To determine if ciprofloxacin therapy alters the response to warfarin treatment, 36 adult patients attending three university-affiliated outpatient anticoagulation clinics randomly received a 12-day course of ciprofloxacin (750 mg twice daily) and a 12-day course of placebo; each course was separated by a 2-week washout period. Prothrombin times (PTs), concentrations of S-warfarin and R-warfarin (the isomers of warfarin), and concentrations of clotting factors II and VII were determined three times weekly for 9 weeks. By day 12 of ciprofloxacin therapy, concentrations of S-warfarin remained unchanged compared with those after placebo therapy, but R-warfarin concentrations increased significantly (1.15 times those after placebo therapy; P = .001); concentrations of clotting factors II and VII decreased (0.903 and 0.872 times those after placebo therapy, respectively, P < or = .020). The mean PT ratio after 12 days of ciprofloxacin therapy increased slightly (1.032 times that after placebo therapy; P = .057), but no patient had bleeding or a change in PT that required alteration in warfarin or ciprofloxacin therapy. We conclude that warfarin therapy is not a contraindication to the use of ciprofloxacin.

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A longitudinal study was made in a single individual of the effects of 5 increasing doses of diethylstilbestrol, alternated with periods of no treatment, on the concentration of serum sialic acid, haptoglobin, /3-glucuronidase, thyroxine-binding globulin, ceruloplasmin, plasminogen, corticosteroid-binding globulin, and 17-hydroxycorticosteroids. Except for sialic acid and haptoglobin, all these substances reacted with the same pattern of increase during treatment and return toward pretreatment control values during the periods off treatment. The responses of corticosteroid-binding globulin and 17-hydroxycorticosteroids were most closely dose related and were closely correlated with r = +0.91. They were responsive to a dosage of 0.1 mg/day of diethylstilbestrol.