Rabeprazole Warfarin

ANTICOAGULANTS-ORAL PROTON PUMP INHIBITORS Possibly t anticoagulant effect when esomeprazole, lansoprazole or omeprazole is added to warfarin Uncertain at present. Omeprazole and lansoprazole are known to induce CYP1A2, which plays a role in activation of coumarins Monitor INR more closely. 1 dose may be required. If 10%, 20% or 30% over range, omit dose for 1, 2 or 3 days respectively consider i maintenance dose by 10%. Regular dosing of a proton pump inhibitor is preferable if affects INR significantly. Not reported with pantoprazole or rabeprazole... 

Clinically important, potentially hazardous interactions with amiodarone, atazanavir, azithromycin, bosentan, ciprofibrate, clarithromycin, clopidogrel, cyclosporine, darunavir, delavirdine, diltiazem, erythromycin, fosamprenavir, fusidic acid, gemfibrozil, grapefruit juice, imatinib, itraconazole, lopinavir, rabeprazole, ranolazine, red rice yeast, ritonavir, roxithromycin, selenium, St John s wort, tacrolimus, telithromycin, tipranavir, verapamil, warfarin... 

In pharmacological studies, omeprazole caused a minor increase in k-warfarin levels, with no or a minor increase in anticoagulant effect. Conversely, lansoprazole, pantoprazole and rabeprazole did not alter warfarin pharmacokinetics or anticoagulant effect Omeprazole does not appear to alter the effects of aeenoeoumarol and pantoprazole does not appear to later the effects of phenpro-coumon. Nevertheless, a number of isolated reports describe increased anticoagulant effects when PPIs are given with coumarins. 

In a plaeebo-controlled study a single 0.75-mg/kg dose of warfarin was given to 21 patients before and after rabeprazole 20 mg daily for 7 days. No significant changes in prothrombin times or in the pharmaeokineties of R- or 5-warfarin were seen. However, the manufaeturer notes that there have been reports of increased INR and prothrombin time in patients re-eeiving rabeprazole and warfarin. ... 

Humphries TJ, Naidi RV, Spera AC, T.a7ar JD, Laurent AL, Spanyers SA Coadministiation of rabeprazole sodium (E3810) does not affect the pharmacokinetics of anhydrous theophylline O warfarin Gostioewteratogy (1996) 110 (Siqpl), A138. 

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