Paracetamol Acenocoumarol

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]... 

Enalapril, paracetamol, sotalol, dipyrone, vancomycin, captopril, fluconazole, cefazolin, metoprolol, aspirin, ticlopidine, prednisolone, propranolol, digoxin, sildenafil, furosemide, dexamethasone, carvedilol, ketoprofen, nifedipine, terbinafine, acenocoumarol, spironolactone/urine HPLC DAD Column LiChroCART Purospher STAR, RP-18e (250 x 4 mm, 5 pm) Mobile phase MeOH ACN 0.05 % TFA in water (gradient elution) Detection DAD X = 200 50 nm Adjusted to pH 7.0, protein precipitation LOD 0.01-1.44 pg/mL LOQ 0.04-4.35 pg/mL [72]... 

An equal number of randomised studies have found a modest increase in the anticoagulant effect (e.g. an increase in HSR of 1) of coumarins as have reported no effect. One retrospective cohort study reported that concurrent use tends to increase the incidence of upper gastrointestinal bleeding, but other cohort studies found no evidence of a change in anticoagulant effect. There are isolated case reports of an increase in anticoagulant effects in patients taking warfarin or acenocoumarol and paracetamol... 

There are only 5 published case reports of a possible interaction between paracetamol without opioids and a coumarin (warfarin or acenocoumarol), which are summarised in Table 12.5 , (p.439). In addition, there are two reports of a possible interaction with paracetamol combined with codeine or dihydrocodeine listed in Table 12.5 , (p.439), and 7 others with paracetamol combined with dextropropoxyphene (propoxyphene) , (p.436). Note that this incidence is very rare, given the widespread use of paracetamol, and the fact that it is generally considered safe for use with warfarin. 

Case report (1999) 72-year-old Acenocoumarol 1 to 2 g daily long-term 13 days after stopping paracetamol, the INR decreased from a range of 2.5 to 3 down to 1.62. INR gradually increased on restarting paracetamol 14... 

Case report (2004) 77-year-old Acenocoumarol 2 to 2.5 g daily for a few weeks INR 5.4 then 9.1 one week later, tient restabilised on same acenocoumarol dose and asked not to take more paracetamol than 2 g daily for more than 3 days IS... 

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