Diclofenac Acenocoumarol

In a crossover study in 29 patients stabilised on acenocoumarol, diclofenac 25 mg four times daily for one week did not alter the anticoagulant effect (prothrombin value) of acenocoumarol, when compared with placebo. Other studies similarly eonlirm that diclofenac does not alter the anticoagulant effect of either phenprocoumon or warfarin. ... 

Acenocoumarol, amiodarone, celecoxib, coumadin, dexamethasone, diclofenac, etoposide, fluconazole, fluoxetine, fluvas-tatin, fluvoxamine, ghmepiride, ghpizide, glyburide, ibuprofen, irbesartan, isoniazid, losartan, midazolam, phenylbutazone, phenytoin, rifampin, teniposide, tenoxicam, thiotepa, tolbutamide, torsemide, vitamin D, warfarin... 

Sotalol, metoprolol, propranolol, carvedilol, nifedipine, captopril, cilazapril, milrinone, ticlopidine, acenocoumarol, furosemide, acetylsalicylic acid, salicylic acid, ibuprofen, naproxen, ketoprofen, diclofenac, paracetamol, dipyrone, mildronate, sildenafil, dexa-methasone, carbamazepine, terbinafine/urine UHPLC MS/MS Column Zorbax Rapid Resolution High Definition SB-C18 (50 x 2.1 mm, 1.8 pm) Mobile phase Solvent A 0.1 % HCOOH in water Solvent B MeOH (gradient elution) Detection MS/MS, ionization ESI Protein precipitation LOQ 0.05-0.60 ng/mL [71]... 

Aliskiren, prasugrel, rivaroxaban, prednisolone, propranolol, ketoprofen, nifedipine, naproxen, terbinafine, ibuprofen, diclofenac, sildenafil, acenocoumarol/urine UHPLC UV Column Poroshell 120EC-Ci8 (100 X 3.0 mm 2.7 pm) Mobile phase Solvent A 0.05 % TFA in water Solvent B ACN (gradient elution) Detection 2 = 221, 228, 230, 240, 250, 275, 280 nm Extraction SPE/column CgHs/elution MeOH LOD 0.003-0.217 pg/mL LOQ 0.01-0.650 pg/mL [75]... 

Extracted acebutolol, acenocoumarol, acepromazine, aceprometazine, acetaminophen, ajmaline, albuterol, alimemazine, alminoprofen, alpidem, alprazolam, alprenolol, amisul-pride, amitriptyline, amodiaquine, amoxapine, aspirin, atenolol, benazepril, benperidol, benzocaine, benzoylecgonine, bepridil, betaxolol, bromazepam, brompheniramine, bumad-izone, bupivacaine, buprenorphine, buspirone, caffeine, carbamazepine, carbinoxamine, carpipramine, carteolol, celiprolol, cetirizine, chlorambucil, chlordiazepoxide, chlormeza-none, chlorophenacinone, chloroquine, chlorpheniramine, chlorpromazine, chlorpropamide, cibenzoline, cicletanine, clemastine, clobazam, clomipramine, clonazepam, clonidine, clorazepate, clozapine, cocaine, codeine, colchicine, (yamemazine, cyclizine, cycloguanil, cyproheptadine, c arabine, dacarbazine, daunorubicin, debrisoquine, demexiptiline, de-sipramine, dextromethorphan, dextromoramide, dextropropo3gq)hene, diazoxide, diclofenac, dihydralazine, diphenhydramine, dipyridamole, disopyramide, dosulepine, doxepin. 

Noninterfering amiloride, acebutolol, acenocoumarol, acetaminophen, aspirin, allopuri-nol, ambroxol, amoxicillin, atenolol, bendroflumethiazide, benzbromarone, bezafibrate, biperiden, bisacodyl, bromazepam, butizide, captopril, cimetidine, ciprofloxacin, clobu-tinol, clonidine, cotinine, diazepam, diclofenac, digitoxin, digoxin, dihydrocodeine, dihy-droergotamine, diltiazem, doxepin, doxycycline, enalapril, erythromycin, fenoterol, furosemide, glibenclamide, heparin, h3qjoxanthine, ibuprofen, indomethacin, isosorbide... 

A 39-ycar-old woman taking acenocoumarol, celiprolol, triamterene, cyclothiazide, pravastatin and diosmin had a rise in her prothrombin levels from 0.3 to 1 within 8 days of starting to take diclofenac and misoprostol 400 micrograms daily. A day after these two drugs had been withdrawn her prothrombin level had fallen to 0.67, and after another 3 days to 0.32. The reasons for this reaction are not known, but suspicion falls on the misoprostol beeause diclofenac, if and when it interacts with anticoagulants, increases rather than reduces their effects (see Coumarins -i- NSAIDs Diclofenac , p.429). But just why misoprostol should cause these changes is not clear. 

Studies surest that diclofenac does not alter the anticoagulant effect of acenocoumarol, phenprocoumon or warfarin, su esting dose adjustments are unlikely to be needed. Isolated cases of raised INRs have been described. Note that all NSAIDs increase the risk of gastrointestinal bleeding, and an increased risk is seen when they are combined with anticoagulants. 

However, a patient taking acenocoumarol developed a pulmonary haemorrhage associated with a very prolonged prothrombin time within 10 days of starting to take diclofenac. Another report mentions a Chinese patient taking warfarin who developed an INR of 4 within 4 days of using a 1% diclofenac topical gel for joint pain. ... 

MichotF,AJdacicK, Glaus L. A double-blind clinical trial to determine ifanintemction exists between diclofenac sodium and the oral anticoagulant acenocoumarol (nicoumalone). J Int MedRes( 975)3, 153-7. 

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