Drug interactions between Miradon and sarecycline
Interactions between your drugs
Applies to: Miradon (anisindione) and sarecycline
Consumer information for this interaction is not currently available.
MONITOR: Tetracyclines may increase the hypoprothrombinemic effects of warfarin and similar anticoagulants. The mechanism of interaction has not been established, but may involve depression of plasma prothrombin activity or suppression of vitamin K-producing bacteria in the gastrointestinal tract, although the latter may be of limited clinical importance except in patients whose dietary intake of vitamin K is severely reduced. There have been case reports of bruising, hematomas, and bleeding in association with increased prothrombin times or INRs in patients stabilized on warfarin and other coumarins several days to weeks following the addition of a tetracycline antibiotic. An early study from 1962 reported that 6 out of 9 anticoagulant patients had a significant fall in their prothrombin-proconvertin concentration when treated with chlortetracycline 250 mg four times daily for 4 days. In a population-based cohort study of 1124 patients receiving acenocoumarol or phenprocoumon over a 7.75-year period, Dutch investigators found that doxycyline use increased the risk of overanticoagulation (defined as INR >=6.0) with an adjusted relative risk of 4.3, and that the risk was most strongly increased 4 or more days after start of doxycycline. In subsequent cohort studies, the same group of investigators also reported that the relative risk of hospitalization for bleeding was increased in patients receiving acenocoumarol or phenprocoumon concomitantly with doxycycline or tetracycline.
MANAGEMENT: Caution is advised when warfarin and similar anticoagulants are used with tetracyclines. The INR should be checked frequently and the anticoagulant dosage adjusted accordingly, particularly following initiation or discontinuation of tetracycline 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.
- 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
- "Product Information. Seysara (sarecycline)." Allergan Inc, Irvine, CA.
- Magid E "Tolerance to anticoagulants during antibiotic therapy." Scand J Clin Lab Invest 14 (1962): 565-6
- Hasan SA "Interaction of doxycycline and warfarin: an enhanced anticoagulant effect." Cornea 26 (2007): 742-3
- "Product Information. Declomycin (demeclocycline)." Lederle Laboratories, Wayne, NJ.
- Ku LL, Ward CO, Durgin SJ "A clinical study of drug interaction and anticoagulant therapy." Drug Intell Clin Pharm 4 (1970): 300-6
- Visser LE, Penning-Van Bees FJ, Harrie Kasbergen AA, et al. "Overanticoagulation associated with combined use of antibacterial drugs and acenocoumarol or phenprocoumon anticoagulants." Thromb Haemost 88 (2002): 705-10
- Penning-van Beest FJ, Koerselman J, Herings RM "Risk of major bleeding during concomitant use of antibiotic drugs and coumarin anticoagulants." J Thromb Haemost 6 (2008): 284-90
- Baciewicz AM, Bal BS "Bleeding associated with doxycycline and warfarin treatment." Arch Intern Med 161 (2001): 1231
- O'Donnell D "Antibiotic-induced potentiation of oral anticoagulant agents." Med J Aust 150 (1989): 163-4
- Westfall LK, Mintzer DL, Wiser TH "Potentiation of warfarin by tetracycline." Am J Hosp Pharm 37 (1980): 1620, 5
- Udall JA "Human sources and absorption of vitamin K in relation to anticoagulation stability." JAMA 194 (1965): 107-9
- "Product Information. Xerava (eravacycline)." Tetraphase Pharmaceuticals, Inc, Watertown, MA.
- Caraco Y, Rubinow A "Enhanced anticoagulant effect of coumarin derivatives induced by doxycycline coadministration." Ann Pharmacother 26 (1992): 1084-6
- Wells PS, Holbrook AM, Crowther NR, Hirsh J "Interactions of warfarin with drugs and food." Ann Intern Med 121 (1994): 676-83
- "Product Information. Nuzyra (omadacycline)." Paratek Pharmaceuticals, Inc., Boston, MA.
- Koch-Weser J, Sellers EM "Drug interactions with coumarin anticoagulants (second of two parts)." N Engl J Med 285 (1971): 547-58
Drug and food interactions
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.
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.
Drug Interaction Classification
|Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.|
|Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.|
|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.|
|No interaction information available.|
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.