Coumadin and P-1000
Determining the interaction of Coumadin and P-1000 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:Bioflavonoids may alter the blood levels and effects of warfarin. You may need more frequent monitoring of your prothrombin time or INR by your doctor to safely use both medications. Let your doctor know if your condition changes or you experience unusual bleeding or bruising. 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: Limited data suggest that flavonoids may affect the metabolism of warfarin. Various flavonoids including some flavones (e.g., 6-hydroxyflavone, 7-hydroxyflavone, chrysin, baicalein, apigenin, luteolin, scutellarein, wogonin) and flavonols (e.g., galangin, fisetin, kaempferol, morin, quercetin) have been found in vitro to inhibit CYP450 2C9, the isoenzyme responsible for the metabolic clearance of the biologically more active S(-) enantiomer of warfarin. However, there have been no specific reports of an interaction. In a study of 59 patients who were taking warfarin chronically and given a preparation called Limbrel that contains flavocoxid (baicalin and catechin) and citrated zinc bisglycinate, prothrombin times measured two weeks after the addition of Limbrel were unchanged in the majority of patients. However, the prothrombin time was lengthened in two patients and shortened in two others beyond 2 standard deviations. It is not known whether these changes represented variation in laboratory testing or reflect a CYP450 polymorphism affecting warfarin metabolism. The product labeling states that Limbrel is not a significant inhibitor of CYP450 1A2, 2C9, 2C19, 2D6, or 3A4 in vitro.
MANAGEMENT: The INR may need to be monitored more closely following addition or discontinuation of flavonoid preparations, and the warfarin dosage adjusted as necessary. The manufacturer recommends monitoring the INR one to two weeks after initiating Limbrel in patients anticoagulated with warfarin.
- "Product Information. Limbrel500 (bioflavonoids-zinc glycinate)." Primus Pharmaceuticals Inc, Scottsdale, AZ.
- Si D, Wang Y, Zhou YH, et al "Mechanism of CYP2C9 inhibition by flavones and flavonols." Drug Metab Dispos 37 (2009): 629-34
- Monostory K, Vereczkey L, Levai F, Szatmari I "Ipriflavone as an inhibitor of human cytochrome P450 enzymes." Br J Pharmacol 123 (1998): 605-10
- "Product Information. Limbrel250 (bioflavonoids-zinc glycinate)." Primus Pharmaceuticals Inc, Scottsdale, AZ.
Generic Name: bioflavonoids
Brand name: Amino-Opti-C, Limbrel, P-1000, Pan C 500, Peridin-C, Rutin, Span C, Vasoflex D1
Synonyms: n.a.
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.
Coumadin - P-1000 
Coumadin - P-1000 
Coumadin - P-1000 
Coumadin - P-1000 
Coumadin - P-1000 
Coumadin - P-1000 
Coumadin - P-1000 
Coumadin - P-1000 
Coumadin - P-1000 
Coumadin - P-1000 
Coumadin - P-1000 
Coumadin - P-1000