Document Detail

Leflunomide and warfarin interaction: case report and review of the literature.
MedLine Citation:
PMID:  16716139     Owner:  NLM     Status:  MEDLINE    
A 61-year-old Caucasian woman receiving long-term anticoagulation with warfarin for recurrent thromboembolism and atrial fibrillation was found to have an elevated international normalized ratio (INR) after she started leflunomide therapy for rheumatoid arthritis. Her INR had been stable for 4 months before this event. The patient required an overall decrease of 22% in her weekly warfarin dose to maintain a therapeutic INR within the goal range of 2.0-3.0 after adding leflunomide therapy. A comprehensive PubMed/MEDLINE search was conducted to identify literature addressing the potential interaction between warfarin and leflunomide. Evidence describing the interaction and its potential mechanism was limited to one published case report and to in vitro data, respectively. Our case report provides additional support that such an interaction exists and that it was at least partly responsible for the subsequent increase in the patient's INR. Therefore, continued evaluation and documentation of this potential drug interaction is imperative. To reduce the risk of adverse effects related to excessive anticoagulation with the start of leflunomide in patients taking warfarin, clinicians should increase their frequency of INR monitoring and adjust the warfarin dosage accordingly to maintain therapeutic anticoagulation.
Jennifer Chonlahan; Mary Ann Halloran; Amy Hammonds
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Pharmacotherapy     Volume:  26     ISSN:  0277-0008     ISO Abbreviation:  Pharmacotherapy     Publication Date:  2006 Jun 
Date Detail:
Created Date:  2006-05-23     Completed Date:  2006-11-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8111305     Medline TA:  Pharmacotherapy     Country:  United States    
Other Details:
Languages:  eng     Pagination:  868-71     Citation Subset:  IM    
Department of Pharmacy: Clinical and Administrative Sciences, College of Pharmacy, University of Oklahoma, Oklahoma City, Oklahoma 73117, USA.
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MeSH Terms
Anti-Inflammatory Agents, Non-Steroidal / adverse effects,  therapeutic use
Anticoagulants / adverse effects,  therapeutic use
Arthritis, Rheumatoid / drug therapy
Atrial Fibrillation / drug therapy
Blood Coagulation / drug effects
Drug Interactions
International Normalized Ratio
Isoxazoles / adverse effects,  therapeutic use*
Middle Aged
Thromboembolism / drug therapy
Warfarin / adverse effects,  therapeutic use*
Reg. No./Substance:
0/Anti-Inflammatory Agents, Non-Steroidal; 0/Anticoagulants; 0/Isoxazoles; 75706-12-6/leflunomide; 81-81-2/Warfarin

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

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