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Coumadin and Prozac

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

Check result:

Coumadin <> Prozac

Relevance: 01.06.2022 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 FLUoxetine may cause you to bleed more easily. You may need a dose adjustment based on 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: Several case reports, including one report of cerebral hemorrhage, suggest that fluoxetine may increase the anticoagulant effects of warfarin. Postulated mechanisms include displacement of warfarin from plasma protein-binding sites, inhibition of the CYP450 2C9 hepatic metabolism of warfarin by fluoxetine, and direct inhibitory effect of fluoxetine on hemostasis. Animal studies have also suggested that fluoxetine (given in very high doses) may increase prothrombin time in animals treated with warfarin. Two small studies of human volunteers, however, found no alteration in the prothrombin time in individuals treated with fluoxetine and warfarin. It is not known if other oral anticoagulants interact with fluoxetine in a similar manner.

MANAGEMENT: Close clinical and laboratory monitoring for altered anticoagulant effect is recommended if oral anticoagulants and fluoxetine must be used together. 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

"Product Information. Prozac (fluoxetine)." Dista Products Company, Indianapolis, IN.
Ciraulo DA, Shader RI "Fluoxetine drug-drug interactions. II." J Clin Psychopharmacol 10 (1990): 213-7
Thijssen HH, Flin ois JP, Beaune PH "Cytochrome P4502C9 is the principal catalyst of racemic acenocoumarol hydroxylation reactions in human liver microsomes." Drug Metab Dispos 28 (2000): 1284-90
Claire RJ, Servis ME, Cram DL Jr "Potential interaction between warfarin sodium and fluoxetine." Am J Psychiatry 148 (1991): 1604
Dent LA, Orrock MW "Warfarin-fluoxetine and diazepam-fluoxetine interaction." Pharmacotherapy 17 (1997): 170-2
Ford MA, Anderson ML, Rindone JP, Jaskar DW "Lack of effect of fluoxetine on the hypoprothrombinemic response of warfarin." J Clin Psychopharmacol 17 (1997): 110-2
Woolfrey S, Gammack NS, Dewar MS, Brown PJ "Fluoxetine-warfarin interaction." BMJ 307 (1993): 241

Coumadin

Generic Name: warfarin

Brand name: Coumadin, Jantoven

Synonyms: n.a.

What is Coumadin?

Prozac

Generic Name: fluoxetine

Brand name: Prozac, Prozac Weekly, Sarafem, Rapiflux, Selfemra, PROzac Pulvules

Synonyms: Prozac Capsules

What is Prozac?

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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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