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Jantoven

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Jantoven

Side Effects
Interactions

SIDE EFFECTS

Potential adverse reactions to Jantoven® Tablets (Warfarin Sodium Tablets, USP) may include:

Rare events of tracheal or tracheobronchial calcification have been reported in association with long-term warfarin therapy. The clinical significance of this event is unknown. Priapism has been associated with anticoagulant administration, however, a causal relationship has not been established.

Read the Jantoven (warfarin sodium tablets) Side Effects Center for a complete guide to possible side effects

DRUG INTERACTIONS

Drug-Drug and Drug-Disease Interactions

Numerous factors, alone or in combination, including changes in diet and medications, including botanicals, may influence response of the patient to anticoagulants. It is generally good practice to monitor the patient's response with additional PT/INR determinations in the period immediately after discharge from the hospital, and whenever other medications, including botanicals, are initiated, discontinued or taken irregularly. The following factors are listed for reference; however, other factors may also affect the anticoagulant response.

Drugs may interact with Jantoven® Tablets (Warfarin Sodium Tablets, USP) through pharmacodynamic or pharmacokinetic mechanisms. Pharmacodynamic mechanisms for drug interactions with Jantoven® Tablets (warfarin sodium tablets) are synergism (impaired hemostasis, reduced clotting factor synthesis), competitive antagonism (vitamin K), and altered physiologic control loop for vitamin K metabolism (hereditary resistance). Pharmacokinetic mechanisms for drug interactions with Jantoven (warfarin sodium tablets) ® Tablets are mainly enzyme induction, enzyme inhibition, and reduced plasma protein binding. It is important to note that some drugs may interact by more than one mechanism.

The following factors, alone or in combination, may be responsible for INCREASED PT/INR response:

ENDOGENOUS FACTORS:

blood dyscrasias - see
CONTRAINDICATIONS
cancercollagen vascular disease
congestive heart failure
diarrhea
elevated temperature
hepatic disorders
  infectious hepatitis
  jaundice
hyperthyroidism
poor nutritional state
steatorrhea
vitamin K deficiency

EXOGENOUS FACTORS:

Potential drug interactions with Jantoven® Tablets (warfarin sodium tablets) are listed below by drug class and by specific drugs.

Classes of Drugs
5-lipoxygenase Inhibitor
Adrenergic Stimulants, Central
Alcohol Abuse Reduction
  Preparations
Analgesics
Anesthetics, Inhalation
Antiandrogen
Antiarrhythmics
Antibiotics
  Aminoglycosides (oral)
  Cephalosporins, parenteral
  Macrolides
  Miscellaneous
  Penicillins, intravenous,
high dose
  Quinolones
(fluoroquinolones)
  Sulfonamides, long acting
  Tetracyclines
Anticoagulants
Anticonvulsants
Antidepressants
Antimalarial Agents
Antineoplastics
Antiparasitic/Antimicrobials
Antiplatelet Drugs/Effects
Antithyroid Drugs
Beta-Adrenergic Blockers
Cholelitholytic Agents Diabetes Agents, Oral
Diuretics
Fungal Medications,
  Intravaginal, Systemic
Gastric Acidity and Peptic Ulcer Agents
Gastrointestinal
  Prokinetic Agents,
  Ulcerative Colitis Agents
Gout Treatment Agents
Hemorrheologic Agents
Hepatotoxic Drugs
Hyperglycemic Agents
Hypertensive Emergency
  Agents
Hypnotics
Hypolipidemics
  Bile Acid-Binding Resins
  Fibric Acid Derivatives
  HMG-CoA Reductase
Inhibitors
Leukotriene Receptor
  Antagonist
Monoamine Oxidase Inhibitors
Narcotics, prolonged
Nonsteroidal Anti-
  Inflammatory Agents
Proton Pump Inhibitors
Psychostimulants
Pyrazolones
Salicylates
Selective Serotonin
  Reuptake Inhibitors
Steroids, Adrenocortical
Steroids, Anabolic (17-Alkyl
  Testosterone Derivatives)
Thrombolytics
Thyroid Drugs
Tuberculosis Agents
Uricosuric Agents
Vaccines
Vitamins

Specific Drugs Reported
acetaminophen
alcohol
allopurinol
aminosalicyclic acid
amiodarone HCl
argatroban
aspirin
atenolol
atorvastatin
azithromycin
bivalirudin
capecitabine
cefamandole
cefazolin
cefoperazone
cefotetan
cefoxitin
ceftriaxone
celecoxib
cerivastatin
chenodiol
chloramphenicol
chloral hydrate
chlorpropamide
cholestyramine
cimetidine
ciprofloxacin
cisapride
clarithromycin
clofibrate
cyclophosphamide
danazol
dextran
dextrothyroxine
diazoxide
diclofenac
dicumarol
diflunisal
disulfiram
doxycycline
erythromycin
esomeprazole
ethacrynic acid
ezetimibe
fenofibrate
fenoprofen
fluconazole
fluorouracil
fluoxetine
flutamide
fluvastatin
fluvoxamine
gefitinib
gemfibrozil
glucagon
halothane
heparin
ibuprofen
ifosfamide indomethacin
influenza virus
  vaccine
itraconazole
Jantoven® Tablets (warfarin sodium tablets)
  overdose
ketoprofen
ketorolac
lansoprazole
lepirudin
levamisole
levofloxacin
levothyroxine
liothyronine
lovastatin
mefenamic acid
methimazole
methyldopa
methylphenidate
methylsalicylate
  ointment (topical)
metronidazole
miconazole,
  (intravaginal, oral, systemic)
moricizine
  hydrochloride
nalidixic acid
naproxen
neomycin
norfloxacin
ofloxacin
olsalazine
omeprazole
oxandrolone
oxaprozin
oxymetholone
pantoprazole
paroxetine
penicillin G,
  intravenous
pentoxifylline
phenylbutazone
phenytoin
piperacillin
piroxicam
pravastatin
prednisone
propafenone
propoxyphene
propranolol
propylthiouracil
quinidine
quinine
rabeprazole
ranitidine
rofecoxib
sertraline
simvastatin
stanozolol
streptokinase
sulfamethizole
sulfamethoxazole
sulfinpyrazone
sulfisoxazole
sulindac
tamoxifen
tetracycline
thyroid
ticarcillin
ticlopidine
tissue plasminogen
  activator (t-PA)
tolbutamide
tramadol trimethoprim/
  sulfamethoxazole
urokinase
valdecoxib
valproate
vitamin E
zafirlukast
zileuton
also: other medications affecting blood elements which may modify hemostasis
dietary deficiencies
prolonged hot weather
unreliable PT/INR determinations
Increased and decreased PT/INR responses have been reported.

The following factors, alone or in combination, may be responsible for DECREASED PT/INR response:

ENDOGENOUS FACTORS:

edema
hereditary coumarin resistance
hyperlipemia
hypothyroidism
nephrotic syndrome

EXOGENOUS FACTORS:

Potential drug interactions with Jantoven® Tablets (Warfarin Sodium Tablets, USP) are listed below by drug class and by specific drugs.

Classes of Drugs
Adrenal Cortical Steroid
  Inhibitors
Antaids
Antianxiety Agents
Antiarrhythmics
Antibiotics
Anticonvulsantst
Antidepressants
Antihistamines
Antineoplastics
Antipsychotic Medications
Antithyroid Drugs
Barbiturates Diuretics
Enteral NutritionaSupplements
Fungal Medications,Systemic
Gastric Acidity and PepticUlcer Ajents
Hypnotics
Hypolipidemics
Bile Acid-Binding Resins
HMG-CoA Reductase Inhibitors
Immunosuppressives
Oral Contraceptives,
Estrojen Containing
Selective Estrogen Receptor
Modulators
Steroids, Adrenocortical
Tuberculosis Agents
Vitamins

Specific Drugs Reported
alcohol
aminoglutethimide
amobarbital
atorvastatin
azathioprine
butabarbital
butalbitalcar
bamazepine
chloral hydrate
chlordiazepoxide
chlorthalidone
cholestyramine
clozapine
corticotropin
cortisone
cyclophosphamide
dicloxacillin
ethchlorvynol
glutethimide
griseofulvin
haloperidol
Jantoven® Tablets (warfarin sodium tablets) underdosage
meprobamate
6-mercaptopurine
methimazole
moricizine hydrochloride
nafcillin
paraldehyde
pentobarbital
phenobarbital
phenytoin
pravastatin
prednisone
primidone
propylthiouracil
raloxifeneranitidine
rifampin
secobarbita
spironolactone
sucralfate
vitamin C (high dose)
vitamin K
also: diet high in vitamin K
unreliable PT/INR determinations
Increased and decreased PT/INR responses have been reported.

Because a patient may be exposed to a combination of the above factors, the net effect of Jantoven® Tablets (warfarin sodium tablets) on PT/INR response may be unpredictable. More frequent PT/INR monitoring is therefore advisable. Medications of unknown interaction with coumarins are best regarded with caution. When these medications are started or stopped, more frequent PT/INR monitoring is advisable. It has been reported that concomitant administration of warfarin and ticlopidine may be associated with cholestatic hepatitis.

Botanical (Herbal) Medicines

Caution should be exercised when botanical medicines (botanicals) are taken concomitantly with Jantoven® Tablets (warfarin sodium tablets) . Few adequate, well-controlled studies exist evaluating the potential for metabolic and/or pharmacologic interactions between botanicals and Jantoven® Tablets (warfarin sodium tablets) . Due to a lack of manufacturing standardization with botanical medicinal preparations, the amount of active ingredients may vary. This could further confound the ability to assess potential interactions and effects on anticoagulation. It is good practice to monitor the patient's response with additional PT/INR determinations when initiating or discontinuing botanicals. Specific botanicals reported to affect Jantoven® Tablets (warfarin sodium tablets) therapy include the following:

  • Bromelains, danshen, dong quai (Angelica sinensis), garlic, Ginkgo biloba, ginseng and cranberry products are associated most often with an INCREASE in the effects of Jantoven® Tablets (warfarin sodium tablets) .
  • Coenzyme Q10 (ubidecarenone) and St. John's wort are associated most often with a DECREASE in the effects of Jantoven® Tablets (warfarin sodium tablets)

Some botanicals may cause bleeding events when taken alone (e.g., garlic and Ginkgo biloba) and may have anticoagulant, antiplatelet, and/or fibrinolytic properties. These effects would be expected to be additive to the anticoagulant effects of Jantoven® Tablets (warfarin sodium tablets) . Conversely, other botanicals may have coagulant properties when taken alone or may decrease the effects of Jantoven® Tablets (warfarin sodium tablets) . Some botanicals that may affect coagulation are listed below for reference; however, this list should not be considered all- inclusive. Many botanicals have several common names and scientific names. The most widely recognized common botanical names are listed.

Botanicals that contain coumarins with potential anticoagulant effects:
Alfalfa
Angelica (Dong Quai)
Aniseed
Arnica
Asa Foetida
Bogbean1
Boldo
Buchu
Capsicum2
Cassia3
Celery
Chamomile (German and Roman)
Dandelion3
Fenugreek
Horse Chestnut
Horseradish
Licorice3
Meadowsweet1
Nettle Parsley
Passion Flower
Prickly Ash (Northern)
Quassia
Red Clover
Sweet Clover
Sweet Woodruff
Tonka Beans
Wild Carrot
Wild Lettuce

Miscellaneous botanicals with anticoagulant properties:
Bladder Wrack (Fucus) Pau d'arco

Botanicals that contain salicylate and/or have antiplatelet properties:
Agrimony4
Aloe Gel
Aspen
Black Cohosh
Black Haw
Bogbean1
Cassia3
Clove
Dandelion3
Feverfew
Garlic5
German Sarsaparilla
Ginger
Ginkgo Biloba
Ginseng (Panax)5
Licorice3
Meadowsweet1
Onion5
Policosanol
Poplar
Senega
Tamarind
Willow
Wintergreen

Botanicals with fibrinolytic properties:
Bromelains
Capsicum2
Garlic5
Ginseng (Panax)5
Inositol Nicotinate
Onion5

Botanicals with coagulant properties:
Agrimony4
Goldenseal
Mistletoe
Yarrow
1Contains coumarins and salicylate.
2Contains coumarins and has fibrinolytic properties.
3Contains coumarins and has antiplatelet properties.
4Contains salicylate and has coagulant properties.
5Has antiplatelet and fibrinolytic properties.

Effect on Other Drugs

Coumarins may also affect the action of other drugs. Hypoglycemic agents (chlorpropamide and tolbutamide) and anticonvulsants (phenytoin and phenobarbital) may accumulate in the body as a result of interference with either their metabolism or excretion.

Special Risk Patients

Jantoven® Tablets (warfarin sodium tablets) is a narrow therapeutic range (index) drug, and caution should be observed when warfarin sodium is administered to certain patients such as the elderly or debilitated or when administered in any situation or physical condition where added risk of hemorrhage is present.

Intramuscular (I.M.) injections of concomitant medications should be confined to the upper extremities which permits easy access for manual compression, inspections for bleeding and use of pressure bandages. Caution should be observed when Jantoven® Tablets (warfarin sodium tablets) (or warfarin) are administered concomitantly with nonsteroidal anti- inflammatory drugs (NSAIDs), including aspirin, to be certain that no change in anticoagulation dosage is required. In addition to specific drug interactions that might affect PT/INR, NSAIDs, including aspirin, can inhibit platelet aggregation, and can cause gastrointestinal bleeding, peptic ulceration and/or perforation. Acquired or inherited warfarin resistance should be suspected if large daily doses of Jantoven® Tablets (warfarin sodium tablets) are required to maintain a patient's PT/INR within a normal therapeutic range.

Last reviewed on RxList: 3/24/2008
This monograph has been modified to include the generic and brand name in many instances.

Side Effects
Interactions
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