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Interaction between warfarin and trazodone.

N L Small1, K A Giamonna

  • 1Department of Pharmacy, Central Texas Veterans Healthcare System, Temple 76504, USA. nancy.small@med.va.gov

The Annals of Pharmacotherapy
|June 22, 2000
PubMed
Summary
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Clinicians should monitor warfarin patients carefully when trazodone is initiated or stopped. This drug interaction can significantly alter prothrombin time (PT) and international normalized ratio (INR), requiring dosage adjustments.

Area of Science:

  • Pharmacology
  • Clinical Pharmacy
  • Drug Interactions

Background:

  • Warfarin is known to have numerous drug interactions.
  • Limited data exist regarding the interaction between trazodone and warfarin.

Observation:

  • Three cases of significant trazodone-warfarin interaction were identified.
  • Changes in prothrombin time (PT) and international normalized ratio (INR) exceeded 1.0.
  • INR increased upon trazodone discontinuation and decreased upon initiation.

Findings:

  • A clinically significant interaction between trazodone and warfarin exists.
  • The onset of interaction is variable.
  • Potential mechanisms include substrate competition or protein-binding competition.

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Implications:

  • Avoid as-needed trazodone for sleep in warfarin patients due to INR instability.
  • Educate patients and clinicians about this potential interaction.
  • Monitor anticoagulant effect closely when initiating or stopping trazodone.