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Moxifloxacin and warfarin: additional evidence for a clinically relevant interaction
Lindsay M Arnold1, Lindsay R Nissen, Tien M H Ng
1Department of Pharmacy, Boston Medical Center, Boston, Massachusetts, USA.
Pharmacotherapy
|June 2, 2005
Summary
Fluoroquinolone antibiotics like moxifloxacin may interact with warfarin, increasing the risk of bleeding. This study highlights three cases of elevated international normalized ratio (INR) after moxifloxacin use, emphasizing the need for careful monitoring.
Area of Science:
- Pharmacology
- Drug Interactions
- Clinical Medicine
Background:
- Warfarin is a commonly prescribed anticoagulant.
- Fluoroquinolones are broad-spectrum antibiotics.
- A potential drug interaction between fluoroquinolones and warfarin has been suggested but not fully elucidated.
Observation:
- Three patients on stable warfarin therapy were administered moxifloxacin.
- Two patients exhibited persistent elevations in their international normalized ratio (INR) after starting moxifloxacin.
- One patient experienced a significant INR increase after a single dose of moxifloxacin.
Findings:
- Moxifloxacin administration was associated with increased INR in all observed patients.
- The interaction led to potentially dangerous anticoagulation levels.
- These findings challenge existing information regarding this drug interaction.
Implications:
- Clinicians should be vigilant for potential warfarin-moxifloxacin interactions.
- Close INR monitoring is crucial when co-prescribing these medications.
- Further research is needed to understand the mechanism and clinical significance of this interaction.