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Drug Interactions between Disalcid and Miradon

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

anisindione salsalate

Applies to: Miradon (anisindione) and Disalcid (salsalate)

Consumer information for this interaction is not currently available.

GENERALLY AVOID: Nonsteroidal anti-inflammatory drugs (NSAIDs) may potentiate the hypoprothrombinemic effect and bleeding risk associated with oral anticoagulants. In a one-year observational study of a population of coumarin users, the relative risk of bleeding complications due to concomitant NSAID use was 5.8 compared to coumarin use alone. Some investigators suggest that the risk of hemorrhagic peptic ulcers in particular may be substantially increased, especially in elderly or debilitated patients. A retrospective epidemiologic study of patients aged 65 years or older reported a nearly 13-fold increase in the risk of developing hemorrhagic peptic ulcer disease in concurrent users of oral anticoagulants and NSAIDs compared with nonusers of either drug. Fatalities have been reported. The pharmacologic effects of NSAIDs that contribute to this interaction include gastrointestinal irritation, prolongation of prothrombin time, and inhibition of platelet adhesion and aggregation. In addition, various NSAIDs have also been shown to alter the pharmacokinetics of warfarin and other oral anticoagulants, resulting in increased INR or prothrombin time. However, some studies failed to demonstrate any evidence of an interaction.

MANAGEMENT: NSAIDs should be administered with oral anticoagulants only if benefit outweighs risk. The INR should be checked frequently and oral anticoagulant dosage adjusted accordingly, particularly following initiation or discontinuation of NSAIDs in patients who are stabilized on their anticoagulant regimen. Patients should be advised to promptly report any signs of unusual bleeding or bruising to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, red or brown urine, or red or black stools. Salicylates (except aspirin) appear to have less effect on coagulation and may be preferable in patients treated with oral anticoagulants. Nevertheless, caution is advised and close monitoring for gastrointestinal bleeding is recommended, particularly in elderly or debilitated patients.

References

  1. Flessner MF, Knight H "Prolongation of prothrombin time and severe gastrointestinal bleeding associated with combined use of warfarin and ketoprofen." JAMA 259 (1988): 353
  2. Ku LL, Ward CO, Durgin SJ "A clinical study of drug interaction and anticoagulant therapy." Drug Intell Clin Pharm 4 (1970): 300-6
  3. Koch-Weser J, Sellers EM "Drug interactions with coumarin anticoagulants (second of two parts)." N Engl J Med 285 (1971): 547-58
  4. Cryst C, Hammar S "Acute granulomatous interstitial nephritis due to co-trimoxazole." Am J Nephrol 8 (1988): 483-8
  5. Aggeler PM, O'Reilly RA, Leong L, Kowitz PE "Potentiation of anticoagulant effect of warfarin by phenylbutazone." N Engl J Med 276 (1967): 496-501
  6. Serlin MJ, Mossman S, Sibeon RG, Tempero KF, Breckeridge AM "Interaction between diflunisal and warfarin." Clin Pharmacol Ther 28 (1980): 493-8
  7. Rhodes RS, Rhodes PJ, Klein C, Sintek CD "A warfarin-piroxicam drug interaction." Drug Intell Clin Pharm 19 (1985): 556-8
  8. Dahl SL, Ward JR "Pharmacology, clinical efficacy, and adverse effects of piroxicam, a new nonsteroidal anti-inflammatory agent." Pharmacotherapy 2 (1982): 80-9
  9. Loftin JP, Vesell ES "Interaction between sulindac and warfarin: different results in normal subjects and in an unusual patient with a potassium-losing renal tubular defect." J Clin Pharmacol 19 (1979): 733-42
  10. Self TH, Evans WE, Ferguson T "Drug enhancement of warfarin activity." Lancet 2 (1975): 557-8
  11. Buchanan GR, Martin V, Levine PH, et al. "The effects of "anti-platelet" drugs on bleeding time and platelet aggregation in normal human subjects." Am J Clin Pathol 68 (1977): 355-9
  12. Udall JA "Drug interference with warfarin therapy." Clin Med 77 (1970): 20-5
  13. Schulman S, Henriksson K "Interaction of ibuprofen and warfarin on primary haemostasis." Br J Rheumatol 28 (1989): 46-9
  14. Bull J, Mackinnon J "Phenylbutazone and anticoagulant control." Practitioner 215 (1975): 767-72
  15. O'Reilly RA "Phenylbutazone and sulfinpyrazone interaction with oral anticoagulant phenprocoumon." Arch Intern Med 142 (1982): 1634-7
  16. O'Reilly RA, Goulart DA "Comparative interaction of sulfinpyrazone and phenylbutazone with racemic warfarin: alteration in vivo of free fraction of plasma warfarin." J Pharmacol Exp Ther 219 (1981): 691-4
  17. Kaufman DW, Kelly JP, Sheehan JE, Laszlo A, Wiholm BE, Alfredsson L, Koff RS, Shapiro S "Nonsteroidal anti-inflammatory drug use in relation to major upper gastrointestinal bleeding." Clin Pharmacol Ther 53 (1993): 485-94
  18. Koren JF, Cochran DL, Janes RL "Tolmetin-warfarin interaction." Am J Med 82 (1987): 1278-80
  19. Self TH, Soloway MS, Vaughn D "Possible interaction of indomethacin and warfarin." Drug Intell Clin Pharm 12 (1978): 580-2
  20. Stricker BH, Delhez JL "Interaction between flurbiprofen and courmarins." Br Med J 285 (1982): 812-3
  21. Mieszczak C, Winther K "Lack of interaction of ketoprofen with warfarin." Eur J Clin Pharmacol 44 (1993): 205-6
  22. Davis LJ, Kayser SR, Hubsher J, Williams RL "Effect of oxaprozin on the steady-state anticoagulant activity of warfarin." Clin Pharm 3 (1984): 295-7
  23. Ermer JC, Hicks DR, Wheeler SC, Kraml M, Jusko WJ "Concomitant etodolac affects neither the unbound clearance nor the pharmacologic effect of warfarin." Clin Pharmacol Ther 55 (1994): 305-16
  24. Wells PS, Holbrook AM, Crowther NR, Hirsh J "Interactions of warfarin with drugs and food." Ann Intern Med 121 (1994): 676-83
  25. Serlin MJ, Breckenridge AM "Drug interactions with warfarin." Drugs 25 (1983): 610-20
  26. Brouwers JRBJ, Desmet PAGM "Pharmacokinetic-pharmacodynamic drug interactions with nonsteroidal anti-inflammatory drugs." Clin Pharmacokinet 27 (1994): 462-85
  27. Schafer AI "Effects of nonsteroidal antiinflammatory drugs on platelet function and systemic hemostasis." J Clin Pharmacol 35 (1995): 209-19
  28. Gabb GM "Fatal outcome of interaction between warfarin and a non-steroidal anti-inflammatory drug." Med J Aust 164 (1996): 700-1
  29. Pardo A, GarciaLosa M, FernandezPavon A, delCastillo S, PascualGarcia T, GarciaMendez E, DalRe R "A placebo-controlled study of interaction between nabumetone and acenocoumarol." Br J Clin Pharmacol 47 (1999): 441-4
  30. Dennis VC, Thomas BK, Hanlon JE "Potentiation of oral anticoagulation and hemarthrosis associated with nabumetone." Pharmacotherapy 20 (2000): 234-9
  31. "Product Information. Mobic (meloxicam)." Boehringer-Ingelheim PROD (2001):
  32. Knijff-Dutmer EA, Schut GA, van de Laar MA "Concomitant coumarin-NSAID therapy and risk for bleeding." Ann Pharmacother 37 (2003): 12-6
  33. Shorr RI, Ray WA, Daugherty JR, Griffin MR "Concurrent use of nonsteroidal anti-inflammatory drugs and oral anticoagulants places elderly persons at high risk for hemorrhagic peptic ulcer disease." Arch Intern Med 153 (1993): 1665-70
  34. Held H, Kaminski B, von Oldersausen HF "Die beeinflussung der elimination von glycodiazin durch leber- und nierenfunctionssorungen und durch eine behandlung mit phenylbutazone, phenprocumarol und doxycyclin." Diabetologia 6 (1970): 386-91
  35. Penning-van Beest F, Erkens J, Petersen KU, Koelz HR, Herings R "Main comedications associated with major bleeding during anticoagulant therapy with coumarins." Eur J Clin Pharmacol 61 (2005): 439-44
View all 35 references

Drug and food interactions

Moderate

anisindione food

Applies to: Miradon (anisindione)

Nutrition and diet can affect your treatment with anisindione. Therefore, it is important to keep your vitamin supplement and food intake steady throughout treatment. For example, increasing vitamin K levels in the body can promote clotting and reduce the effectiveness of anisindione. While there is no need to avoid products that contain vitamin K, you should maintain a consistent level of consumption of these products. Foods rich in vitamin K include beef liver, broccoli, Brussels sprouts, cabbage, collard greens, endive, kale, lettuce, mustard greens, parsley, soy beans, spinach, Swiss chard, turnip greens, watercress, and other green leafy vegetables. Moderate to high levels of vitamin K are also found in other foods such as asparagus, avocados, dill pickles, green peas, green tea, canola oil, margarine, mayonnaise, olive oil, and soybean oil. However, even foods that do not contain much vitamin K may occasionally affect the action of anisindione. There have been reports of patients who experienced bleeding complications and increased INR or bleeding times after consuming large quantities of cranberry juice, mangos, grapefruit, grapefruit juice, grapefruit seed extract, or pomegranate juice. Again, you do not need to avoid these foods completely, but it may be preferable to limit their consumption, or at least maintain the same level of use while you are receiving anisindione. Talk to a healthcare provider if you are uncertain about what foods or medications you take that may interact with anisindione. It is important to tell your doctor about all medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

When anisindione is given with enteral (tube) feedings, you may interrupt the feeding for one hour before and one hour after the anisindione dose to minimize potential for interaction. Feeding formulas containing soy protein should be avoided.

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Moderate

anisindione food

Applies to: Miradon (anisindione)

Using anisindione together with ethanol can cause you to bleed more easily. If you take anisindione you should avoid large amounts of alcohol, but moderate consumption (one to two drinks per day) are not likely to affect the response to anisindione if you have normal liver function. You may need a dose adjustment in addition to testing of your prothrombin time or International Normalized Ratio (INR). Call your doctor promptly if you have any unusual bleeding or bruising, vomiting, blood in your urine or stools, headache, dizziness, or weakness. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Moderate

salsalate food

Applies to: Disalcid (salsalate)

Ask your doctor before using salsalate together with ethanol. Do not drink alcohol while taking salsalate. Alcohol can increase your risk of stomach bleeding caused by salsalate. Call your doctor at once if you have symptoms of bleeding in your stomach or intestines. This includes black, bloody, or tarry stools, or coughing up blood or vomit that looks like coffee grounds. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Moderate

anisindione food

Applies to: Miradon (anisindione)

Rarely, vitamin supplements containing vitamin K may reduce the effectiveness of anisindione. This may be more likely to occur in individuals who have low levels of vitamin K in their blood. Before using any vitamin supplement, you should check the label to make sure it does not contain vitamin K. If it does, let your doctor know before you start using it. You may need more frequent monitoring of your INR after starting the supplement or whenever it is discontinued, and appropriate adjustments made in your dosage if necessary. It is important to tell your doctor about all other medications you use, including other nutritional supplements and herbs. Do not stop using any medications without first talking to your doctor.

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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