Basic Information
ID DDInter257 and DDInter542
Interaction Barbiturates reduce the effects of oral anticoagulants by inducing their hepatic metabolism. Anticoagulant dosage requirements may be increased by 30% to 60%. After the barbiturate is discontinued, excessive anticoagulation and bleeding may occur if the anticoagulant dose is not reduced.
Management Close attention should be paid to alterations in coagulation if a patient must take both drugs and for several weeks after the dose of the barbiturate is changed or discontinued. Alternatively, a benzodiazepine might be used instead of a barbiturate, if appropriate. Patients should be advised to promptly report any signs of blood clots (e.g. chest pain, shortness of breath, sudden loss of vision, or pain, redness or swelling in an extremity).
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Clin Pharmacol Ther 6 (1965): 420-9 [13] Guo LQ, Yamazoe Y "Inhibition of cytochrome P450 by furanocoumarins in grapefruit juice and herbal medicines." Acta Pharmacol Sin 25 (2004): 129-36 [14] Bodiford AB, Kessler FO, Fermo JD, Ragucci KR "Elevated international normalized ratio with the consumption of grapefruit and use of warfarin." SAGE Open Med Case Rep 0 (2013): 1-3 [15] Suvarna R, Pirmohamed M, Henderson L "Possible interaction between warfarin and cranberry juice." BMJ 327 (2003): 1454 [16] Lee M, Schwartz RN, Sharifi R "Warfarin resistance and vitamin K." Ann Intern Med 94 (1981): 140-1 [17] Beckey NP, Korman LB, Parra D "Effect of the moderate consumption of olestra in patients receiving long-term warfarin therapy." Pharmacotherapy 19 (1999): 1075-9 [18] Brandin H, Myrberg O, Rundlof T, Arvidsson AK, Brenning G "Adverse effects by artificial grapefruit seed extract products in patients on warfarin therapy." 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Alternative for Butalbital N05C
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Alternative for Dicoumarol B01A
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Potential Metabolism Interactions
Substrate-Substrate Interaction：If more than one drug is metabolized by the same CYP, it is possible that its metabolism is inhibited because of the competition between the drugs. That means, it can be useful to lower the dosage of the drugs in the drug-cocktail because they remain longer in the organism than in monotherapy.
Inhibitor-Inhibitor Interaction：Combining two or more inhibitors of one CYP, should be compensated by lowering the dosage of these drugs because the metabolism is reduced and the drugs remain longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.
Inhibitor-Substrate Interaction：Combining drugs that have inhibitory effect and are substrates of one particular CYP, should be compensated by lowering the dosage. They rest longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.