| Serious Interaction between Miconazole
and Warfarin - A Case Report - |
(Department of Cardiovascular Surgery, Mitsui Memorial
Hospital, Tokyo, Japan)
| Sachito Fukuda |
Kazuhiro Naito |
Ikutaro Kigawa |
|
The patient was placed on anticoagulant
therapy with warfarin after aortic valve replacement. Although
it was initially possible to stabilize the international normalized
ratio (INR＝2.90), the prothrombin time was significantly prolonged
(INR＝31.39) after intravenous infusion of miconazole for 9 days
at a dose of 200mg/day to treat lichen planus. Warfarin therapy
was discontinued until the INR decreased to within the acceptable
range, which required 14 days, and then warfarin was resumed.
A stable INR value was achieved approximately 50 days later.
Treatment with miconazole results in significant promotion of
the anticoagulant effect of warfarin and a long period was required
before normalization of the INR could be achieved in this patient.
Accordingly, miconazole therapy should only be indicated in patients
receiving treatment with warfarin when administration is essential.
Caution should be employed when using this drug in combination
with warfarin, and careful monitoring of the bleeding time is
necessary.
Jpn. J. Cardiovasc. Surg. 32：152 -154 (2003) |
|
