Pharmacist in the dark???

[catwoman]

I took 3 Rxes to Costco -- 200mg capsules of acyclovir (100 caps), 500mg caps of amoxi and 10mg of Flexeril.
Told the person who took the scrips from me that I needed to know if any of the drugs would interact with warfarin.
She asked the pharmacist, who said no.
I realize that amoxi GENERALLY does not pose a problem, but antibiotics do raise the INR. Taking 2000mg of amoxi before dentals might not raise the INR significantly for a prolonged period, but if you have to stay on amoxi, wouldn't it raise it?

I'm just wondering how much the pharmacist really knows about drug interactions with warfarin...

 

[Guest]

Amoxicillin does not interact with warfarin at the level of molecule to molecule. It is usually rapidly absorbed so it doesn't interfere with the bacteria in the intestine. A few people do not absorb it rapidly and it will have some effect, but these are a tiny minority.

 

[perrybucsdad]

I like going to this site to see what drugs effects have on each other. It allows you to put in all of your Rx's and see the possible interactions between them all.

http://www.drugdigest.org/DD/Interaction/ChooseDrugs/1,4109,,00.html

 

[catwoman]

Al:
I took amoxi for 3 days in February for bronchitis -- also had fever. My INR shot way up (at least for me, it was way up).

I became concerned about amoxi after that.... I know the fever had some effect on the INR, but could the amoxi have affected it too?

 

[catwoman]

I like going to this site to see what drugs effects have on each other. It allows you to put in all of your Rx's and see the possible interactions between them all.

http://www.drugdigest.org/DD/Interaction/ChooseDrugs/1,4109,,00.html

Interesting website. Will play with it...

 

[Ross]

I like going to this site to see what drugs effects have on each other. It allows you to put in all of your Rx's and see the possible interactions between them all.

http://www.drugdigest.org/DD/Interaction/ChooseDrugs/1,4109,,00.html

Thanks! I've been looking for a site like this for a long time now.

 

[Guest]

The site looks reasonably accurate. My students and I thought it was useful. Mostly our disagreement with it was the ratings about the severity of the interaction. For instance I have seen severe reactions with warfarin and fluorouracil and it rates it as moderate.

I like that you can put in brand names and natural products.

I would say that anything rated moderate or higher should be checked out.

I would rate it about 4.5 stars of a possible 5. The students say that it is the best they have seen.

Thanks for this link.

 

[perrybucsdad]

I use it mostly as a double check with my doc and pharmacist. I understand that it's not going to be 100% accurate as far as the severity, but it at least gives you some indication as to what may interact.

I found it interesting when I put in natural supplements and the medications that I was taking. Stuff that I thought was safe, was not.

The other side is that it says Warfarin interacts with everything, but this is not really a problem if you are constant with what you take. It will allow you to anticipate a swing though and check your INR in a week to see what type of swing that you took.

 

[catwoman]

Interesting note at that website about interaction between alcohol and warfarin (is Moo here?):

"Warfarin is generally used to prevent your blood from "coagulating" or forming blood clots. Although the cause of this potential interaction is not clearly understood, alcohol (ethanol) may decrease the anticoagulant effect of warfarin. This is more likely to occur when large amounts of alcohol are consumed over a long period of time. Based on information from several studies involving people who consumed small to moderate amounts of alcohol while taking warfarin, this interaction does not appear to cause any harmful effects. However, accidental injuries may occur when alcohol is consumed to the point that it impairs judgment. Because warfarin may increase the risk of excessive bleeding, caution is advised. You may want to ask your healthcare provider about this potential interaction if you think you are having problems."
(Red highlighting is mine.)

In other words, don't get falling-down drunk???

 

[Guest]

The interactions programs on retail pharmacy computers have some problems, too. Probably because of the fear of lawsuits many of them have every possible interaction included. For some the only report was that something happened to a few lab animals back in the 1970s. That might protect the software manufacturers from litigation but what it causes may be even worse. For example warfarin and azathioprine. The combination is prescribed infrequently, so many pharmacists will look at the screed and think, "I'ver never heard of that" and override it. In reality, I have seen some very dramatic changes in the INR from this one. So no system is perfect. It does not hurt to screen several ways and do some on your own.

 

[Nancy]

When Joe gets a new medication, I always check it out in as many ways as I can.

You won't believe the things I've found that some of his specialists have prescribed, and which Joe did not have filled. The side effects were downright scary, and the interractions just as bad. He's on about 14-16 different meds per day, so I have to check out a lot.

Joe has a couple of doctors he always checks things out with because they have the best knowledge and know his case the best. They usually won't say an outright NO to someone else's idea, but they word it so you can read between the lines and get a negative drift. There have been times when the hospital pharmacist has been consulted before he tries some of these things. They are quite up front with the information.

Joe also has a typed up list of his "nasties", those drugs which have caused terrible problems, even though they weren't technically allergic reactions, or interractions with other meds. Just no-goes for Joe.

 

[Guest]

I have read that the most important things that you can do when you are admitted to the hospital is to know what medications you are on, what strengths you take and when you take them. The next most important is to know what drugs caused bad reactions - not necessarily allergies although they always word it like that.

My observation is that knowing the brand and generic names are sometimes important. My mother fell out of bed and broke her leg because she hallucinated from a Duragesic patch. When they got her to the hospital they were going to do a test and were planning to give her an injection of fentanyl. I told the nurse that she was admitted because of hallucinating on a Duragesic patch. The nurse told me that fentanyl and Duragesic were not the same thing. I told her to look it up. All fentanyl is not Duragesic but all Duragesic is fentanyl. She was not happy when she had to get orders for something else.