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Related Experiment Videos

Potential interaction involving warfarin and ritonavir

K R Knoell1, T M Young, E S Cousins

  • 1College of Pharmacy, Ohio State University, Columbus, OH, USA.

The Annals of Pharmacotherapy
|January 7, 1999
PubMed
Summary

Adding ritonavir to warfarin therapy unexpectedly decreased warfarin

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Area of Science:

  • Pharmacology
  • Drug Interactions
  • HIV Therapeutics

Background:

  • Warfarin is a common anticoagulant.
  • Ritonavir is a protease inhibitor used in HIV treatment.
  • Warfarin metabolism is primarily mediated by CYP2C9 and CYP3A4.

Observation:

  • A patient on warfarin for an inferior vena cava thrombus was initiated on ritonavir, clarithromycin, and zidovudine.
  • The patient experienced a significant decrease in warfarin's effect (International Normalized Ratio - INR).
  • Warfarin dosage had to be nearly doubled to maintain therapeutic INR levels.

Findings:

  • Discontinuation of ritonavir led to a rapid increase in INR.
  • Warfarin dose requirements significantly decreased upon ritonavir cessation.
  • The interaction between warfarin and ritonavir resulted in a paradoxical decrease in anticoagulation, contrary to expectations.

Implications:

  • Clinicians should anticipate unpredictable warfarin and ritonavir interactions.
  • Close monitoring of INR is crucial when initiating or discontinuing ritonavir in patients on warfarin.
  • The mechanism behind this paradoxical interaction remains unclear and warrants further investigation.

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