Warfarin Amoxicillin

PO H. pylori Infxn 40 mg/d PO, plus clarithromycin 500 mg PO bid amoxicillin 1000 mg bid for 10 d Caution [B, /-] Contra Component sensitivity Disp Caps, IV SE HA, D, abd pain Interactions t Effects W7 amoxicillin, clarithromycin T effects OF benzodiaz ines, warfarin X effects OF digoxin, keto-conazole, iron salts EMS Use caution w/ diazepam, may t risk of diazepam tox OD May cause sweating, blurred vision, tach, and confusion symptomatic and supportive... 

Estazolam (Prosom) [C-IV] [Hypnotic/Benzodiazepine] Uses Short-term management of insomnia Action Benzodiazepine Dose 1-2 mg PO qhs PRN -1- in hqjatic impair/elderly/debilitated Caution [X, -] t Effects w/ CNS d ressants Contra PRG Disp Tabs SE Somnolence, weakness, palpitations, anaphylaxis, angioedema, amnesia Interactions t Effects W7 amoxicillin, clarithromycin T effects OF diaz am, phen5rtoin, warfarin X effects W7 food X effects OF azole antifungals, digoxin EMS Use caution w/ other benzodiazepines, may need a reduced dose concurrent EtOH and caffeine use can t CNS effects OD May cause alt ed reflexes, drowsiness, CNS depression, slurred speech, and Szs flumazenU can be used as an antidote... 

Lactamase Inhibitor] Uses Ear, lower resp, sinus, UTI, skin Infxns caused by i-lactamase-producing H. influenzae, S. aureus, E. coli Action Combo 3-lac-tam antibiotic i-lactamase inhibitor Dose Adults. 250-500 mg PO q8h or 875 mg ql2h XR 2000 mg PO ql2h Peds. 20-40 mg/kg/d as amoxicillin PO q8h or 45 mg/kg/d + ql2h X in renal impair take w/ food Caution [B, enters breast milk] Disp Tabs, chew tabs, susp SE Abd discomfort, N/V/D, allergic Rxn, vaginitis Notes Do not substitute two 250-mg tabs for one 500-mg tab (OD of clavulanic acid) max clavulanic acid 125 mg/dose Interactions T Effects OF warfarin, MTX,... 

Clinically important, potentially hazardous interactions with alfentanil, aminophylline, amisulpride, amoxicillin, ampicillin, anticonvulsants, astemizole, atorvastatin, benzodiazepines, bromocriptine, buprenorphine, bupropion, carbamazepine, cilostazol, ciprofloxacin, cisapride, clindamycin, colchicine, cyclosporine, dasatinib, digoxin, dihydroergotamine, diltiazem, disopyramide, enoxacin, eplerenone, ergotamine, eszopiclone, everolimus, fluconazole, fluoxetine, fluvastatin, gatifloxacin, HMG-CoA reductase inhibitors, imatinib, itraconazole, ketoconazole, lomefloxacin, lorazepam, lovastatin, methadone, methylprednisolone, methysergide, midazolam, mizolastine, moxifloxacin, nitrazepam, norfloxacin, ofloxacin, paroxetine, pimozide, pravastatin, quinolones, ranolazine, repaglinide, rupatadine, sertraline, sildenafil, simvastatin, sparfloxacin, sulpiride, tacrolimus, terfenadine, triazolam, troleandomycin, vardenafil, verapamil, vinblastine, warfarin, zaleplon, zolpidem, zuclopenthixol... 

In one cohort study in patients taking acenocoumarol or phenprocoumon, no cases of over-anticoagulation (DSTR greater than 6) occurred in patients taking flucloxacillin (25 patients received this antibacterial). Note that this study did show an increase for amoxicillin, see above. A bulletin briefly mentions a case of an increased prothrombin time in a patient taking warfarin with ampicillin and flucloxacillin. ... 

Davydov L, Yermolnik M, Cuni LJ. Warfarin and amoxicillin/clavulanate drug interaction. Arm Pharmacother (2003) 37, 367-70. 

Warfarin In a large population-based, nested case-control study from Canada 2151 cases of upper gastrointestinal hemorrhage were identified in almost 135 000 subjects > 66 years of age receiving warfarin continuously [129 ]. When matched with up to 10 age- and sex-matched controls, cases were 3.84 times more likely (95% Cl = 2.33, 6.33) to have recently received co-trimoxazole. Ciprofioxacin use also significantly increased the risk of hemorrhage (OR = 1.94 95% Cl = 1.28, 2.95) but use of amoxicillin, nitrofurantoin or norfi-oxacin did not. Co-trimoxazole inhibits CYP2C9, responsible for metabolism of the 5-enantiomer of warfarin. 

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