TY - JOUR
T1 - An adverse interaction between warfarin and capecitabine
T2 - A case report and review of the literature
AU - Copur, M. Sitki
AU - Ledakis, Peter
AU - Bolton, Mark
AU - Morse, Anne K.
AU - Werner, Thomas
AU - Norvell, Max
AU - Muhvic, Joan
AU - Chu, Edward
PY - 2001/11
Y1 - 2001/11
N2 - Warfarin is one of the most commonly used oral anticoagulants in the clinic. It is well established that a wide range of antineoplastic drugs interact with warfarin, resulting in altered coagulation parameters and/or bleeding sequelae. While altered coagulation parameters have been observed in patients taking the oral 5-fluorouracil prodrug, capecitabine, in combination with warfarin, no report to date has described clinically overt evidence of bleeding. Herein, we report 2 cancer patients who presented with bleeding episodes that most likely resulted from an adverse interaction between capecitabine and warfarin after 6 weeks of concomitant therapy. In each case, there was a marked elevation in both the prothrombin time and international normalized ratio (> 10), with subsequent gastrointestinal bleeding. The exact mechanism of this interaction is yet unknown, but it is possible that capecitabine might, in some manner, reduce the hepatic metabolism of warfarin. Close monitoring of coagulation parameters is recommended for all patients receiving concomitant warfarin and capecitabine, with appropriate adjustment of warfarin dosage. The nature and extent of this interaction requires further investigation.
AB - Warfarin is one of the most commonly used oral anticoagulants in the clinic. It is well established that a wide range of antineoplastic drugs interact with warfarin, resulting in altered coagulation parameters and/or bleeding sequelae. While altered coagulation parameters have been observed in patients taking the oral 5-fluorouracil prodrug, capecitabine, in combination with warfarin, no report to date has described clinically overt evidence of bleeding. Herein, we report 2 cancer patients who presented with bleeding episodes that most likely resulted from an adverse interaction between capecitabine and warfarin after 6 weeks of concomitant therapy. In each case, there was a marked elevation in both the prothrombin time and international normalized ratio (> 10), with subsequent gastrointestinal bleeding. The exact mechanism of this interaction is yet unknown, but it is possible that capecitabine might, in some manner, reduce the hepatic metabolism of warfarin. Close monitoring of coagulation parameters is recommended for all patients receiving concomitant warfarin and capecitabine, with appropriate adjustment of warfarin dosage. The nature and extent of this interaction requires further investigation.
KW - Capecitabine
KW - Drug interaction
KW - Warfarin
UR - http://www.scopus.com/inward/record.url?scp=0035522654&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0035522654&partnerID=8YFLogxK
U2 - 10.3816/CCC.2001.n.019
DO - 10.3816/CCC.2001.n.019
M3 - Article
C2 - 12450435
AN - SCOPUS:0035522654
SN - 1533-0028
VL - 1
SP - 182
EP - 184
JO - Clinical colorectal cancer
JF - Clinical colorectal cancer
IS - 3
ER -