Drug interactions between Depakote Sprinkles and Miradon
| Results for the following 2 drugs: |
|---|
| Depakote Sprinkles (divalproex sodium) |
| Miradon (anisindione) |
Interactions between your selected drugs
anisindione ↔ divalproex sodium
Applies to:Miradon (anisindione) and Depakote Sprinkles (divalproex sodium)
MONITOR: Valproic acid may transiently potentiate the hypoprothrombinemic effect of warfarin and other oral anticoagulants. The mechanism is protein binding displacement by valproic acid, resulting in increased plasma concentrations of unbound (active) anticoagulant drug. In an in vitro study, valproic acid increased the unbound fraction of warfarin by up to 33%. The clinical significance of this effect is unknown. The interaction was suspected in one case report, although a causal relationship was not established. Because drug clearance is also increased with higher levels of unbound drug, the pharmacokinetic effect produced by valproic acid is expected to balance out over time, resulting in little or no net effect on anticoagulant pharmacokinetics in the long-term. However, valproic acid appears to cause dose-related thrombocytopenia. This effect should be considered in patients treated concomitantly with oral anticoagulants.
MANAGEMENT: Based on the proposed transient nature of the pharmacokinetic interaction, appropriate monitoring for excessive hypoprothrombinemia is recommended during the first week following the addition of valproic acid to a stabilized regimen of warfarin or other oral anticoagulants. Patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools.
See also...
Drug Interaction Classification
The classifications below are a guideline only. The relevance of a particular drug interaction to a specific patient is difficult to determine using this tool alone given the large number of variables that may apply.
| Major | Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. |
| Moderate | Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. |
| Minor | Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. |
Do not stop taking any medications without consulting your healthcare provider.
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