Enhanced elimination of warfarin during treatment with cholestyramine.

Jähnchen, E.; Meinertz, Thomas; Gilfrich, H. J.; Kersting, F; Groth, Ulrich

doi:10.1111/j.1365-2125.1978.tb01651.x

Cited by 61 publications

(25 citation statements)

References 14 publications

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“…Absorption of oral anticoagulants, digitalis glycosides, and diuretics, for example, may be affected to a clinically significant degree (Hunninghake et al, 1982;Jahnchen et al, 1978;. Many, but not all drugs, have been shown to adsorb to activated charcoal in vitro and in vivo and it is used in the treatment of acute intoxications (Neuvonen & Olkkola, 1988).…”

Section: Introductionmentioning

confidence: 99%

The effect of cholestyramine and activated charcoal on glipizide absorption.

Kivistö

Neuvonen

1990

Brit J Clinical Pharma

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Section: Introductionmentioning

confidence: 99%

The effect of cholestyramine and activated charcoal on glipizide absorption.

Kivistö

Neuvonen

1990

Brit J Clinical Pharma

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“…A similar explanation may account for decreased INR when warfarin is coadministered with bile acid-binding polymers such as cholestyramine. Staggering the doses of cholestyramine and warfarin is recommended (eg, giving warfarin 2 hours before or 6 hours after cholestyramine), but this may not completely avoid a drug interaction, suggesting that there may be some other mechanism involved in addition to inhibited absorption [43].…”

Section: Pharmacologic Treatmentmentioning

confidence: 98%

Concomitant drug, dietary, and lifestyle issues in patients with atrial fibrillation receiving anticoagulation therapy for stroke prophylaxis

Nutescu

Helgason²

2005

Curr Treat Options Cardio Med

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Atrial fibrillation is a common cardiac arrhythmia and the leading risk factor for stroke. In those at moderate to high risk of stroke, oral anticoagulation therapy with warfarin (a vitamin K antagonist) significantly reduces not only the frequency of such events but also their severity and the associated risk of death. However, achieving optimal anticoagulation with this agent is clinically challenging in view of its complex pharmacokinetic and pharmacodynamic profile. In this regard, concomitant drug therapy (both prescription and over-the-counter medications, including herbal products, vitamins, and various nutritional supplements), along with alcohol intake, dietary factors, and changes in lifestyle, can significantly affect anticoagulation control and thereby expose patients to the risk of bleeding or thromboembolic complications (due to over- and underanticoagulation, respectively). Therefore, it is recommended that intensified monitoring of anticoagulation be performed at initiation and discontinuation of concomitant drug therapy, and in the case of significant dietary and lifestyle changes. Moreover, many patients receive inadequate education and are unaware of such risks and their implications, highlighting the need for better awareness and education on this important aspect of anticoagulation therapy.

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“…Some acidic drugs, such as warfarin and hydrochlorothiazide, show a decreased absorption (Jahnchen et al, 1978;Hunninghake & King, 1978;Renowden et al, 1985) while others, like aspirin and tolbutamide, have a delayed absorption when ingested with cholestyramine (Hunninghake & Pollack, 1977). The absorption of phenytoin is unaffected both by cholestyramine and colestipol (Callaghan et al, 1983).…”

Section: Discussionmentioning

confidence: 99%

Effects of resins and activated charcoal on the absorption of digoxin, carbamazepine and frusemide.

Neuvonen

Kivistö

Hirvisalo

1988

Brit J Clinical Pharma

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1. The interference of resins and activated charcoal with the absorption of digoxin, carbamazepine and frusemide was studied. 2. In a cross‐over study consisting of four phases, single doses of colestipol hydrochloride (10 g), cholestyramine (8 g), activated charcoal (8 g) or water only were given to six healthy volunteers immediately after the simultaneous ingestion of digoxin (0.25 mg), carbamazepine (400 mg) and frusemide (40 mg). Plasma and urine concentrations of the test drugs and the urine volumes were determined up to 72 h. 3. The absorption of digoxin was not reduced by colestipol, moderately (30‐40%, P less than 0.05) reduced by cholestyramine and greatly (96%) by charcoal. 4. The absorption of carbamazepine was not decreased by cholestyramine, slightly (10%) by colestipol and greatly (90%) by activated charcoal. 5. The absorption and the diuretic effect of frusemide were significantly diminished by all agents. The bioavailability was reduced by colestipol 80%, by cholestyramine 95% and by activated charcoal 99.5%. 6. The interference with the gastrointestinal absorption of most of the basic drugs by colestipol and cholestyramine seems to be minimal. On the other hand, the resins may seriously impair the absorption of certain acidic drugs, for example frusemide.

show abstract

Enhanced elimination of warfarin during treatment with cholestyramine.

Cited by 61 publications

References 14 publications

The effect of cholestyramine and activated charcoal on glipizide absorption.

The effect of cholestyramine and activated charcoal on glipizide absorption.

Concomitant drug, dietary, and lifestyle issues in patients with atrial fibrillation receiving anticoagulation therapy for stroke prophylaxis

Effects of resins and activated charcoal on the absorption of digoxin, carbamazepine and frusemide.

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