Drug interactions between Miradon and Nexavar
| Results for the following 2 drugs: |
|---|
| Miradon (anisindione) |
| Nexavar (sorafenib) |
Interactions between your selected drugs
anisindione ↔ sorafenib
Applies to:Miradon (anisindione) and Nexavar (sorafenib)
MONITOR: Coadministration of oral anticoagulants in combination with sorafenib may potentiate the risk of bleeding. The mechanism of interaction is unknown, although an increased risk of bleeding is associated with the use of these agents alone. Studies with human liver microsomes have shown that sorafenib is a competitive inhibitor of CYP450 2C9, the isoenzyme responsible for the metabolism of warfarin and some other oral anticoagulants. However, concomitant treatment of warfarin with sorafenib did not produce changes in mean PT/INR compared to placebo. Infrequent bleeding events and elevations in the prothrombin time or INR have been reported in patients taking warfarin while on sorafenib therapy. In one case report, a 70-year-old patient receiving warfarin for atrial fibrillation was admitted for lower extremity hemorrhage and diagnosed with warfarin toxicity approximately one month after starting sorafenib therapy for hepatocellular carcinoma. His INR had increased to 39.5 from 2.9 less than two weeks prior, and his prothrombin time was 84.8. The patient received 2 units of packed red blood cells, sorafenib was discontinued, and warfarin was held during his hospital stay. Following discharge, therapeutic INR levels were attained over the next month by resuming his previous warfarin dosage. Sorafenib was restarted, but was permanently discontinued approximately two weeks later when the patient's INR increased to 4.7.
MANAGEMENT: Caution is advised if oral anticoagulants are prescribed with sorafenib. The INR should be checked frequently and anticoagulant dosage adjusted accordingly, particularly following initiation, discontinuation or change of dosage of sorafenib in patients who are stabilized on their anticoagulant regimen. 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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