Danaparoid can interact majorly with drugs such as Warfarin, Hirudins (Bivalirudin, Lepirudin) and Other Anticoagulants like Heparin, Enoxaparin, Dalteparin, Tinzaparin, Fondaparinux, Phenindione, Argatroban, Rivaroxaban, Apixaban and Dabigatran.
While MIC is a good measure of antibiotic activity, it is static and reflects in vitro activity. PK and PD of the drug needs to be considered together with MIC if we wish to obtain an in vivo prediction of drug action and success.
While MIC is a good measure of antibiotic activity, it is static and reflects in vitro activity. PK and PD of the drug needs to be considered together with MIC if we wish to obtain an in vivo prediction of drug action and success.
Quinolones are synthetic, bactericidal antibacterial agents with broad-spectrum activity. They inhibit the enzyme topoisomerase II, a DNA gyrase that is necessary for the replication of the microorganism.
Pharmacology of cephalosporins, monobactums and carbapenums including their mechanism of action, indications, adverse effects.
The various generations of cephalosporins and their spectrum of action
Drug interactions of Low Molecular weight Heparins (LMWHs)Naina Mohamed, PhD
Low Molecular weight Heparins (LMWHs) may interact majorly with drugs such as Warfarin, Heparin and Other Anticoagulants like Danaparoid, Bivalirudin, Rivaroxaban, Apixaban, Dabigatran and Antiplatelet agents such as Aspirin, Clopidogrel, Ticagrelor, etc.
Hirudins such as Bivalirudin, Desirudin, Lepirudin can interact majorly with drugs such as Warfarin, Heparin, Enoxaparin, Dalteparin, Tinzaparin, Fondaparinux, Phenindione, Argatroban, Rivaroxaban, Apixaban and Dabigatran.
Quinolones are synthetic, bactericidal antibacterial agents with broad-spectrum activity. They inhibit the enzyme topoisomerase II, a DNA gyrase that is necessary for the replication of the microorganism.
Pharmacology of cephalosporins, monobactums and carbapenums including their mechanism of action, indications, adverse effects.
The various generations of cephalosporins and their spectrum of action
Drug interactions of Low Molecular weight Heparins (LMWHs)Naina Mohamed, PhD
Low Molecular weight Heparins (LMWHs) may interact majorly with drugs such as Warfarin, Heparin and Other Anticoagulants like Danaparoid, Bivalirudin, Rivaroxaban, Apixaban, Dabigatran and Antiplatelet agents such as Aspirin, Clopidogrel, Ticagrelor, etc.
Hirudins such as Bivalirudin, Desirudin, Lepirudin can interact majorly with drugs such as Warfarin, Heparin, Enoxaparin, Dalteparin, Tinzaparin, Fondaparinux, Phenindione, Argatroban, Rivaroxaban, Apixaban and Dabigatran.
Argatroban can interact majorly with drugs such as Heparin, Enoxaparin, Dalteparin, Tinzaparin, Bivalirudin, Lepirudin, Fondaparinux, Phenindione, Danaparoid, Rivaroxaban, Apixaban, and Dabigatran.
Concomitant use of Heparin and Telavancin or Oritavancin is contraindicated. Heparin may also interact majorly with other Anticoagulants such as Enoxaparin, Dalteparin, Bivalirudin, Danaparoid, Rivaroxaban, Apixaban and Dabigatran.
Complementary and alternative therapies for Coronary Heart Disease (CHD)Naina Mohamed, PhD
Dietary supplements used to treat Coronary Heart Disease (CHD) include Omega 3 fatty acids, Vitamin C, Vitamin E, Fiber and Coenzyme Q10. And the Mind-Body approaches to treat CHD include Chelation therapy, Meditation, Acupuncture, Reflexology and Tai chi.
• Concomitant use of Dabigatran and Itraconazole or Ketoconazole is contraindicated.
• Drugs such as Heparin, Enoxaparin, Dalteparin, Tinzaparin, Bivalirudin, Lepirudin, Fondaparinux, Phenindione, Danaparoid, Rivaroxaban, Apixaban, Verapamil, Quinidine, Amiodarone, Ketoconazole, Itraconazole, Ritonavir, Saquinavir, Nelfinavir, Tacrolimus and Cyclosporine increase the risk of Dabigatran induced bleeding.
• Coadministration of Dabigatran with P-Glycoprotein Inducers like Carbamazepine, Rifampin or St. John's wort elevate the risk of Thrombosis.
Complementary and alternative therapies for hyperlipidemiaNaina Mohamed, PhD
CAM for Hyperlipidemia includes Dietary Supplements (Omega-3 Fatty Acids, Plant sterols and stanols, Soy protein, Flax seed, Red yeast rice), Herbal Supplements (Ginger, Garlic, Ginseng) and Mind – Body Practices (Transcendental Meditation and Yoga).
Complementary and alternative therapies for hypertensionNaina Mohamed, PhD
To treat hypertension many CAM approaches are useful including Mind and Body Practices such as Dynamic Aerobic (Endurance) Exercise, Dynamic Resistance Exercise, Device-Guided Slow Breathing, Transcendental Meditation (TM), Biofeedback Techniques and Acupuncture, Herbal Supplements such as Garlic, Black cumin, Cinnamon, Flaxseed, Sour Tea, Ginger, Cardamom, Green Tea, Sweet basil, Celery, Ginseng, Saffron, Goldthread, Oats, Chinese hawthorn, Carrot, Tomato, Pomegranate, Radish and Sesame and Dietary Supplements like Coenzyme Q10, Omega 3 FAs, Melatonin and Vitamin D.
Warfarin interacts majorly with drugs such as Tamoxifen, Simvastatin, Penicillins, cephalosporins, Macrolide antibiotics, Fluoroquinolones, Sulphonamides, Azole antifungals, Amiodarone, Enoxaparin, Danaparoid, Antiplatelets, Fish oil, Vitamin K rich foods, Green tea, Pomegranate etc.
The health benefits of Smoking Cessation such as Better sex, Improved fertility, Younger looking skin, Whiter teeth, Better breathing, Longer life, Less stress, Improved smell and taste, More energy and Healthier loved ones are discussed in this presentation.
• It is Contraindicated to use Fibrinolytics and Defibrotide concomitantly.
• Drugs increasing the risk of Fibrinolytics associated Bleeding include…
o Anticoagulants (Warfarin, Heparin, Enoxaparin, Dabigatran, etc)
o Antiplatelet agents (Aspirin, Clopidogrel, etc)
o Pentosan Polysulfate Sodium
• Herbs increasing the risk of Fibrinolytics associated Bleeding include…
o Fenugreek
o Garlic
o Ginkgo
o Evening Primrose Oil
o Clove Oil
o Anise
o Turmeric (Curcumin)
o Licorice
o Asafetida
o Capsicum (Capsaicin)
o Celery
o Kava
o Cat's claw
o Medowsweet
o Feverfew
o Tan-shen
Clinically Important Drug Interactions of FibrinolyticsNaina Mohamed, PhD
• It is Contraindicated to use Fibrinolytics and Defibrotide concomitantly.
• Drugs increasing the risk of Fibrinolytics associated Bleeding include…
o Anticoagulants (Warfarin, Heparin, Enoxaparin, Dabigatran, etc)
o Antiplatelet agents (Aspirin, Clopidogrel, etc)
o Pentosan Polysulfate Sodium
• Herbs increasing the risk of Fibrinolytics associated Bleeding include…
o Fenugreek
o Garlic
o Ginkgo
o Evening Primrose Oil
o Clove Oil
o Anise
o Turmeric (Curcumin)
o Licorice
o Asafetida
o Capsicum (Capsaicin)
o Celery
o Kava
o Cat's claw
o Medowsweet
o Feverfew
o Tan-shen
Drug Interactions of Recombinant Tissue Plasminogen Activators (rtPA)Naina Mohamed, PhD
Drug Interactions of Recombinant Tissue Plasminogen Activators (rtPA):
• The risk of Orolingual Angioedema is increased by the concomitant use of Alteplase and ACE inhibitors (Captopril, Lisinopril, Perindopril, etc).
• Concurrent use of Alteplase and Nitroglycerin (GTN) results in Less coronary artery reperfusion, Longer time to reperfusion, and more coronary artery Reocclusion
• It is Contraindicated to use Fibrinolytics and Defibrotide concomitantly.
• Drugs increasing the risk of Fibrinolytics associated Bleeding include…
o Anticoagulants (Warfarin, Heparin, Enoxaparin, Dabigatran, etc)
o Antiplatelet agents (Aspirin, Clopidogrel, etc)
o Pentosan Polysulfate Sodium
• Herbs increasing the risk of Fibrinolytics associated Bleeding include…
o Fenugreek
o Garlic
o Ginkgo
o Evening Primrose Oil
o Clove Oil
o Anise
o Turmeric (Curcumin)
o Licorice
o Asafetida
o Capsicum (Capsaicin)
o Celery
o Kava
o Cat's claw
o Medowsweet
o Feverfew
o Tan-shen
• Concurrent use of Streptokinase and Antiplatelet agents such as Aspirin, Dipyridamole and Clopidogrel results in elevated risk of Bleeding.
• It is Contraindicated to use Fibrinolytics and Defibrotide concomitantly.
• Drugs increasing the risk of Fibrinolytics associated Bleeding include…
o Anticoagulants (Warfarin, Heparin, Enoxaparin, Dabigatran, etc)
o Antiplatelet agents (Aspirin, Clopidogrel, etc)
o Pentosan Polysulfate Sodium
• Herbs increasing the risk of Fibrinolytics associated Bleeding include…
o Fenugreek
o Garlic
o Ginkgo
o Evening Primrose Oil
o Clove Oil
o Anise
o Turmeric (Curcumin)
o Licorice
o Asafetida
o Capsicum (Capsaicin)
o Celery
o Kava
o Cat's claw
o Medowsweet
o Feverfew
o Tan-shen
Warfarin. Most used oral anticoagulant in the world. In some cases it has no alternative. Has many side effects. Careful monitoring and judicious titration of dose can make it best. Live long Warfarin.
Anticoagulants, commonly referred to as blood thinners, are chemical substances that prevent or reduce coagulation of blood, prolonging the clotting time.
• Vorapoxar may interact with CYP3A4 enzyme inhibitors such as Ketoconazole, Itraconazole, Posaconazole, Clarithromycin, Nefazodone, Ritonavir, etc.
• Vorapoxar may also interact with CYP3A4 enzyme inducers like Rifampin.
• Cilostazol is a selective inhibitor of phosphodiesterase 3 (PDE3) and it is an antiplatelet drug and a vasodilator.
• Cilostazol can interact with Omeprazole, Fluoxetine, Fluvoxamine, Aspirin, Ticlopidine, Ticagrelor, Nefazodone, Azole antifungals, Idelalisib, Amiodarone, Cobicistat, Piperaquine and Ginkgo.
Glycoprotein IIB/IIIA inhibitors interact with Other Antiplatelets (Aspirin, Ticlopidine, Dipyridamole, etc.) and Ginkgo and increase the risk of bleeding.
Drug Interactions of Dipyridamole (Antiplatelt - Adenosine reuptake inhibitor)Naina Mohamed, PhD
Dipyridamole is used as an Antiplatelet drug by inhibiting the reuptake of adenosine. Dipyridamole can interact with many drugs including ADP blockers (Clopidogrel, Prasugrel, Ticlopidine, Ticagrelor, etc), Glycoprotein IIB/IIIA inhibitors (Abciximab, Tirofiban, etc.), Fibrinolytics (Reteplase, Tenecteplase, Streptokinase, etc.), Adenosine, Treprostinil, Sulfinpyrazone, Regadenoson, Distigmine and Ginkgo.
Drug Interactions of ADP receptor Blockers (Antiplatelets)Naina Mohamed, PhD
· ADP receptor Blockers (Antiplatelets) include Thienopyridines (Clopidogrel, Prasugrel, Ticlopidine) and Non-Thienopyridines (Ticagrelor, Cangrelor, Elinogrel ).
· The risk of adverse effects could be reduced by healthcare professionals through the screening, education, and follow up on suspected drug interactions.
Aspirin is an antiplatelet drug and it produces antiplatelet activity in lower doses (75-100 mg daily), while Higher dose of Aspirin (Up to 3600 mg daily in divided doses) is required for it’s analgesic effects.
§ Islamic fasting is similar to Alternate Day Fasting (ADF), since the feast and fast periods of Islamic fasting lasts 12 hours in average.
§ Though Islamic fasting is associated with some adverse effects, there was no detrimental effects on health attributed directly to them, in health individuals. And the adverse effects of fasting could be minimized very easily by following the preventive measures.
§ The chronic patients with Diabetes, Coronary Artery Disease (CAD), Cancer, Ulcer, Urolithiasis, Chronic Kidney Disease (CKD), etc. should consult the healthcare professionals before observing Fasting.
§ Moreover, Islam exempts the Sick, Travelers and Pregnant, Breast Feeding and Menstruating women from fasting.
§ Islamic Fasting can be good for health if it's done correctly.
¢ The imbalance between caloric intake and expenditure might result in to Overweight or Obesity.
¢ An US study reported that the Complementary and Alternative Medicine (CAM) use is high and continues to increase.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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2. Introduction
Anticoagulants are the drugs used to prevent harmful blood clots which
can cause serious conditions like Deep Vein Thrombosis (DVT), Pulmonary
Embolism (PE), or a Stroke, by affecting blood coagulation factors.
Interaction between one or more coadministered medications leading to
change in their effectiveness or toxicity, is termed as “Adverse drug
interaction”.
Anticoagulants can interact with prescription drugs, Over-the-counter
(OTC) medications, Herbal products, Dietary supplements, Vitamins,
Foods, Diseases, and Genetics (family history).
4. Defibrotide &
Antithrombotics
Concomitant use of defibrotide and a systemic antithrombotic agent is
contraindicated.
http://www.bloodjournal.org/content/120/21/3411?sso-checked=true
Antithrombotics
+ Defibrotide
Additive
antithrombotic
effects
Increased risk
bleeding
Contraindicated
5. Danaparoid & Warfarin
More frequent monitoring of Prothrombin time/INR is recommended,
When concomitant use is required.
Danaparoid +
Warfarin
Additive
anticoagulation
Elevated risk of
bleeding
6. Danaparoid &
Hirudins
If coadministration is required, closely monitor the patient for signs and
symptoms of bleeding, and neurologic impairment in patients who are receiving
neuraxial anesthesia or undergoing spinal puncture.
Danaparoid +
Hirudins (Bivalirudin,
Lepirudin)
Additive
anticoagulation
Increased risk of
bleeding
7. Danaparoid &
Other Anticoagulants
Use caution and monitor closely for bleeding when Danaparoid is used
concomitantly with other Anticoagulants.
Danaparoid + Other Anticoagulants
(Heparin, Enoxaparin, Dalteparin,
Tinzaparin, Fondaparinux,
Argatroban, Rivaroxaban, Apixaban,
Dabigatran)
Additive anticoagulation Increased risk of bleeding
8. Anticoagulants &
Fibrinolytics
Observe patients for external bleeding and be alert for signs and symptoms of
internal bleeding, if concomitant use of an anticoagulant and a fibrinolytic agent
is required.
https://www.ncbi.nlm.nih.gov/pubmed/11085346
Anticoagulants +
Fibrinolytics (Alteplase,
Retaplase, Tenecteplase,
Streptokinase, Urokinase)
Additive
anticoagulation
Increased risk of
bleeding
9. Anticoagulants &
Antiplatelet agents
Concomitant use warrants close monitoring.
http://circ.ahajournals.org/content/116/3/305
Anticoagulants +
Antiplatelet agents (Aspirin,
Clopidogrel, Ticagrelor, etc)
Additive anticoagulation Increased risk of bleeding
10. Anticoagulants &
Fenofibrate
Reduce the dose of the anticoagulant by about one-third at the start of
treatment, if concomitant use is required.
Then gradually adjust the dose based on the results of INR monitoring.
https://www.ncbi.nlm.nih.gov/pubmed/12549950
Anticoagulants +
Fenofibrate
Additive effects on
anticoagulation
Enhanced bleeding
risk
11. Anticoagulants &
Orlistat
Caution should be exercised when Anticoagulants and Orlistat are used
concurrently.
https://www.ncbi.nlm.nih.gov/pubmed/12659605
Anticoagulants + Orlistat
Orlistat may reduce the
absorption of fat-soluble
vitamins, including vitamin
K
Increased risk of bleeding
12. Anticoagulants &
NSAIDs
If used concomitantly, monitor for signs of bleeding.
http://www.aafp.org/afp/2009/1215/p1371.html
Anticoagulants + NSAIDs
(Ibuprofen, Diclofenac,
Naproxen, etc)
NSAIDs possess antiplatelet
effects
Increased risk of bleeding
13. Anticoagulants & SSRIs
Serotonin is essential in initiating the hemostatic response of platelets to vascular injury.
Monitor patient for signs of increased bleeding When SSRIs and an anticoagulant are given
concurrently.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2728939/
Anticoagulants + Selective serotonin
reuptake inhibitors (SSRIs)
(Fluvoxamine, Paroxetine,
Vortioxetine, Escitalopram,
Sertraline, Nefazodone, vilazodone)
SSRIs block the uptake of
serotonin by platelets
Decreased function of plateletsIncreased risk of Bleeding
14. Anticoagulants & SNRIs
Serotonin is essential in initiating the hemostatic response of platelets to vascular injury.
Monitor patient for signs of increased bleeding When SNRIs and an anticoagulant are given
concurrently.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2728939/
Anticoagulants + Selective Serotonin and
Norepinephrine Reuptake Inhibitors
(SNRIs)
(Venlafaxine, Desvenlafaxine, Duloxetine,
Milnacipran, Levomilnacipran,
Sibutramine)
SNRIs block uptake of
by platelets
Decreased function of
platelets
Increased risk of Bleeding
15. Anticoagulants &
St. John's Wort
Prothrombin time should be monitored closely.
Patients should not discontinue St. John's Wort without notifying their health
care provider.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4917631/
Anticoagulants + St.John's Wort
St. John's Wort induce CYP3A4 and
CYP1A2 mediated metabolism of R-
warfarin and CYP2C9 mediated S-
warfarin metabolism
Decreased warfarin plasma
concentrations leading to Reduced
anticoagulant effectiveness
16. Anticoagulants &
Ginkgo
Extreme caution is advised, due to the severity of the bleeding cases reported.
http://onlinelibrary.wiley.com/doi/10.1002/mnfr.200700098/epdf
Anticoagulants + Ginkgo
Ginkgolide B of Ginkgo may
inhibit Platelet Activating
Factor (PAF) induced
aggregation
Increased risk of bleeding
17. Anticoagulants & Garlic
Monitor bleeding time and signs and symptoms of excessive bleeding, if
garlic is taken with an anticoagulant.
http://onlinelibrary.wiley.com/doi/10.1002/mnfr.200700072/epdf
Anticoagulants + Garlic
Garlic has Anti-platelet,
Antithrombotic and
Fibrinolytic activities
Increased risk of bleeding
18. Anticoagulants +
Papaya
The patient should be monitored closely for symptoms of bleeding and
the INR should be closely monitored, if taken concomitantly.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3025393/
Anticoagulants + Papaya
Papain of Papaya may
damage the mucous
membranes of the
gastrointestinal tract
Increased bleeding risk
19. Anticoagulants &
Chamomile
Patients should be educated about the potential risk of using chamomile
products, while being treated with warfarin.
Monitor the patient for signs and symptoms of excessive bleeding.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1435958/
Anticoagulants +
Chamomile (Matricaria
chamomilla)
Coumarins present in
chamomile may potentiate
the effect of anticoagulants
Increased risk of bleeding
20. Anticoagulants &
Coenzyme Q10
Caution is advised if coenzyme Q10 and Anticoagulants are taken together.
Monitor the INR to determine continued therapeutic effect.
https://www.ncbi.nlm.nih.gov/pubmed/9621803
Anticoagulants +
Coenzyme Q10
Coenzyme Q10 is
chemically similar to
Vitamin K2
Reduced
anticoagulant
effectiveness
21. Anticoagulants &
Ginger
Caution is advised if ginger and an anticoagulant are taken concomitantly.
https://www.ncbi.nlm.nih.gov/pubmed/11144706
Anticoagulants + Ginger
Ginger may inhibit
thromboxane B2 formation
& may increase
levels
Increased risk of bleeding
22. Anticoagulants &
Fenugreek
Monitor bleeding time and signs and symptoms of excessive bleeding, if
fenugreek and anticoagulants are used concomitantly.
http://onlinelibrary.wiley.com/doi/10.1592/phco.21.5.509.34492/epdf
Anticoagulants +
Fenugreek
Coumarin content
of fenugreek may
add to the effect of
anticoagulants
Increased risk of
bleeding
23. Anticoagulants & Anise
Caution is advised if anise is taken with an anticoagulant. Monitor for signs and
symptoms of increased excessive bleeding.
http://www.ajhp.org/content/57/13/1221.long
Anticoagulants +
Anise
Coumarin content of
Anise may add to
the effect of
anticoagulants
Increased risk of
bleeding
24. Anticoagulants & Clove
Oil
Monitor the patient closely for signs and symptoms of bleeding, if both are
taken together.
http://www.ajhp.org/content/57/13/1221.long
Anticoagulants + Clove Oil
Eugenol and Acetyl
in clove oil inhibit platelet
aggregation
Increased risk of bleeding
25. Anticoagulants &
Asafetida
Monitor the patient closely for signs and symptoms of bleeding.
http://www.ajhp.org/content/57/13/1221.long
Anticoagulants +
Asafetida
Asafetida contains
free ferulic acid and
coumarin
Increased risk of
bleeding
26. Anticoagulants &
Capsaicin
Signs and symptoms of excessive bleeding should be monitored closely if
capsaicin (or large amounts of red pepper) and anticoagulants are taken
concomitantly.
http://article.sciencepublishinggroup.com/pdf/10.11648.j.cmr.20140305.17.pdf
Anticoagulants + Capsaicin
Capsaicin may inhibit
platelet aggregation and
enhance fibrinolytic activity
Increased risk of bleeding
27. Anticoagulants &
Evening primrose oil
Monitor for signs and symptoms of excessive bleeding.
https://www.ncbi.nlm.nih.gov/pubmed/19783511
Anticoagulants + Evening primrose
oil
Gamma-linolenic acid from
primrose oil may inhibit
thromboxane B2 production and
increase prostacyclin production
Increased risk of bleeding
28. Anticoagulants &
Licorice
Monitor for signs and symptoms of excessive bleeding, if licorice is taken with an
anticoagulant.
https://www.ncbi.nlm.nih.gov/pubmed/23671711
Anticoagulant
+ Licorice
Inhibition of thrombin and
platelet aggregation by
licorice
Increased risk
of bleeding
29. Anticoagulants & Celery
Monitor the patient closely for signs and symptoms of bleeding, if both are taken
together.
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Anticoagulants +
Celery
Apigenin content of Celery, may inhibit
thromboxane A2 formation leading to
reduced platelet aggregation & Celery
contains coumarin derivatives, which
may produce additional anticoagulant
effects
Increased risk of
bleeding
30. TIPS for Patients on
Anticoagulants
Do not double the dose to compensate a missed one.
Do not forget to discuss with your surgeon or dentist about the regular use of
Anticoagulant prior to any surgery.
Talk to your Physician or Pharmacist before taking any other medications, including
prescription and OTC (Over-The-Counter) medicines.
Contact your doctor if you develop severe diarrhea, an infection or a fever.
Seek immediate medical advice if there is signs of bleeding such as blood in your stools
or urine, nose-bleeds, bleeding gums, excessive menstrual bleeding or excessive
bruising.
Be careful with knives and try to minimize the risk of falling.
Always adhere to the prescribed dosage schedule.
Wear or carry an identification stating that You are on Anticoagulant.
31. Conclusion
Drug interactions can result in significant morbidity and mortality and thus
minimizing the risk for drug interactions should be a goal in drug therapy.
The patients with clotting disorders should bring a list of all of the drugs they
are taking including prescription drugs, over-the-counter drugs, and any
supplements, herbal or otherwise, during their visit to the doctor or
pharmacist.
The risk of adverse effects could be reduced by healthcare professionals
through the screening, education, and follow up on suspected drug
interactions.
If possible, the patients are recommended to fill all their prescriptions at one
pharmacy.
Pharmacists can play a crucial role in identifying possible drug interactions by
asking patients on Anticoagulants about their herbal and other alternative
medicine product use.
32. References
Stockley’s Drug Interactions, 9e
Karen Baxter
Goodman & Gilman's: The Pharmacological Basis of Therapeutics,
12e
Laurence L. Brunton, Bruce A. Chabner, Björn C. Knollmann
Basic & Clinical Pharmacology, 12e
Bertram G. Katzung, Susan B. Masters, Anthony J. Trevor
A Manual of Adverse Drug Interactions
J.P. Griffin, P.F. D'Arcy
Clinical Manual of Drug Interaction Principles for Medical Practice
Gary H. Wynn, Jessica R. Oesterheld, Kelly L. Cozza, Scott C.
Armstrong