CLINICAL USE

Anticoagulant

DOSE IN NORMAL RENAL FUNCTION

Depends on INR

PHARMACOKINETICS

  • Molecular weight                           : 330.3
  • %Protein binding                           : 99
  • %Excreted unchanged in urine     : 0
  • Volume of distribution (L/kg)       : 0.14
  • half-life – normal/ESRD (hrs)      : 37/Unchanged

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50     : Dose as in normal renal function
  • 10 to 20     : Dose as in normal renal function
  • <10           : Dose as in normal renal function

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD                : Not dialysed. Dose as in normal renal function
  • HD                     : Not dialysed. Dose as in normal renal function
  • HDF/high flux   : Unknown dialysability. Dose as in normal renal function
  • CAV/VVHD      : Not dialysed. Dose as in normal renal function

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugs There Are Many Significant Interactions With Warfarin Prescribe With Care With Regard To The Following: Anticoagulant effect enhanced by: alcohol, amiodarone, anabolic steroids, aspirin, azithromycin, aztreonam, bicalutamide, cephalosporins, chloramphenicol, cimetidine, ciprofloxacin, clarithromycin, clopidogrel, cranberry juice, danazol, danshen, dextropropoxyphene, dipyridamole, disulfiram, entacapone, erythromycin, esomeprazole, exenatide, ezetimibe, fibrates, fluconazole, flutamide, fluvastatin, glucosamine, grapefruit juice, itraconazole, ketoconazole, levamisole, levofloxacin, levothyroxine, macrolides, methylphenidate, metronidazole, miconazole, mirtazepine, nalidixic acid, neomycin, norfloxacin, NSAIDs, ofloxacin, omeprazole, pantoprazole, paracetamol, penicillins, proguanil, propafenone, rosuvastatin, saquinavir, SSRIs, simvastatin, sitaxentan, sulfinpyrazone, sulphonamides, tamoxifen, testosterone, tetracyclines, tigecycline, toremifene, tramadol, trimethoprim, valproate, venlafaxine, voriconazole Anticoagulant effect decreased by: acitretin, atorvastatin, azathioprine, barbiturates, carbamazepine, ginseng, griseofulvin, mercatopurine, mitotane, oral contraceptives, phenytoin, primidone, rifampicin, St John’s wort (avoid concomitant use), sucralfate, vitamin K Anticoagulant effects enhanced/reduced by: amprenavir, anion exchange resins, atazanavir, corticosteroids, dietary changes, nevirapine, ritonavir, tricyclics

  • Analgesics: increased risk of bleeding with IV diclofenac and ketorolac – avoid concomitant use Antidiabetic agents: enhanced hypoglycaemic effect with sulphonylureas Camomile: enhanced anticoagulation
  • Ciclosporin: there have been a few reports of altered anticoagulant effect; decreased ciclosporin levels have been seen rarely Cytotoxics: increased risk of bleeding with erlotinib and imatinib; enhanced effect with etoposide, fluorouracil, ifosfamide and sorafenib Melatonin: possibly enhanced INR

    ADMINISTRATION

    Reconstition

    Route

    Oral

    Rate of Administration

    Comments

    OTHER INFORMATION

    Inactive metabolites renally excreted and may accumulate in renal impairment Reduced protein binding in renal impairment .

  • Related News