Phenindione.txt

CLINICAL USE

Anticoagulant

DOSE IN NORMAL RENAL FUNCTION

Day 1: 200 mgDay 2: 100 mgMaintenance dose: 50–150 mg daily according to INR

PHARMACOKINETICS

Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :222.2

%Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :>97

%Excreted unchanged in urine &nbsp &nbsp : No data

Volume of distribution (L/kg) &nbsp &nbsp &nbsp :No data

half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :5–6/–

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 &nbsp &nbsp : Dose as in normal renal function

10 to 20 &nbsp &nbsp : Dose as in normal renal function

<10 &nbsp &nbsp &nbsp &nbsp &nbsp : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Unknown dialysability. Dose as in normal renal function

HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Unknown dialysability. Dose as in normal renal function

HDF/high flux &nbsp :Unknown dialysability. Dose as in normal renal function

CAV/VVHD &nbsp &nbsp &nbsp:Unknown dialysability. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsThere Are Many Significant Interactions With Coumarins. 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, dextropropoxyphene, dipyridamole, disulfiram, erythromycin, esomeprazole, ezetimibe, fibrates, fluconazole, flutamide, fluvastatin, grapefruit juice, itraconazole, ketoconazole, levamisole, levofloxacin, macrolides, methylphenidate, metronidazole, miconazole, nalidixic acid, neomycin, norfloxacin, NSAIDs, ofloxacin, omeprazole, pantoprazole, paracetamol, penicillins, propafenone, ritonavir, rosuvastatin, SSRIs, simvastatin, sitaxentan, sulfinpyrazone, sulphonamides, tamoxifen, testosterone, tetracyclines, thyroxine, tigecycline, toremifene, tramadol, trimethoprim, valproate, voriconazoleAnticoagulant effect decreased by: acitretin, azathioprine, barbiturates, carbamazepine, griseofulvin, mercatopurine, mitotane, oral contraceptives, phenytoin, primidone, rifampicin, St John’s wort – avoid concomitant use, sucralfate, vitamin KAnticoagulant effects enhanced/reduced by: amprenavir, anion exchange resins, corticosteroids, dietary changes, tricyclics

Analgesics: increased risk of bleeding with IV diclofenac and ketorolac – avoid concomitant useAntidiabetic agents: enhanced hypoglycaemic effect with sulphonylureas

Ciclosporin: there have been a few reports of altered anticoagulant effect; decreased ciclosporin levels have been seen rarelyCytotoxics: increased risk of bleeding with erlotinib and imatinib; enhanced effect with etoposide, fluorouracil, ifosfamide and sorafenib

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

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Comments

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OTHER INFORMATION

Titrate dose to INR Enhanced anticoagulant effect in renal impairment, due to reduced protein bindingMetabolites of phenindione often colour the urine pink or orange.

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