Abciximab
Adverse Effect: Excessive bleeding Clinical Management: Concurrent administration of Abciximab and oral anticoagulants, including Phenindione, is contraindicated. Phenindione 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 hemorrhaging.
Amitriptyline
Adverse Effect: Increased risk of bleeding Clinical Management:Frequent adjustments of the anticoagulant dose may be required.
Amlodipine
Adverse Effect: an increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent Amlodipine and Phenindione 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 Phenindione , the prothrombin time ratio or INR (international normalized ratio) should be closely monitored with the addition and withdrawal of Amoxapine , 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: Phenindione should be discontinued prior to the initiation of therapy with Ardeparin . If this is not possible, patients receiving Ardeparin and Phenindione 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: an increased risk of bleeding Clinical Management: The use of Aspirin with Phenindione 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.
Carbimazole
Adverse Effect: decreased Phenindione effectiveness Clinical Management: In patients receiving Phenindione , 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.
Cimetidine
Adverse Effect: An increased risk of bleeding Clinical Management: This combination should be avoided. Famotidine, ranitidine, or nizatidine do not appear to interact with Cimetidine and would probably be preferred for concomitant administration with phenindione.
Cisapride
Adverse Effect: 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 phenindione 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 Phenindione , the prothrombin time ratio or INR (international normalized ration) should be closely monitored with the addition and withdrawal of Clomipramine , 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 oral anticoagulant therapy, 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: Phenindione should be discontinued prior to the initiation of therapy with Dalteparin . If this is not possible, patients receiving Dalteparin and an Phenindione 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 Phenindione 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 phenindione 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 Phenindione 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 Phenindione , 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. 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 Phenindione , the prothrombin time ratio or INR (international normalized ratio) should be closely monitored with the addition and withdrawal of Doxepin, 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 Phenindione hematoma when neuraxial anesthesia is employed Clinical Management: Phenindione should be discontinued prior to the initiation of therapy with Enoxaparin . If this is not possible, patients receiving Enoxaparin and Phenindione 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 Phenindione should be monitored for excessive bleeding, especially from the gastrointestinal tract.
Fluconazole
Adverse Effect: Increased risk of bleeding Clinical Management: In patients receiving Phenindione , 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: an increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent Flunarizine and Phenindione should be monitored for excessive bleeding, especially from the gastrointestinal tract.
Flurbiprofen
Adverse Effect: An increased risk of bleeding Clinical Management: In patients receiving Phenindione , the prothrombin time (PT) or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with Flurbiprofen . Coagulation parameters should also be reassessed periodically during concurrent therapy. Adjustments of the phenindione dose may be necessary in order to maintain the desired level of anticoagulation. Clinicians and patients should be aware of the increased potential for bleeding, especially from the gastrointestinal tract, during concomitant therapy.
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 Phenindione , the dose of the Phenindione 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 Phenindione , 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 Phenindione , the prothrombin time (PT) or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with Ibuprofen . Coagulation parameters should also be reassessed periodically during concurrent therapy. Adjustments of the phenindione dose may be necessary in order to maintain the desired level of anticoagulation. Clinicians and patients should be aware of the increased potential for bleeding, especially from the gastrointestinal tract, during concomitant therapy.
Imipramine
Adverse Effect: Increased risk of bleeding Clinical Management: In patients receiving Imipramine and Phenindione , the prothrombin time ratio or INR (international normalized ratio) should be closely monitored with the addition and withdrawal of Imipramine , and should be periodically reassessed during concurrent therapy. Achieving a stable dosage 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 Phenindione , 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 indomethacin. Coagulation parameters should also be reassessed periodically during concurrent therapy. Adjustments of the phenindione dose may be necessary in order to maintain the desired level of anticoagulation. Clinicians and patients should be aware of the increased potential for bleeding, especially from the gastrointestinal tract, during concomitant therapy.
Itraconazole
Adverse Effect: An increased risk of bleeding Clinical Management: Avoid concurrent use of itraconazole and phenindione. If the two must be used together, monitor coagulation parameters (international normalized ratio (INR) and prothrombin time (PT) times) carefully during and after itraconazole therapy. Close clinical monitoring is essential and dosage adjustment of Phenindione 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 Phenindione 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 phenindione 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 Phenindione , 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 ketoprofen. Coagulation parameters should also be reassessed periodically during concurrent therapy. Adjustments of the phenindione dose may be necessary in order to maintain the desired level of anticoagulation. Clinicians and patients should be aware of the increased potential for bleeding, especially from the gastrointestinal tract, during concomitant therapy.
Ketorolac
Adverse Effect: An increased risk of bleeding Clinical Management: Although ketorolac has been shown to have less effect on platelet aggregation and to cause less gastric erosion than other nonsteroidal antiinflammatory drugs (NSAIDs), caution should still be exercised when using ketorolac and Phenindione concurrently. The prothrombin time (PT) or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of ketorolac treatment, and should also be reassessed periodically during concurrent therapy. Adjustments of the phenindione dose may be necessary in order to maintain the desired level of anticoagulation. Clinicians and patients should be aware of the increased potential for bleeding, especially from the gastrointestinal tract, during concomitant therapy.
Lacidipine
Adverse Effect: an increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent Lacidipine and Phenindione 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 Phenindione 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 Phenindione , 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 mefenamic acid. Coagulation parameters should also be reassessed periodically during concurrent therapy. Adjustments of the phenindione dose may be necessary in order to maintain the desired level of anticoagulation. Clinicians and patients should be aware of the increased potential for bleeding, especially from the gastrointestinal tract, during concomitant therapy.
Meloxicam
Adverse Effect: An increased risk of bleeding Clinical Management: In patients receiving Phenindione , 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 meloxicam. Coagulation parameters should also be reassessed periodically during concurrent therapy. Adjustments of the phenindione dose may be necessary in order to maintain the desired level of anticoagulation. Clinicians and patients should be aware of the increased potential for bleeding, especially from the gastrointestinal tract, during concomitant therapy.
Metronidazole
Adverse Effect: An increased risk of bleeding Clinical Management: In patients receiving Phenindione , 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 phenindione dose may be necessary in order to maintain the desired level of anticoagulation.
Miconazole
Adverse Effect: An increased risk of bleeding Clinical Management: In patients receiving Phenindione , 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 phenindione dose may be necessary in order to maintain the desired level of anticoagulation.
Nabumetone
Adverse Effect: An increased risk of bleeding Clinical Management: Although nabumetone has been shown to have less effect on platelet aggregation and to cause less gastric erosion than other nonsteroidal antiinflammatory drugs (NSAIDs), caution should still be exercised when using nabumetone and Phenindione together. Coagulation parameters should be monitored with the addition and withdrawal of nabumetone therapy, and should be reassessed periodically during concurrent treatment. Adjustments of the phenindione dose may be necessary in order to maintain the desired level of anticoagulation. Clinicians and patients should be aware of the increased potential for bleeding, especially from the gastrointestinal tract, during concomitant therapy.
Nadroparin
Adverse Effect: Increased risk of bleeding and hematoma when neuraxial anesthesia is employed Clinical Management: Phenindione should be discontinued prior to the initiation of therapy with Nadroparin . If this is not possible, patients receiving Nadroparin and Phenindione 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.
Naproxen
Adverse Effect: An increased risk of bleeding Clinical Management: Although short-term controlled studies have not shown a significant effect on prothrombin times (PT) when naproxen is coadministered with coumarin-type anticoagulants, caution should still be exercised when using naproxen and Phenindione concurrently. The PT or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with naproxen, and should also be reassessed periodically during concurrent therapy. Adjustments of the phenindione dose may be necessary in order to maintain the desired level of anticoagulation. Clinicians and patients should be aware of the increased potential for bleeding, especially from the gastrointestinal tract, during concomitant therapy.
Nifedipine
Adverse Effect: Increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent Nifedipine and Phenindione should be monitored for excessive bleeding, especially from the gastrointestinal tract.
Nimesulide
Adverse Effect: An increased risk of bleeding Clinical Management: In patients receiving Phenindione , 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 nimesulide. Coagulation parameters should also be reassessed periodically during concurrent therapy. Adjustments of the phenindione dose may be necessary in order to maintain the desired level of anticoagulation. Clinicians and patients should be aware of the increased potential for bleeding, especially from the gastrointestinal tract, during concomitant therapy.
Nimodipine
Adverse Effect: an increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent Nimodipine and Phenindione should be monitored for excessive bleeding, especially from the gastrointestinal tract.
Nitrendipine
Adverse Effect: an increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent Nitrendipine and Phenindione should be monitored for excessive bleeding, especially from the gastrointestinal tract.
Nortriptyline
Adverse Effect: an increased risk of bleeding Clinical Management: In patients receiving Nortriptyline and Phenindione , 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.
Oxymetholone
Adverse 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: The concurrent use of phenindione 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 phenindione dose may be necessary in order to maintain the desired level of anticoagulation. Clinicians and patients should be aware of the increased potential for bleeding, especially from the gastrointestinal tract, during concomitant therapy.
Phenobarbitone
Adverse Effect: decreased anticoagulant effectiveness Clinical Management: With coadministration of phenobarbital and Phenindione , monitor international normalized ratio (INR) and adjust anticoagulant doses accordingly.
Phenylbutazone
Adverse Effect: An increased risk of bleeding Clinical Management: The concurrent use of phenindione 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 phenindione dose may be necessary in order to maintain the desired level of anticoagulation. Clinicians and patients should be aware of the increased potential for bleeding, especially from the gastrointestinal tract, during concomitant therapy.
Piroxicam
Adverse Effect: An increased risk of bleeding Clinical Management: In patients receiving Phenindione , the prothrombin time (PT) or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of Piroxicam , including piroxicam. Coagulation parameters should also be reassessed periodically during concurrent therapy. Adjustments of the phenindione dose may be necessary in order to maintain the desired level of anticoagulation. Clinicians and patients should be aware of the increased potential for bleeding, especially from the gastrointestinal tract, during concomitant therapy.
Primidone
Adverse Effect: decreased Phenindione effectiveness Clinical Management: In patients receiving Phenindione , 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: an 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 Phenindione 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 phenindione 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.
Stanozolol
Adverse 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.
Tenoxicam
Adverse Effect: An increased risk of bleeding Clinical Management: In patients receiving Phenindione , 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 tenoxicam. Coagulation parameters should also be reassessed periodically during concurrent therapy. Adjustments of the phenindione dose may be necessary in order to maintain the desired level of anticoagulation. Clinicians and patients should be aware of the increased potential for bleeding, especially from the gastrointestinal tract, during concomitant therapy.
Testosterone
Adverse Effect: increased risk of bleeding Clinical Management: Concurrent use of Testosterone and indione,dicumarol,phenprocoumonand warfarin should be avoided when possible. If the drugs must be used together, frequent monitoring of the anticoagulant response must be maintained.
Tetracycline
Adverse Effect: An increased risk of bleeding Clinical Management: In patients receiving oral anticoagulant therapy with phenindione, the prothrombin time ratio or INR (international normalized ratio) should be closely monitored with the addition and withdrawal of treatment with tetracycline, and should be reassessed periodically during concurrent therapy. Adjustments of the phenindione dose may be necessary in order to maintain the desired level of anticoagulation.
Thyroxine
Adverse Effect: An increased risk of bleeding Clinical Management: In patients receiving Phenindione , the prothrombin time rate or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with Thyroxine , and reassessed periodically during concurrent therapy. Adjustments of the Phenindione dose may be necessary in order to maintain the desired level of anticoagulation. However, patients already stabilized on thyroxine and thyroid hormones and are euthyroid will respond normally to 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: Phenindione should be discontinued prior to the initiation of therapy with Tinzaparin . If this is not possible, patients receiving Tinzaparin and Phenindione 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 Trimipramine and Phenindione , the prothrombin time ratio or INR (international normalized ratio) should be closely monitored with the addition and withdrawal of Trimipramine , and should be periodically reassessed during concurrent therapy.Frequent adjustments of the anticoagulant dose may be required.
Urokinase
Adverse Effect: an increased risk of bleeding Clinical Management: Phenindione 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 Phenindione should be monitored for excessive bleeding, especially from the gastrointestinal tract. |