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Capecitabine and Coumadin

Determining the interaction of Capecitabine and Coumadin and the possibility of their joint administration.

Check result:

Capecitabine <> Coumadin

Relevance: 09.07.2022 Reviewer: Shkutko P.M., M.D., in

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 capecitabine 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 CLOSELY: Fluorouracil and its prodrug capecitabine may significantly potentiate the hypoprothrombinemic effect of warfarin and other oral anticoagulants. The mechanism of the interaction is unknown. Altered coagulation parameters and/or bleeding have been reported in patients stabilized on a coumarin-derivative anticoagulant such as warfarin following the addition of fluorouracil or capecitabine. Based on reported cases, increases in INR or prothrombin time may occur within a couple days after initiation of chemotherapy and continue gradually over several months and even after stopping chemotherapy. Tegafur, another prodrug, may theoretically also interact.

MANAGEMENT: Patients should be closely monitored during concomitant therapy. The INR or PT should be checked frequently and anticoagulant dosage adjusted accordingly, particularly following initiation or discontinuation of fluorouracil or capecitabine 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.

References

Brown MC "An adverse interaction between warfarin and 5-fluorouracil: A case report and review of the literature." Chemotherapy 45 (1999): 392-5
Brown MC "Multisite mucous membrane bleeding due to a possible interaction between warfarin and 5-flourouracil." Pharmacotherapy 17 (1997): 631-3
Aki Z, Kotiloglu G, Ozyilkan O "A patient with a prolonged prothrombin time due to an adverse interaction between 5-fluorouracil and warfarin." Am J Gastroenterol 95 (2000): 1093-4
"Product Information. Xeloda (capecitabine)." Roche Laboratories, Nutley, NJ.
Kolesar JM, Johnson CL, Freeberg BL, Berlin JD, Schiller JH "Warfarin-5-FU interaction - A consecutive case series." Pharmacotherapy 19 (1999): 1445-9
Carabino J, Wang F "International Normalized Ratio fluctuation with warfarin-fluorouracil therapy." Am J Health Syst Pharm 59 (2002): 875
Wajima T, Mukhopadhyay P "Possible interactions between warfarin and 5-fluorouracil." Am J Hematol 40 (1992): 238
Scarfe MA, Israel MK "Possible drug interaction between warfarin and combination of levamisole and fluorouracil." Ann Pharmacother 28 (1994): 464-7

Capecitabine

Generic Name: capecitabine

Brand name: Xeloda

Synonyms: n.a.

What is Capecitabine?

Coumadin

Generic Name: warfarin

Brand name: Coumadin, Jantoven

Synonyms: n.a.

What is Coumadin?

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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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