Basic Information
ID DDInter1090 and DDInter1951
Interaction Cephalosporins may potentiate the anticoagulant effects of vitamin K antagonists. Possible mechanisms include inhibited growth of vitamin K-producing intestinal bacteria, inhibited production of vitamin K-dependent clotting factors via a methylthiotetrazole (MTT) side chain (e.g., cefamandole, cefmetazole, cefoperazone, cefotetan), and/or inhibited platelet activity.
Management Prothrombin time and INR should be monitored and the patient closely observed for signs of bleeding. The anticoagulant dose may be adjusted as indicated. Patients should be advised to notify their physicians if they experience any signs or symptoms that may indicate excessive anticoagulation, such as unusual or prolonged bleeding, bruising, coffee ground emesis, change in stool or urine color, headache, dizziness, or weakness.
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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.