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Interaction between warfarin and sulphamethoxazole

W J Tilstone, J M Gray, R H Nimmo-Smith

Postgraduate Medical Journal

|July 1, 1977

Summary

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Co-trimoxazole may interact with warfarin by displacing it from albumin, but this is only clinically significant in patients with high warfarin levels and low albumin. Careful monitoring is advised for these specific patient groups.

Area of Science:

Pharmacology
Drug Interactions
Clinical Pharmacy

Background:

Warfarin is a widely used anticoagulant.
Co-trimoxazole is a common antibiotic.
Potential drug interactions require thorough investigation.

Observation:

A patient exhibited potential interaction between warfarin and co-trimoxazole.
In vitro and in vivo studies were conducted to investigate this interaction.

Findings:

Sulfamethoxazole, a component of co-trimoxazole, can displace warfarin from plasma albumin binding sites.
This displacement occurs at high warfarin plasma concentrations.
The interaction is most clinically significant in patients with high warfarin doses and low plasma albumin.

Related Experiment Videos

Implications:

Co-trimoxazole is not contraindicated in patients on warfarin therapy.
Caution is advised for patients with high warfarin-to-albumin ratios.
Monitoring is recommended for patients receiving high-dose warfarin concurrently with co-trimoxazole.