Warfarin capecitabine interactions

Warfarin—(major interaction), results in increased anticoagulant effects, increased risk of bleeding monitor coagulation parameters closely phenytoin—may require phenytoin dose reduction monitor phenytoin levels closely leucovorin increases the activity and toxicity of capecitabine... 

Capecitabine is used for the treatment of colorectal and breast cancers. It is contraindicated in patients with known hypersensitivity to capecitabine or any of its components or to 5-fluorouracil and in patients with known dihydropyrimidine dehydrogenase (DPD) deficiency. The use of capecitabine is restricted in patients with severe renal impairment. The drag can induce diarrhea, sometimes severe. Other side effects include anemia, hand-foot syndrome, hyperbilirubinemia, nausea, stomatitis, pyrexia, edema, constipation, dyspnea, neutropenia, back pain, and headache. Cardiotoxicity has been observed with capecitabine. A clinically important drag interaction between capecitabine and warfarin has been demonstrated. Care should be exercised when the drag is co-administered with CYP2X9 substrates. 

Uncertain. However, in a pharmacokinetic study in rats, fluorouracil significantly reduced the total clearance of5-warfarin by inhibiting its metabolism. Data from the clinical study with the fluorouracil prodrug, capecitabine, suggests this interacts similarly. ... 

Fairly well-documented and established interactions of clinical importance. Prothrombin times should be regularly monitored in patients taking warfarin and other coumarins and requiring fluorouracil, capecitabine or other fluorouracil pro-drugs, anticipating the need to reduce the warfarin dose. Note that, from a disease perspective, when treating venous throm-... 

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Saif MW, Wasif N. Interaction between capecitabine and gemdtabine with warfarin in a patient with pancreatic cancer. JOP 2008 9(6) 739-A3. 

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