tindamax and Anisindione Interactions

Interactions between tindamax(tinidazole) and Anisindione (anisindione)

anisindione and tinidazole (Moderate Drug-Drug)

MONITOR: Coadministration with tinidazole may enhance the hypoprothrombinemic effect of warfarin and other oral anticoagulants. The interaction has been reported with metronidazole, another agent in the nitroimidazole class, and warfarin. Significant bleeding and elevation of prothrombin time have been observed. The proposed mechanism is metronidazole inhibition of CYP450 2C9, the isoenzyme responsible for the metabolic clearance of the more active S(-) enantiomer of warfarin. No data are available for tinidazole.

MANAGEMENT: Given its structural similarities to metronidazole, the potential for interaction with warfarin and other oral anticoagulants should be considered during coadministration with tinidazole. The INR should be checked frequently and anticoagulant dosage adjusted accordingly, particularly following initiation and for up to 8 days after discontinuation of tinidazole therapy 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.