Drug interaction: omeprazole and phenprocoumon

Oral anticoagulants like the coumarin derivatives are characterised by a particularly narrow therapeutic range. Any interfering co-medication can pose a challenge to establishing a stable anticoagulant dosage regimen and thus present a serious risk for the patient. Here we describe two cases of patients on anticoagulant therapy that suggest possible drug interactions between phenprocoumon and the proton pump inhibitor omeprazole.

In both patients, the International Normalised Ratio (INR) increased beyond the therapeutic range after they were given omeprazole for the treatment of gastrointestinal symptoms. The INR returned to therapeutic levels after the phenprocoumon dose was reduced (Case 1) and omeprazole discontinued (Case 2).

The increased anticoagulant activity of phenprocoumon observed in the two described cases and the known interaction potential of omeprazole suggest that the clearance of phenprocoumon may have been reduced due to competitive inhibition of its degradation by omeprazole. Drug interactions may be one of the reasons for the difficulties encountered with some patients in establishing a stable anticoagulant therapy. Physicians should carefully review any concurrently used medication and if possible opt for drugs with a low interaction potential.