources of Data. Statistical Analysis. Demographic Features and Anticoagulation History. Concomitant Medications. Analgesic and Antipyretic Use. Alcohol Intake. Concurrent Illness.
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