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Coumadin (warfarin) Disease Interactions

There are 8 disease interactions with Coumadin (warfarin):

Major

Oral Anticoagulants (Includes Coumadin) ↔ Bleeding

Severe Potential Hazard, High plausibility

Applies to: Thrombocytopathy, Thrombocytopenia, Coagulation Defect, Infectious Endocarditis, Vitamin K Deficiency, Myeloproliferative Disorder, Bleeding, Esophageal Ulceration, Peptic Ulcer, Colonic Ulceration, Ulcerative Colitis, Aortic Aneurysm, Cerebral Aneurysm, Pericarditis, Pre-eclampsia/Eclampsia, Vasculitis, Diverticulitis, Malnourished, Vitamin C Deficiency

In general, the use of oral anticoagulants is contraindicated in patients with active bleeding or a hemorrhagic diathesis or other significant risks for bleeding, including hemostatic and/or coagulation defects associated with hemophilia, hypoprothrombinemia, thrombocytopenia, thrombocytopathy, severe hepatic impairment, and myeloproliferative disorders such as leukemia or polycythemia vera. Additionally, oral anticoagulants are usually contraindicated in the presence of any active ulceration of the gastrointestinal, respiratory, or genitourinary tracts; cerebrovascular hemorrhage; aneurysms (cerebral, dissecting aortic); pericarditis and pericardial effusions; bacterial endocarditis; and eclampsia, preeclampsia, or threatened abortion. These patients may be at increased risk for uncontrollable hemorrhage or bleeding complications during therapy with oral anticoagulants. Other potential contraindications include diverticulitis, vasculitis, malnutrition, and vitamin C or vitamin K deficiency. The decision to administer anticoagulants must be based upon clinical judgment in which the risks are weighed against the benefits in each patient.

References

  1. Levine MN, Hirsh J "Hemorrhagic complications of anticoagulant therapy." Semin Thromb Hemost 12 (1986): 39-57
  2. Landefeld CS, Cook EF, Flatley M, Weisberg M, Goldman L "Identification and preliminary validation of predictors of major bleeding in hospitalized patients starting anticoagulant therapy." Am J Med 82 (1987): 703-13
  3. Palareti G, Leali N, Coccheri S, Poggi M, Manotti C, Dangelo A, Pengo V, Erba N, Moia M, Ciavarella N, Devote G, Berrettini M, "Bleeding complications of oral anticoagulant treatment: an inception-cohort, prospective collaborative study (ISCOAT)." Lancet 348 (1996): 423-8
  4. White RH, McKittrick T, Takakuwa J, Callahan C, McDonell M, Fihn S "Management and prognosis of life-threatening bleeding during warfarin therapy." Arch Intern Med 156 (1996): 1197-201
  5. "Product Information. Coumadin (warfarin)." DuPont Pharmaceuticals, Wilmington, DE.
  6. Brigden ML "When bleeding complicates oral anticoagulant therapy: how to anticipate, investigate, and treat." Postgrad Med 98 (1995): 153
  7. Morgan RJ, Bristol JB "Unusual findings in a patient taking warfarin - Retroperitoneal haematoma." Postgrad Med J 75 (1999): 299-300
  8. Landefeld CS, Rosenblatt MW, Goldman L "Bleeding in outpatients treated with warfarin: relation to the prothrombin time and important remediable lesions." Am J Med 87 (1989): 153-9
  9. Hylek EM, Singer DE "Risk factors for intracranial hemorrhage in outpatients taking warfarin." Ann Intern Med 120 (1994): 897-902
  10. Lee KS, Marwick T "Hemopericardium and cardiac tamponade associated with warfarin therapy." Cleve Clin J Med 60 (1993): 336-8
  11. Dajani YF "Hematuria in patients on anticoagulants." N Engl J Med 297 (1977): 222
  12. Landfeld CS, Goldman L "Major bleeding in outpatients treated with warfarin: incidence and prediction by factors known at the start of outpatient therapy." Am J Med 87 (1989): 144-52
  13. Jimenez J "Abdominal pain in a patient using warfarin - Intramural haematoma of the small bowel in the setting of the warfarin anticoagulation." Postgrad Med J 75 (1999): 747-8
View all 13 references
Major

Oral Anticoagulants (Includes Coumadin) ↔ Diabetes

Severe Potential Hazard, High plausibility

Applies to: Diabetes Mellitus

Therapy with oral anticoagulants should be administered cautiously in patients with severe diabetes because they may be at increased risk for hemorrhage. The INR should be monitored closely, and 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. "Product Information. Coumadin (warfarin)." DuPont Pharmaceuticals, Wilmington, DE.
Major

Oral Anticoagulants (Includes Coumadin) ↔ Hypertension

Severe Potential Hazard, High plausibility

Applies to: Hypertension, Pheochromocytoma

In general, the use of oral anticoagulants is contraindicated in patients with malignant or severe, uncontrolled hypertension. These patients may be at increased risk for cerebral hemorrhage. Therapy with oral anticoagulants should be administered cautiously in patients with moderate hypertension.

References

  1. Hylek EM, Singer DE "Risk factors for intracranial hemorrhage in outpatients taking warfarin." Ann Intern Med 120 (1994): 897-902
  2. "Product Information. Coumadin (warfarin)." DuPont Pharmaceuticals, Wilmington, DE.
Major

Oral Anticoagulants (Includes Coumadin) ↔ Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

Oral anticoagulants (coumarin and indandione derivatives) are primarily metabolized by the liver. Patients with hepatic impairment may have a heightened response to these agents due to decreased clearance of the drugs as well as defective hemostasis associated with impaired synthesis of clotting factors by the liver. Therapy with oral anticoagulants should be administered cautiously in patients with severe or moderate liver disease. The INR should be monitored closely, and 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. Landefeld CS, Cook EF, Flatley M, Weisberg M, Goldman L "Identification and preliminary validation of predictors of major bleeding in hospitalized patients starting anticoagulant therapy." Am J Med 82 (1987): 703-13
  2. Shetty HG, Fennerty AG, Routledge PA "Clinical pharmacokinetic considerations in the control of oral anticoagulant therapy." Clin Pharmacokinet 16 (1989): 238-53
  3. Demirkan K, Stephens MA, Newman KP, Self TH "Response to warfarin and other oral anticoagulants: effects of disease states." South Med J 93 (2000): 448-54; quiz 455
  4. Williams RL, Schary WL, Blaschke TF, et al "Influence of acute viral hepatitis on disposition and pharmacologic effect of warfarin." Clin Pharmacol Ther 20 (1976): 90-7
  5. "Product Information. Coumadin (warfarin)." DuPont Pharmaceuticals, Wilmington, DE.
View all 5 references
Major

Oral Anticoagulants (Includes Coumadin) ↔ Protein C Deficiency

Severe Potential Hazard, Moderate plausibility

Applies to: Protein C Deficiency

Tissue necrosis is a rare complication that develops during the initiation of oral anticoagulant therapy due to thrombotic occlusion of venules in the dermis and subcutaneous tissues. Hereditary, familial, or clinical deficiencies of protein C or its cofactor, protein S, may be associated with a hypercoagulable state and an increased risk of the complication. Therapy with oral anticoagulants should be administered cautiously in patients with known or suspected deficiency in protein C-mediated anticoagulant response. Concomitant administration with heparin for the first 5 to 7 days of oral anticoagulant therapy may minimize the risk. If tissue necrosis develops, oral anticoagulant therapy should be discontinued promptly and vitamin K or frozen plasma administered at once. Heparin should then be considered for anticoagulation.

References

  1. Locht H, Lindstrom FD "Severe skin necrosis following warfarin therapy in a patient with protein C deficiency." J Intern Med 233 (1993): 287-9
  2. "Product Information. Coumadin (warfarin)." DuPont Pharmaceuticals, Wilmington, DE.
  3. Cole MS, Minifee PK, Wolma FJ "Coumarin necrosis: a review of the literature." Surgery 103 (1988): 271-7
  4. Eby CS "Warfarin-induced skin necrosis." Hematol Oncol Clin North Am 7 (1993): 1291-300
  5. Kandrotas RJ, Deterding J "Genital necrosis secondary to warfarin therapy." Pharmacotherapy 8 (1988): 351-4
  6. Griffin JP "Anticoagulants and skin necrosis." Adverse Drug React Toxicol Rev 13 (1994): 157-67
  7. Colman RW, Rao AK, Rubin RN "Warfarin skin necrosis in a 33-year-old woman." Am J Hematol 43 (1993): 300-3
  8. LaPrade RF, Fowler BL, Ryan TG "Skin necrosis with minidose warfarin used for prophylaxis against thromboembolic disease after hip surgery." Orthopedics 16 (1993): 703-4
  9. Zimbelman J, Lefkowitz J, Schaeffer C, Hays T, MancoJohnson M, Manhalter C, Nuss R "Unusual complications of warfarin therapy: Skin necrosis and priapism." J Pediat 137 (2000): 266-8
  10. Humphries JE, Gardner JH, Connelly JE "Warfarin skin necrosis: recurrence in the absence of anticoagulant therapy." Am J Hematol 37 (1991): 197-200
  11. Stewart AJ, Penman ID, Cook MK, Ludlam CA "Warfarin-induced skin necrosis." Postgrad Med J 75 (1999): 233-5
  12. Cheng A, Scheinfeld NS, McDowell B, Dokras AA "Warfarin skin necrosis in a postpartum woman with protein S deficiency." Obstet Gynecol 90(4 Pt 2) (1997): 671-2
  13. Mehta RL, Scott G, Sloand JA, Francis CW "Skin necrosis associated with acquired protein C deficiency in patients with renal failure and calciphylaxis." Am J Med 88 (1990): 252-7
  14. Horn JR, Danziger LH, Davis RJ "Warfarin-induced skin necrosis: report of four cases." Am J Hosp Pharm 38 (1981): 1763-8
View all 14 references
Moderate

Oral Anticoagulants (Includes Coumadin) ↔ Decreased Response

Moderate Potential Hazard, Moderate plausibility

Applies to: Fluid Retention, Hyperlipidemia, Hypothyroidism

Patients with edema, hereditary coumarin resistance, hyperlipidemia, hypothyroidism, or nephrotic syndrome may exhibit lower than expected hypoprothrombinemic response to oral anticoagulants. Thus, more frequent laboratory (PT/INR) monitoring and dosage adjustment of anticoagulant may be required based on changes in the patient's condition.

References

  1. Ganeval D, Fischer AM, Barre J, et al "Pharmacokinetics of warfarin in the nephrotic syndrome and effect on vitamin K-dependent clotting factors." Clin Nephrol 25 (1986): 75-80
  2. Rice AJ, McIntosh TJ, Fouts JR, et al "Decrease sensitivity to warfarin in patients with myxedema." Am J Med Sci 262 (1971): 211-5
  3. "Product Information. Coumadin (warfarin)." DuPont Pharmaceuticals, Wilmington, DE.
  4. Walters MB "The relationship between thyroid function and anticoagulant therapy." Am J Cardiol 11 (1963): 112-4
  5. Stephens MA, Self TH, Lancaster D, Nash T "Hypothyroidism: effect on warfarin anticoagulation." South Med J 82 (1989): 1585-6
  6. Demirkan K, Stephens MA, Newman KP, Self TH "Response to warfarin and other oral anticoagulants: effects of disease states." South Med J 93 (2000): 448-54; quiz 455
View all 6 references
Moderate

Oral Anticoagulants (Includes Coumadin) ↔ Increased Response

Moderate Potential Hazard, Moderate plausibility

Applies to: Congestive Heart Failure, Collagen Vascular Disease, Diarrhea, Fever, Malabsorption Syndrome, Hyperthyroidism

Patients with a collagen vascular disease (e.g., systemic lupus erythematosus, rheumatoid arthritis, scleroderma), congestive heart failure (especially decompensated disease), severe or prolonged diarrhea, fever, hyperthyroidism, malabsorption, or steatorrhea may exhibit greater than expected hypoprothrombinemic response to oral anticoagulants. Thus, more frequent laboratory (PT/INR) monitoring and dosage adjustment of anticoagulant may be required based on changes in the patient's condition. 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. Vagenakis AG, Cote R, Miller ME, et al "Enhancement of warfarin-induced hypoprothrombinemia by thyrotoxicosis." Johns Hopkins Med J 131 (1972): 69-73
  2. "Product Information. Coumadin (warfarin)." DuPont Pharmaceuticals, Wilmington, DE.
  3. Landefeld CS, Cook EF, Flatley M, Weisberg M, Goldman L "Identification and preliminary validation of predictors of major bleeding in hospitalized patients starting anticoagulant therapy." Am J Med 82 (1987): 703-13
  4. Owens JC, Neely WB, Owen WR "Effect of sodium dextrothyroxine in patients receiving anticoagulants." N Engl J Med 266 (1962): 76-9
  5. Demirkan K, Stephens MA, Newman KP, Self TH "Response to warfarin and other oral anticoagulants: effects of disease states." South Med J 93 (2000): 448-54; quiz 455
  6. Self TH, Straughn AB, Weisburst MR "Effect of hyperthryroidism on hypoprothrombinemic response to warfarin." Am J Hosp Pharm 33 (1976): 387-9
  7. Black JA "Diarrhoea, vitamin k, and warfarin." Lancet 344 (1994): 1373
  8. Smith JK, Aljazairi A, Fuller SH "INR elevation associated with diarrhea in a patient receiving warfarin." Ann Pharmacother 33 (1999): 301-4
  9. Self T, Weisburst M, Wooten E, Straughn A, Oliver J "Warfarin-induced hypoprothrombinemia: potentiation by hyperthyroidism." JAMA 231 (1975): 1165-6
  10. Kellett HA, Sawers JS, Boulton FE, Cholerton S, Park BK, Toft AD "Problems of anticoagulation with warfarin in hyperthyroidism." Q J Med 58 (1986): 43-51
View all 10 references
Moderate

Oral Anticoagulants (Includes Coumadin) ↔ Renal Dysfunction

Moderate Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction

There is no evidence that hypoprothrombinemic response to oral anticoagulants (coumarin and indandione derivatives) is altered in renal impairment due to decreased plasma protein binding, thus dosage adjustments are generally not necessary. However, patients with renal impairment may demonstrate platelet defects and may be at increased risk for bleeding. Therapy with oral anticoagulants should be administered cautiously in patients with severe or moderate renal dysfunction. The INR should be monitored closely, and 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. Bachmann K, Shapiro R, Mackiewicz J "Warfarin elimination and responsiveness in patients with renal dysfunction." J Clin Pharmacol 17 (1977): 292-9
  2. Demirkan K, Stephens MA, Newman KP, Self TH "Response to warfarin and other oral anticoagulants: effects of disease states." South Med J 93 (2000): 448-54; quiz 455
  3. Yacobi A, Udall JA, Levy G "Serum protein binding as a determinant of warfarin body clearance and anticoagulant effect." Clin Pharmacol Ther 19 (1976): 552-8
  4. Shetty HG, Fennerty AG, Routledge PA "Clinical pharmacokinetic considerations in the control of oral anticoagulant therapy." Clin Pharmacokinet 16 (1989): 238-53
  5. Landfeld CS, Goldman L "Major bleeding in outpatients treated with warfarin: incidence and prediction by factors known at the start of outpatient therapy." Am J Med 87 (1989): 144-52
  6. Landefeld CS, Cook EF, Flatley M, Weisberg M, Goldman L "Identification and preliminary validation of predictors of major bleeding in hospitalized patients starting anticoagulant therapy." Am J Med 82 (1987): 703-13
  7. Bachmann K, Shapiro R, Mackiewicz J "Influence of renal dysfunction on warfarin plasma protein binding." J Clin Pharmacol 16 (1976): 468-72
  8. "Product Information. Coumadin (warfarin)." DuPont Pharmaceuticals, Wilmington, DE.
View all 8 references

Coumadin (warfarin) drug Interactions

There are 878 drug interactions with Coumadin (warfarin)

Coumadin (warfarin) alcohol/food Interactions

There are 5 alcohol/food interactions with Coumadin (warfarin)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
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 information available.

Do not stop taking any medications without consulting your healthcare provider.

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