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| Interactions: | Abciximab
Adverse Effect: Excessive bleeding
Clinical Management: Concurrent administration of Abciximab and oral anticoagulants, including Acenocoumarol, is contraindicated. Acenocoumarol should not be given within seven days of Abciximab use, unless the patients prothrombin time is less than or equal to 1.2 times control. The combination of Abciximab and oral anticoagulants significantly raises the risk of internal or external haemorrhaging.
Amiodarone
Adverse Effect: Increased risk of bleeding
Clinical Management: In patients receiving Acenocoumarol , the prothrombin time ratio or INR (international normalized ratio) should be closely monitored with the addition and withdrawal of treatment with Amiodarone, and should be reassessed periodically during concurrent therapy. Adjustments of the Acenocoumarol dose may be necessary in order to maintain the desired level of anticoagulation.
Amitriptyline
Adverse Effect: Increased risk of bleeding
Clinical Management:Frequent adjustments of the Acenocoumarol dose may be required.
Amlodipine
Adverse Effect: Increased risk of gastrointestinal hemorrhage
Clinical Management: Patients who are receiving concurrent Amlodipine and Acenocoumarol should be monitored for excessive bleeding, especially from the gastrointestinal tract.
Amoxapine
Adverse Effect: Increased risk of bleeding
Clinical Management: In patients receiving Amoxapine and Acenocoumarol , the prothrombin time ratio or INR (international normalized ratio) should be closely monitored with the addition and withdrawal of Acenocoumarol , and should be periodically reassessed during concurrent therapy. Achieving a stable drug regimen which produces the desired level of anticoagulation may be difficult in patients on this combination, and frequent adjustments of the anticoagulant dose may be required.
Ardeparin
Adverse Effect: Increased risk of bleeding and hematoma when neuraxial anesthesia is employed
Clinical Management: Acenocoumarol should be discontinued prior to the initiation of therapy with Ardeparin . If this is not possible, patients receiving Acenocoumarol and Ardeparin concurrently should be monitored closely for bleeding, which may be serious. Gastrointestinal bleeding is a particular concern with this combination, as is the development of a spinal or epidural hematoma in patients who receive epidural/spinal anesthesia or spinal puncture prior to Ardeparin therapy
Aspirin
Adverse Effect: Increased risk of bleeding
Clinical Management: The use of Aspirin with Acenocoumarol and other anticoagulants should generally be avoided. If concurrent use cannot be avoided, frequent monitoring of the prothrombin time (PT) is indicated and patients should be cautioned to watch for signs of bleeding, especially in the gastrointestinal tract. Adjustments of the anticoagulant dose may be necessary in order to maintain the desired level of anticoagulation. For analgesic purposes, acetaminophen is much preferred for use in patients taking oral anticoagulants.
Benidipine
Adverse Effect: Increased risk of gastrointestinal hemorrhage
Clinical Management:Patients who are receiving concurrent Benidipine and Acenocoumarol should be monitored for excessive bleeding, especially from the gastrointestinal tract.
Carbimazole
Adverse Effect:decreased Acenocoumarol effectiveness
Clinical Management:
In patients receiving Acenocoumarol , the prothrombin time ratio or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with Carbimazole , and should be reassessed periodically during concurrent therapy.
Cisapride
Adverse Effect: An increased risk of bleeding
Clinical Management: In patients receiving oral anticoagulant therapy, the prothrombin time ratio or INR (international normalized ratio) should be closely monitored with the addition and withdrawal of treatment with Cisapride, and should be reassessed periodically during concurrent therapy. Adjustments of the Acenocoumarol dose may be necessary in order to maintain the desired level of anticoagulation.
Clarithromycin
Adverse Effect: An increased risk of bleeding
Clinical Management: In patients receiving oral anticoagulant therapy with acenocoumarol, the prothrombin time ratio or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with clarithromycin, and should be reassessed periodically during concurrent therapy. Adjustments of the acenocoumarol dose may be necessary in order to maintain the desired level of anticoagulation.
Clomipramine
Adverse Effect: Increased risk of bleeding
Clinical Management: In patients receiving Clomipramine and Acenocoumarol , the prothrombin time ratio or INR (international normalized ratio) should be closely monitored with the addition and withdrawal of Acenocoumarol , and should be periodically reassessed during concurrent therapy. Achieving a stable drug regimen which produces the desired level of anticoagulation may be difficult in patients on this combination, and frequent adjustments of the anticoagulant dose may be required.
Cotrimoxazole
Adverse Effect: increased risk of bleeding
Clinical Management: In patients receiving Acenocoumarol , the prothrombin time ratio or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of Cotrimoxazole and should be reassessed periodically during concurrent therapy.
Dalteparin
Adverse Effect: Increased risk of bleeding and hematoma when neuraxial anesthesia is employed
Clinical Management: Acenocoumarol should be discontinued prior to the initiation of therapy with Dalteparin . If this is not possible, patients receiving Dalteparin and Acenocoumarol concurrently should be monitored closely for bleeding, which may be serious. Gastrointestinal bleeding is a particular concern with this combination, as is the development of a spinal or epidural hematoma in patients who receive epidural/spinal anesthesia or spinal puncture prior to low molecular weight heparin therapy.
Danazol
Adverse Effect: increased risk of bleeding
Clinical Management: Concurrent use of Danazol and Acenocoumarol should be avoided when possible. When use of this combination of drugs cannot be avoided, frequent monitoring of the prothrombin time is necessary until any effect on the anticoagulant response has been manifest and is stabilized at an acceptable level.
Diclofenac Preps.
Adverse Effect: An increased risk of bleeding
Clinical Management: Concomitant diclofenac and oral anticoagulant therapy with acenocoumarol presents an increased risk of serious bleeding, particularly from the gastrointestinal tract. This risk does not appear to be due to increased hypoprothrombinemia, and thus increased monitoring of the prothrombin time ratio or INR (international normalized ratio) will not be reflective of the bleeding risk with this combination. Non-acetylated salicylates (e.g., salsalate, magnesium salicylate) are alternative NSAID agents which lack platelet inhibition, while acetaminophen can be used in patients requiring only analgesia.
Diltiazem
Adverse Effect: an increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent Diltiazem and Acenocoumarol should be monitored for excessive bleeding, especially from the gastrointestinal tract.
Dothiepin
Adverse Effect: An increased risk of bleeding Clinical Management: In patients receiving Dothiepin and Acenocoumarol , the prothrombin time ratio or INR (international normalized ratio) should be closely monitored with the addition and withdrawal of Dothiepin. They should be periodically reassessed during concurrent therapy. Achieving a stable drug regimen which produces the desired level of anticoagulation may be difficult in patients on this combination, and frequent adjustments of the anticoagulant dose may be required.
Doxepin
Adverse Effect: Increased risk of bleeding Clinical Management: In patients receiving Doxepin and Acenocoumarol , the prothrombin time ratio or INR (international normalized ratio) should be closely monitored with the addition and withdrawal of Acenocoumarol , and should be periodically reassessed during concurrent therapy. Achieving a stable drug regimen which produces the desired level of anticoagulation may be difficult in patients on this combination, and frequent adjustments of the anticoagulant dose may be required.
Enoxaparin
Adverse Effect: Increased risk of bleeding and hematoma when neuraxial anesthesia is employed Clinical Management: Acenocoumarol should be discontinued prior to the initiation of therapy with Enoxaparin . If this is not possible, patients receiving Enoxaparin and Acenocoumarol concurrently should be monitored closely for bleeding, which may be serious. Gastrointestinal bleeding is a particular concern with this combination, as is the development of a spinal or epidural hematoma in patients who receive epidural/spinal anesthesia or spinal puncture prior to low molecular weight heparin therapy.
Felodipine
Adverse Effect: an increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent Felodipine and Acenocoumarol should be monitored for excessive bleeding, especially from the gastrointestinal tract.
Fluconazole
Adverse Effect: Increased risk of bleeding Clinical Management: In patients receiving Acenocoumarol , the prothrombin time (PT) or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with fluconazole, and should be reassessed periodically during concurrent therapy.
Flunarizine
Adverse Effect: Increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent Flunarizine and Acenocoumarol should be monitored for excessive bleeding, especially from the gastrointestinal tract.
Flurbiprofen
Adverse Effect: an increased risk of bleeding Clinical Management: In patients receiving oral anticoagulation, the prothrombin time (PT) or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with nonsteroidal antiinflammatory drugs (NSAIDs), including fenoprofen. Coagulation parameters should also be reassessed periodically during concurrent therapy. Adjustments of the acenocoumarol dose may be necessary in order to maintain the desired level of anticoagulation
Glucagon
Adverse Effect: An increased risk of bleeding Clinical Management: In patients receiving glucagon in doses of 25 mg or more daily for more than two days and Acenocoumarol , the dose of the Acenocoumarol may need to be reduced and the prothrombin time should be monitored.
Glucomannan
Adverse Effect: Increased risk of bleeding Clinical Management: In patients receiving glucagon in doses of 25 mg or more daily for more than two days and Acenocoumarol , the dose of the anticoagulant may need to be reduced and the prothrombin time should be monitored.
Ibuprofen
Adverse Effect: an increased risk of bleeding Clinical Management: In patients receiving oral anticoagulation, the prothrombin time (PT) or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with nonsteroidal antiinflammatory drugs (NSAIDs), including fenoprofen. Coagulation parameters should also be reassessed periodically during concurrent therapy. Adjustments of the acenocoumarol dose may be necessary in order to maintain the desired level of anticoagulation
Imipramine
Adverse Effect: Increased risk of bleeding Clinical Management: In patients receiving Imipramine and Acenocoumarol , the prothrombin time ratio or INR (international normalized ratio) should be closely monitored with the addition and withdrawal of Acenocoumarol , and should be periodically reassessed during concurrent therapy. Achieving a stable drug regimen which produces the desired level of anticoagulation may be difficult in patients on this combination, and frequent adjustments of the anticoagulant dose may be required.
Indomethacin
Adverse Effect: an increased risk of bleeding Clinical Management: In patients receiving oral anticoagulation, the prothrombin time (PT) or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with nonsteroidal antiinflammatory drugs (NSAIDs), including fenoprofen. Coagulation parameters should also be reassessed periodically during concurrent therapy. Adjustments of the acenocoumarol dose may be necessary in order to maintain the desired level of anticoagulation
Iodine
Adverse Effect: Decreased anticoagulant effectiveness Clinical Management: In patients receiving Acenocoumarol, the prothrombin time ratio or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with Iodine , and should be reassessed periodically during concurrent therapy. Increased Acenocoumarol dose may be required to maintain the desired level of anticoagulation.
Itraconazole
Adverse Effect: An increased risk of bleeding Clinical Management: Avoid concurrent use of itraconazole and acenocoumarol. If the two must be used together, monitor coagulation parameters (international normalized ratio (INR) and prothrombin time (PT)) carefully during and after itraconazole therapy. Close clinical monitoring is essential and dosage adjustment of the anticoagulant agent may be necessary. Even then, safe use of this combination is not assured.
Ketoconazole
Adverse Effect: An increased risk of bleeding Clinical Management: In patients on Acenocoumarol therapy, the prothrombin time (PT) or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with ketoconazole, and should be reassessed periodically during concurrent therapy. Adjustments of the acenocoumarol dose may be necessary in order to maintain the desired level of anticoagulation.
Ketoprofen
Adverse Effect: an increased risk of bleeding Clinical Management: In patients receiving oral anticoagulation, the prothrombin time (PT) or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with nonsteroidal antiinflammatory drugs (NSAIDs), including fenoprofen. Coagulation parameters should also be reassessed periodically during concurrent therapy. Adjustments of the acenocoumarol dose may be necessary in order to maintain the desired level of anticoagulation
Ketorolac
Adverse Effect: an increased risk of bleeding Clinical Management: In patients receiving oral anticoagulation, the prothrombin time (PT) or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with nonsteroidal antiinflammatory drugs (NSAIDs), including fenoprofen. Coagulation parameters should also be reassessed periodically during concurrent therapy. Adjustments of the acenocoumarol dose may be necessary in order to maintain the desired level of anticoagulation
LMWH sod.salt
Adverse Effect: Increased risk of bleeding and hematoma when neuraxial anesthesia is employed Clinical Management: Acenocoumarol should be discontinued prior to the initiation of therapy with LMWH sod.salt . If this is not possible, patients receiving LMWH sod.salt and Acenocoumarol concurrently should be monitored closely for bleeding, which may be serious. Gastrointestinal bleeding is a particular concern with this combination, as is the development of a spinal or epidural hematoma in patients who receive epidural/spinal anesthesia or spinal puncture prior to low molecular weight heparin therapy. Clinicians should be aware that the increased risk of bleeding with this combination will not be fully reflected by the partial thromboplastin time.
Lacidipine
Adverse Effect: Increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent Lacidipine and Acenocoumarol should be monitored for excessive bleeding, especially from the gastrointestinal tract.
Lidoflazine
Adverse Effect: an increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent Lidoflazine and Acenocoumarol should be monitored for excessive bleeding, especially from the gastrointestinal tract.
Mefenamic Acid
Adverse Effect: an increased risk of bleeding Clinical Management: In patients receiving oral anticoagulation, the prothrombin time (PT) or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with nonsteroidal antiinflammatory drugs (NSAIDs), including fenoprofen. Coagulation parameters should also be reassessed periodically during concurrent therapy. Adjustments of the acenocoumarol dose may be necessary in order to maintain the desired level of anticoagulation
Meloxicam Adverse Effect: an increased risk of bleeding Clinical Management: In patients receiving oral anticoagulation, the prothrombin time (PT) or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with nonsteroidal antiinflammatory drugs (NSAIDs), including fenoprofen. Coagulation parameters should also be reassessed periodically during concurrent therapy. Adjustments of the acenocoumarol dose may be necessary in order to maintain the desired level of anticoagulation
Mercaptopurine Adverse Effect: Reduced acenocoumarol therapeutic efficacy Clinical Management: In patients receiving acenocoumarol therapy, the prothrombin time or INR (international normalized ratio) should be closely monitored with the addition and withdrawal of treatment with mercaptopurine, and should be reassessed periodically during concurrent therapy. Adjustments of the acenocoumarol dose may be necessary in order to maintain the desired level of anticoagulation.
Metronidazole Adverse Effect: An increased risk of bleeding Clinical Management: In patients receiving Acenocoumarol , the prothrombin time ratio or INR (international normalized ratio) should be closely monitored with the addition and withdrawal of treatment with metronidazole, and should be reassessed periodically during concurrent therapy. Adjustments of the acenocoumarol dose may be necessary in order to maintain the desired level of anticoagulation.
Mianserin Adverse Effect: Decreased effectiveness of acenocoumarol Clinical Management: Monitor the prothrombin time (PT) in patients stabilized on acenocoumarol therapy who add mianserin to their treatment regimen. An increase in the acenocoumarol dose may be necessary to maintain the desired level of anticoagulation.
Miconazole Adverse Effect: an increased risk of bleeding Clinical Management: In patients receiving Acenocoumarol , the prothrombin time (PT) or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with miconazole, and should be reassessed periodically during concurrent therapy. Adjustments of the acenocoumarol dose may be necessary .
Nabumetone Adverse Effect: an increased risk of bleeding Clinical Management: In patients receiving oral anticoagulation, the prothrombin time (PT) or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with nonsteroidal antiinflammatory drugs (NSAIDs), including fenoprofen. Coagulation parameters should also be reassessed periodically during concurrent therapy. Adjustments of the acenocoumarol dose may be necessary in order to maintain the desired level of anticoagulation
Nadroparin Adverse Effect: Increased risk of bleeding and hematoma when neuraxial anesthesia is employed Clinical Management: Acenocoumarol should be discontinued prior to the initiation of therapy with Nadroparin . If this is not possible, patients receiving Nadroparin and Acenocoumarol concurrently should be monitored closely for bleeding, which may be serious. Gastrointestinal bleeding is a particular concern with this combination, as is the development of a spinal or epidural hematoma in patients who receive epidural/spinal anesthesia or spinal puncture prior to low molecular weight heparin therapy.
NaproxenAdverse Effect: an increased risk of bleeding Clinical Management: In patients receiving oral anticoagulation, the prothrombin time (PT) or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with nonsteroidal antiinflammatory drugs (NSAIDs), including fenoprofen. Coagulation parameters should also be reassessed periodically during concurrent therapy. Adjustments of the acenocoumarol dose may be necessary in order to maintain the desired level of anticoagulation
Nifedipine Adverse Effect: an increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent Nifedipine and Acenocoumarol should be monitored for excessive bleeding, especially from the gastrointestinal tract.
NimesulideAdverse Effect: an increased risk of bleeding Clinical Management: In patients receiving oral anticoagulation, the prothrombin time (PT) or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with nonsteroidal antiinflammatory drugs (NSAIDs), including fenoprofen. Coagulation parameters should also be reassessed periodically during concurrent therapy. Adjustments of the acenocoumarol dose may be necessary in order to maintain the desired level of anticoagulation
NimodipineAdverse Effect: an increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent Nimodipine and Acenocoumarol should be monitored for excessive bleeding, especially from the gastrointestinal tract.
Nitrendipine Adverse Effect: Increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent Nitrendipine and Acenocoumarol should be monitored for excessive bleeding, especially from the gastrointestinal tract.
Nortriptyline Adverse Effect: Increased risk of bleeding Clinical Management: In patients receiving Nortriptyline and Acenocoumarol , the prothrombin time ratio or INR (international normalized ratio) should be closely monitored with the addition and withdrawal of the Nortriptyline , and should be periodically reassessed during concurrent therapy. Frequent adjustments of the anticoagulant dose may be required.
OxymetholoneAdverse Effect: increased risk of bleeding Clinical Management: This combination should be avoided if possible. If used, the prothrombin time ratio or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with oxymetholone.
Oxyphenbutazone Adverse Effect: an increased risk of bleeding Clinical Management: In patients receiving oral anticoagulation, the prothrombin time (PT) or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with nonsteroidal antiinflammatory drugs (NSAIDs), including fenoprofen. Coagulation parameters should also be reassessed periodically during concurrent therapy. Adjustments of the acenocoumarol dose may be necessary in order to maintain the desired level of anticoagulation
Paracetamol Adverse Effect: an increased risk of bleeding Clinical Management: In patients receiving oral anticoagulation, the prothrombin time (PT) or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with nonsteroidal antiinflammatory drugs (NSAIDs), including fenoprofen. Coagulation parameters should also be reassessed periodically during concurrent therapy. Adjustments of the acenocoumarol dose may be necessary in order to maintain the desired level of anticoagulation
Phenacetin Adverse Effect: an increased risk of bleeding Clinical Management: In patients receiving oral anticoagulation, the prothrombin time (PT) or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with nonsteroidal antiinflammatory drugs (NSAIDs), including fenoprofen. Coagulation parameters should also be reassessed periodically during concurrent therapy. Adjustments of the acenocoumarol dose may be necessary in order to maintain the desired level of anticoagulation
PhenobarbitoneAdverse Effect: decreased anticoagulant effectiveness Clinical Management: With coadministration of phenobarbital and Acenocoumarol , monitor international normalized ratio (INR) and adjust anticoagulant doses accordingly.
PhenylbutazoneAdverse Effect: an increased risk of bleeding Clinical Management: The concurrent use of acenocoumarol and phenylbutazone should be discouraged. If concomitant treatment is not avoidable, the prothrombin time (PT) or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with nonsteroidal antiinflammatory drugs (NSAIDs), including phenylbutazone. Coagulation parameters should also be reassessed periodically during concurrent therapy. Adjustments of the acenocoumarol dose may be necessary.
Phenytoin Adverse Effect: Reduced acenocoumarol serum concentrations and therapeutic efficacy Clinical Management: Monitor international normalized ratio (INR). It is possible that acenocoumarol doses may need to be increased.
Piroxicam Adverse Effect: an increased risk of bleeding Clinical Management: In patients receiving oral anticoagulation, the prothrombin time (PT) or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with nonsteroidal antiinflammatory drugs (NSAIDs), including fenoprofen. Coagulation parameters should also be reassessed periodically during concurrent therapy. Adjustments of the acenocoumarol dose may be necessary in order to maintain the desired level of anticoagulation
Primidone Adverse Effect: Decreased Acenocoumarol effectiveness Clinical Management: In patients receiving Acenocoumarol , the prothrombin time ratio or INR (international normalized ratio) should be closely monitored with the addition and withdrawal of treatment with primidone, and should be reassessed periodically during concurrent therapy.
Reviparin Adverse Effect: Increased risk of bleeding and of hematoma when neuraxial anesthesia is employed Clinical Management: Oral anticoagulants should be discontinued prior to the initiation of therapy with Reviparin . If this is not possible, patients receiving Reviparin and Acenocoumarol concurrently should be monitored closely for bleeding, which may be serious. Gastrointestinal bleeding is a particular concern with this combination, as is the development of a spinal or epidural hematoma in patients who receive epidural/spinal anesthesia or spinal puncture prior to low molecular weight heparin therapy.
Rtpa Adverse Effect: excessive bleeding Clinical Management: Coadministration of alteplase and acenocoumarol is contraindicated if the patients prothrombin time is greater than 15 seconds. The combination of alteplase and oral anticoagulants significantly raises the risk of internal or external hemorrhaging.
StanozololAdverse Effect: Increased risk of bleeding Clinical Management: Concurrent use of Stanozolol and anisindione, dicumarol, phenprocoumon and warfarin should be avoided when possible. If the drugs must be used together, frequent monitoring of the anticoagulant response must be maintained.
Tamoxifen Adverse Effect: An increased risk of bleeding Clinical Management: Concurrent administration of tamoxifen and coumarin-type anticoagulants, including acenocoumarol, is contraindicated in high-risk women where tamoxifen is indicated to reduce the incidence of breast cancer. In other clinical situations where tamoxifen is used concurrently with acenocoumarol, the prothrombin time ratio or INR (international normalized ratio) should be closely monitored with the addition and withdrawal of treatment with tamoxifen, and should be reassessed periodically during concurrent therapy.
Tenoxicam Adverse Effect: an increased risk of bleeding Clinical Management: In patients receiving oral anticoagulation, the prothrombin time (PT) or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with nonsteroidal antiinflammatory drugs (NSAIDs), including fenoprofen. Coagulation parameters should also be reassessed periodically during concurrent therapy. Adjustments of the acenocoumarol dose may be necessary in order to maintain the desired level of anticoagulation
Testosterone Adverse Effect: Increased risk of bleeding Clinical Management: Concurrent use of Testosterone and anisindione, dicumarol, phenprocoumon and warfarin should be avoided when possible. If the drugs must be used together, frequent monitoring of the anticoagulant response must be maintained.
Thyroxine Adverse Effect: An increased risk of bleeding Clinical Management: In patients receiving Acenocoumarol therapy, the prothrombin time rate or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with thyroid hormones.Periodic reassessment during concurrent therapy should be done. Adjustments of the Acenocoumarol dose may be necessary in order to maintain the desired level of Acenocoumarol. However, patients already stabilized on thyroxine and other thyroid hormones and are euthyroid will respond normally to the introduction of anticoagulant therapy.No special precautions are necessary.
Tinzaparin Adverse Effect: an increased risk of bleeding and of hematoma when neuraxial anesthesia is employed Clinical Management: Acenocoumarol should be discontinued prior to the initiation of therapy with Tinzaparin . If this is not possible, patients receiving Tinzaparin and an Acenocoumarol concurrently should be monitored closely for bleeding, which may be serious. Gastrointestinal bleeding is a particular concern with this combination, as is the development of a spinal or epidural hematoma in patients who receive epidural/spinal anesthesia or spinal puncture prior to low molecular weight heparin therapy.
Trimipramine Adverse Effect: increased risk of bleeding Clinical Management: In patients receiving tricyclic antidepressants and oral anticoagulant therapy, the prothrombin time ratio or INR (international normalized ratio) should be closely monitored with the addition and withdrawal of the antidepressant, and should be periodically reassessed during concurrent therapy.Frequent adjustments of the anticoagulant dose may be required.
Urokinase Adverse Effect: Increased risk of bleeding Clinical Management: Acenocoumarol should not be coadministered with intravenous doses of urokinase
Verapamil Adverse Effect: an increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent Verapamil and Acenocoumarol should be monitored for excessive bleeding, especially from the gastrointestinal tract. |
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