Skip to main content

Drug Interactions between E-600 and ticlopidine

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

Edit list (add/remove drugs)

Interactions between your drugs

Moderate

vitamin E ticlopidine

Applies to: E-600 (vitamin e) and ticlopidine

MONITOR: Vitamin E may potentiate the effects of anticoagulants and platelet inhibitors. Vitamin E is thought to inhibit the oxidation of reduced vitamin K and interfere with the functions of vitamin K-dependent clotting factors. These effects appear to be dose-dependent and greater in individuals with preexisting vitamin K deficiency. In one study, administration of vitamin E 42 units/day for one month increased the hypoprothrombinemic effect of a single dose of dicumarol in 3 healthy volunteers, as demonstrated by a decrease in prothrombin activity from 52% to 33% thirty-six hours postdose. The interaction was also suspected in a patient who developed ecchymoses and hematuria following two months of vitamin E supplementation at a dosage of 800 to 1200 units/day while taking warfarin. In contrast, two studies found no significant effect of vitamin E on the hypoprothrombinemic effect of chronic warfarin therapy when administered at relatively high dosages (800 or 1200 units/day) to 21 subjects for one month or at low dosages (100 or 400 units/day) to 12 subjects for four weeks. With respect to antiplatelet activities, data from in vitro and ex vivo human studies suggest that vitamin E can inhibit collagen-induced platelet activation and protein kinase C-dependent platelet aggregation. Clinically significant antiplatelet effects have not been consistently observed in published studies, particularly at dosages below 400 units/day. However, there have been isolated reports of excessive bleeding in surgical patients who had taken vitamin E regularly prior to surgery, and one controlled clinical trial found that supplementation with only 50 mg/day of vitamin E resulted in an increase in subarachnoid hemorrhage in male smokers aged 55 to 74 years (n=409). In a random sampling of that same population of male smokers, gingival bleeding was also more common in subjects who received vitamin E with aspirin compared to those who received either agent alone or neither.

MANAGEMENT: Patients should consult a healthcare provider before taking any nutritional supplements like vitamin E. Close clinical and laboratory observation for hematologic complications may be appropriate when vitamin E supplementation at dosages greater than 400 units/day is initiated in patients stabilized on anticoagulant or antiplatelet therapy. The dose of the anticoagulant or antiplatelet drug may require adjustment during and after treatment with vitamin E. 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.

References

  1. Corrigan JJ "The effect of vitamin E on warfarin-induced vitamin K deficiency." Ann N Y Acad Sci 393 (1982): 361-8
  2. Corrigan JJ, Ulfers LL "Effect of vitamin E on prothrombin levels in warfarin-induced vitamin K deficiency." Am J Clin Nutr 34 (1981): 1701-5
  3. Schrogie JJ "Coagulopathy and fat-soluble vitamins." JAMA 232 (1975): 19
  4. "Vitamin K, vitamin E and the coumarin drugs." Nutr Rev 40 (1982): 180-2
  5. "Megavitamin E supplementation and vitamin K-dependent carboxylation." Nutr Rev 41 (1983): 268-70
  6. Kim JM, White RH "Effect of vitamin E on the anticoagulant response to warfarin." Am J Cardiol 77 (1996): 545-6
  7. Helson L "The effect of intravenous vitamin E and menadiol sodium diphosphate on vitamin K dependent clotting factors." Thromb Res 35 (1984): 11-8
  8. Heck AM, DeWitt BA, Lukes AL "Potential interactions between alternative therapies and warfarin." Am J Health Syst Pharm 57 (2000): 1221-7; quiz 1228-30
  9. Celestini A, Pulcinelli FM, Pignatelli P, et al. "Vitamin E potentiates the antiplatelet activity of aspirin in collagen-stimulated platelets." Haematologica 87 (2002): 420-6
  10. Kakishita E, Suehiro A, Oura Y, Nagai K "Inhibitory effect of vitamin E (alpha-tocopherol) on spontaneous platelet aggregation in whole blood." Thromb Res 60 (1990): 489-99
  11. Mardla V, Kobzar G, Samel N "Potentiation of antiaggregating effect of prostaglandins by alpha-tocopherol and quercetin." Platelets 15 (2004): 319-24
  12. Gonzalez-Correa JA, Arrebola MM, Guerrero A, et al. "Influence of vitamin E on the antiplatelet effect of acetylsalicylic acid in human blood." Platelets 16(3-4) (2005): 171-9
  13. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  14. Shalansky S, Lynd L, Richardson K, Ingaszewski A, Kerr C "Risk of warfarin-related bleeding events and supratherapeutic international normalized ratios associated with complementary and alternative medicine: a longitudinal analysis." Pharmacotherapy 27 (2007): 1237-47
  15. Booth SL, Golly I, Sacheck JM, Roubenoff R, Dallal GE, et al. "Effect of vitamin E supplementation on vitamin K status in adults with normal coagulation status." Am J Clin Nutr 80 (2004): 143-8
  16. Freedman JE, Farhat JH, Loscalzo J, Keaney JF "Alpha-tocopherol inhibits aggregation of human platelets by a protein kinase C--dependent mechanism." Circulation 94 (1996): 2434-40
  17. Stampfer MJ, Jakubowski JA, Faigel D, Vaillancourt R, Deykin D "Vitamin E supplementation effect on human platelet function, arachidonic acid metabolism, and plasma prostacyclin levels." Am J Clin Nutr 47 (1988): 700-6
  18. Murohara T, Ikeda H, Otsuka Y, Aoki M, Takajo Y, et al. "Inhibition of platelet adherence to Mononuclear cells by alpha-tocopherol: role of P-selection." Circulation 110 (2004): 141-8
  19. Jandak J, Steiner M, Richardson PD "Alpha-tocopherol, an effective inhibitor of platelet adhesion." Blood 73 (1989): 141-9
  20. Liu M, Wallmon A, Olsson-Mortlock C, Wallin R, Saldeen T "Mixed tocopherols inhibit platelet aggregation in humans: potential mechanisms." Am J Clin Nutr 77 (2003): 700-6
View all 20 references

Switch to consumer interaction data

Drug and food interactions

Moderate

ticlopidine food

Applies to: ticlopidine

ADJUST DOSING INTERVAL: The bioavailability and gastrointestinal tolerance of ticlopidine is enhanced by food.

MANAGEMENT: Patients may be advised to take ticlopidine with meals.

References

  1. "Product Information. Ticlid (ticlopidine)." Syntex Laboratories Inc PROD (2001):

Switch to consumer interaction data

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

Report options

Loading...
QR code containing a link to this page

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.

Medical Disclaimer