Document Detail

Azithromycin and warfarin interaction.
MedLine Citation:
PMID:  15303459     Owner:  NLM     Status:  MEDLINE    
A 57-year-old Caucasian woman came to the clinic with symptoms of an upper respiratory tract infection. She was treated with a 5-day course of oral azithromycin 500 mg on day 1, then 250 mg/day for 4 days. During this period, the patient decreased her cigarette smoking from 1 pack/day to 1 pack every 3 days. No additional confounding variables were present. Two days after the completion of therapy, her international normalized ratio (INR) was 8.32. Six case reports documented in the literature have suggested an azithromycin-warfarin interaction with a resultant increase in INR. Many confounding variables existed in each of these cases, such as hepatic dysfunction, poor appetite, and concomitant drugs that resulted in an increased anticoagulant response. We report a case that involved only one potential confounding variable. Continued documentation of azithromycin-warfarin interactions is valuable considering no mention of this drug interaction exists in most tertiary references and in the package insert for azithromycin, the demonstration that no drug interaction occurred in a retrospective review of 52 cases, and the widespread use of azithromycin in the community. Clinicians should be mindful when prescribing azithromycin in combination with warfarin, and INR values should be monitored.
Sarah P Shrader; Joli D Fermo; Amy L Dzikowski
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Pharmacotherapy     Volume:  24     ISSN:  0277-0008     ISO Abbreviation:  Pharmacotherapy     Publication Date:  2004 Jul 
Date Detail:
Created Date:  2004-08-11     Completed Date:  2004-11-04     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  8111305     Medline TA:  Pharmacotherapy     Country:  United States    
Other Details:
Languages:  eng     Pagination:  945-9     Citation Subset:  IM    
Department of Pharmacy and Clinical Sciences, College of Pharmacy, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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MeSH Terms
Aged, 80 and over
Azithromycin / metabolism*
Drug Interactions
Drug Therapy, Combination
International Normalized Ratio
Middle Aged
Warfarin / metabolism*
Reg. No./Substance:
81-81-2/Warfarin; 83905-01-5/Azithromycin
Comment In:
Pharmacotherapy. 2005 Apr;25(4):630-1; discussion 631   [PMID:  15977924 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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