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Flucloxacillin-warfarin interaction: an under-appreciated phenomenon
Alex Chaudhuri1,2, Stephanie L Wade3
1Department of Infectious Diseases, The Prince Charles Hospital, Brisbane, Queensland, Australia.
Internal Medicine Journal
|July 10, 2018
Summary
Flucloxacillin significantly increases warfarin dosage requirements in patients, necessitating close international normalised ratio (INR) monitoring. This drug interaction, often overlooked, requires careful management to prevent adverse events.
Area of Science:
- Pharmacology
- Clinical Pharmacy
Background:
- Drug interaction databases lack documented evidence of a warfarin-flucloxacillin interaction.
- Case reports suggest flucloxacillin may increase warfarin requirements for therapeutic anticoagulation.
Purpose of the Study:
- To evaluate the impact of flucloxacillin therapy on warfarin dosage in patients requiring anticoagulation.
Main Methods:
- Retrospective, observational cohort study of hospital-in-the-home patients stable on warfarin.
- Comparison of warfarin doses one week prior to and during the final week of antibiotic treatment (flucloxacillin vs. other antibiotics) for at least two weeks.
Main Results:
- Patients on flucloxacillin experienced a 57-130% statistically significant increase in warfarin dose (P < 0.05).
- No significant warfarin dose changes were observed with vancomycin, benzylpenicillin, or piperacillin-tazobactam.
- One comparator on cephazolin showed a dose change, attributed to pre-existing sub-therapeutic INR.
Conclusions:
- Flucloxacillin necessitates increased warfarin dosage to maintain therapeutic INR.
- Close international normalised ratio (INR) monitoring is crucial for patients on prolonged flucloxacillin courses due to the risk of sub-therapeutic anticoagulation.
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