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Jantoven and Purinethol

Determining the interaction of Jantoven and Purinethol and the possibility of their joint administration.

Check result:

Jantoven <> Purinethol

Relevance: 22.11.2022 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 mercaptopurine can decrease the effects of warfarin. Ask your doctor before using warfarin together with mercaptopurine. Call your doctor promptly if you have any signs of blood clots such as chest pain, shortness of breath, sudden loss of vision, or pain, redness or swelling in an extremity. You may need a dose adjustment in addition to testing of your prothrombin time or International Normalized Ratio (INR). It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using your medications without talking to your doctor first.

Professional:

MONITOR: Limited clinical data suggest that the purine analog antimetabolites, azathioprine and mercaptopurine, may reduce the hypoprothrombinemic response to warfarin and other oral anticoagulants. The mechanism has not been fully established but animal studies indicate that enhanced activation or synthesis of prothrombin may be involved. There have been case reports of patients stabilized on oral anticoagulant therapy whose prothrombin time or INR decreased following addition of the antimetabolites and returned to normal only after their discontinuation or an increase in anticoagulant dosage. Bleeding has been reported after discontinuation of the antimetabolite.

MANAGEMENT: Given the potential for interaction and the narrow therapeutic index of oral anticoagulants, patients should be closely monitored during concomitant therapy with azathioprine or mercaptopurine. The INR should be checked frequently and anticoagulant dosage adjusted accordingly, particularly following initiation or discontinuation of antimetabolite therapy in patients who are stabilized on their anticoagulant regimen. Patients should be advised to promptly report any signs of blood clots (e.g. chest pain, shortness of breath, sudden loss of vision, or pain, redness or swelling in an extremity).

References

Rotenberg M, Levy Y, Shoenfeld Y, Almog S, Ezra D "Effect of azathioprine on the anticoagulant activity of warfarin." Ann Pharmacother 34 (2000): 120-2
Rivier G, Khamashta MA, Hughes GR "Warfarin and azathioprine: a drug interaction does exist." Am J Med 95 (1993): 342
Spiers AS, Mibashan RS "Increased warfarin requirement during mercaptopurine therapy: a new drug interaction." Lancet 2 (1974): 221-2
Havrda DE, Rathbun S, Scheid D "A case report of warfarin resistance due to azathioprine and review of the literature." Pharmacotherpy 21 (2001): 355-7
Walker J, Mendelson H, McClure A, Smith MD "Warfarin and azathioprine: clinically significant drug interaction." J Rheumatol 29 (2002): 398-9
Singleton JD, Conyers L "Warfarin and azathioprine: an important drug interaction." Am J Med 92 (1992): 217

Jantoven

Generic Name: warfarin

Brand name: Coumadin, Jantoven

Synonyms: n.a.

What is Jantoven?

Purinethol

Generic Name: mercaptopurine

Brand name: Purinethol, Purixan

Synonyms: n.a.

What is Purinethol?

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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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