Warfarin interaction with fluoroquinolones

All quinolones interact with multivalent cations, forming chelation complexes resulting in reduced absorption. Major offenders are antacids vitamins containing calcium and iron can also be problematic. All fluoroquinolones interact with warfarin, didanosine (ddi), and phenytoin, resulting in decreased absorption or metabolism. Ciprofloxacin and other second-generation drugs interact with theophylline by decreasing its clearance, which leads to theophylline toxicity. 

Warfarin The exact warfarin-quinolone drug interaction is unknown. Reduction of intestinal flora responsible for vitamin K production by antibiotics is probable, as are deaeased metabolism and clearance of warfarin due to CYP450 inhibition by the quinolones. Multivalent cations such as aluminum, magnesium, calcium, iron, zinc, and multivitamins with minerals may chelate with fluoroquinolones and decease the oral absorption if administered concurrently. 

ADRAC. Fluoroquinolone antibiotics interactions with warfarin. Aust Adverse Drug React... 

Schelleman H, Bilker WB, Brensinger CM, Han X, Kimmel SE, Hennessy S. Warfarin with fluoroquinolones, sulfonamides, or azole antifungals interactions and the risk of hospitalization for gastrointestinal bleeding. Clin Pharmacol Ther 2008 84(5) 581-8. 

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