Topical miconazole interacts with warfarin.

[Catie]

A short article posted this month caught my eye, because it's something I didn't realize and Miconazole is in many OTC antifungal creams for jock itch and athlete's foot. I used several last year. I tried to see whether this topic was covered in the drug-interaction sticky already, but that link appears to be broken. If this post and the links I'm submitting aren't appropriate, let me know.

Anyway, because of the interaction, the article from palliativedrugs advises talking with a physician when on warfarin before using these creams, ointments, etc.

http://www.palliativedrugs.com/news/june/topical-miconazole-interaction-with-warfarin.html

Though the title of the Harvard article says "antibiotics," it also discusses antifungal medications and makes mention of topical, oral and vaginal medications, especially the effects of the "azoles."

http://www.health.harvard.edu/heart-health/warfarin-users-beware-of-antibiotics

 

[pellicle]

The advice is aimed at the old school American community who think INR testing one a month is sufficient, some idiots even go once every two months "because I'm stable". The detailed answer is that "it depends" on you and how YOU interact, which is why we advocate self testing, and self testing once a week. Even IFF you were to feel stable if you change your medications then you need to pop that $5 down and test once a week until you understand the effect.

I'm on antibiotics (still) and there is no observable dose difference to the year I was not on antibiotics after my valve surgery and the 3 years since. Others report some differences on INR on the same antibiotics. Still others report significant health effects from the antibiotics ... I don't

So really its not "off the rack" and you have to go tailor made.

But your bio suggests you have no valve replacemnt yet, your answers to paleogirl suggest you are tending towards a tissue valve (which is certainly not a bad choice). Myself I don't care what valve you get because it doesn't matter a pinch of (insertItem) to me. However if all your questions are about trying to make that choice the it would be a lot better and a lot easier to answer if you made that clear.

These shots in the dark on every possible tangent may be not the best manner to tease out the answers you need. I would feel a lot more comfortable answering your questions if I understood your valve choice as so far it seems you are still undecided .

Being a bit more open would make answering less verbose and thus less work

 

[Catie]

I am sorry, Pellicle. I was not seeking any answers in this post, except I mentioned to let me know if it isn't appropriate, and you've done that for me. I'm finding my way in this forum still and it's a learning curve. I did a brief search beforehand and at the time I posted, I thought it might be helpful information. I will try not to make this error again.

I also apologize for any other posts I've made that turned out to be ill-considered, or called on you to write me laborious answers. That has not been my intention. It's in my heart to be respectful, sensitive and helpful. To any degree that I miss that mark, I want to correct my course!

 

[Warrick]

Hi just wanted to say back in December oral Miconazole took my inr up over 7, it took 3 days and then shot up from mid 2s to 6.3 over night, then 7.1 a few days later after the weekend on a reduced warfarin dose.
Was more than a bit scary when I was so new to anticoagulation. I read in the handout that came with the med at the time that it "may affect inr". Not the doctor telling me this information.

Then the mouth swab that was taken when it was prescribed was negative for the infection I was told I had, IMO I don't think it was worth the maybe risk of a minor thrush infection versus bleeding.

 

[Catie]

Warrick, I imagine that was a little scary early on in your journey. That's quite a jump.

 

[Protimenow]

Warrick, I imagine that was a little scary early on in your journey. That's quite a jump.

That's also a good reason for self-testing.
I usually test weekly, but I've tested more frequently when switching sources of warfarin (from one manufacturer to another, for instance) or when I make a change in diet or activity that I consider can possibly change my INR. Of course, if I have unusual bruising or other signs that my INR may be too high, a test is certainly warranted.
It should be noted that there doesn't seem to be a truly accurate test - even blood draws - for INRs above 5 or so.

If your INR rises to danger levels, it's good to have a self test 'suggest' that your INR is above 4, and to probably seek some medical assistance to bring it down to safer levels. Repeat testing, daily if necessary, to confirm that you're back in range will also help. Being able to test at home or work - rather than chasing to a doctor's office, hospital, or lab and waiting for results, is a convenience that gives self testing a distinct advantage over the alternatives.

 

[Warrick]

Yep, and I had the pharmacist (we have some pharmacies here approved for testing but he dropped me when I told him the doctor was telling me different dosages to his dosing algorithm) telling me one thing, the

doctor telling me another and my father(who's got a mechanical valve and been on warfarin for 32 yrs but is fully doctor (mis) managed) telling me don't listen to them any of them... bit of a train wreck at the time

Now I hospital and self test alternating weekly and self manage and its been fine, I've found 3 beers is enough to take my INR to 3.5 where as my father would get rats ass all weekend when I was a kid and then go in for a test and be in range.
Figures...

 

[Catie]

Very good information, Protimenow.

Warrick, that's beyond frustrating, with everyone telling you a different story on how it was supposed to work! Yikes.