Jantoven and Tindamax
Determining the interaction of Jantoven and Tindamax and the possibility of their joint administration.
In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.
Consumer:Using warfarin together with tinidazole can cause you to bleed more easily. You may need a dose adjustment in addition to testing of your prothrombin time or International Normalized Ratio (INR). Call your doctor promptly if you have any unusual bleeding or bruising, vomiting, blood in your urine or stools, headache, dizziness, or weakness. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Professional:MONITOR: Coadministration with tinidazole may enhance the hypoprothrombinemic effect of warfarin and other oral anticoagulants. The interaction has been reported with metronidazole, another agent in the nitroimidazole class, and warfarin. Significant bleeding and elevation of prothrombin time have been observed. The proposed mechanism is metronidazole inhibition of CYP450 2C9, the isoenzyme responsible for the metabolic clearance of the more active S(-) enantiomer of warfarin. No data are available for tinidazole.
MANAGEMENT: Given its structural similarities to metronidazole, the potential for interaction with warfarin and other oral anticoagulants should be considered during coadministration with tinidazole. The INR should be checked frequently and anticoagulant dosage adjusted accordingly, particularly following initiation and for up to 8 days after discontinuation of tinidazole therapy in patients who are stabilized on their anticoagulant regimen. Patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools.
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- Miners JO, Birkett DJ "Cytochrome P4502C9: an enzyme of major importance in human drug metabolism." Br J Clin Pharmacol 45 (1998): 525-38
- Dean RP, Talbert RL "Bleeding associated with concurrent warfarin and metronidazole therapy." Drug Intell Clin Pharm 14 (1980): 864-6
- Serlin MJ, Breckenridge AM "Drug interactions with warfarin." Drugs 25 (1983): 610-20
- Hermans JJ, Thijssen HH "Human liver microsomal metabolism of the enantiomers of warfarin and acenocoumarol: P450 isozyme diversity determines the differences in their pharmacokinetics." Br J Pharmacol 110 (1993): 482-90
- Wells PS, Holbrook AM, Crowther NR, Hirsh J "Interactions of warfarin with drugs and food." Ann Intern Med 121 (1994): 676-83
- O'Reilly RA "The stereoselective interaction of warfarin and metronidazole in man." N Engl J Med 295 (1976): 354-7
- "Product Information. Tindamax (tinidazole)." Presutti Laboratories Inc, Arlington Heights, IL.
- Thijssen HH, Flinois JP, Beaune PH "Cytochrome P4502C9 is the principal catalyst of racemic acenocoumarol hydroxylation reactions in human liver microsomes." Drug Metab Disposition 28 (2000): 1284-90
- Kazmier FJ "A significant interaction between metronidazole and warfarin." Mayo Clin Proc 51 (1976): 782-4
- Kelly JG, O'Malley K "Clinical pharmacokinetics of oral anticoagulants." Clin Pharmacokinet 4 (1979): 1-15
In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.
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