Miconazole and nystatin used as topical antifungal drugs interact equally strongly with warfarin
Summary What is known and Objective: Medline search disclosed 10 case reports of interactions between oral anticoagulants and miconazole oral gel, but none so far between nystatin solution and anticoagulants. We report on change in anticoagulant activity with use of different topical antifungal dru...
Gespeichert in:
| Veröffentlicht in: | Journal of clinical pharmacy and therapeutics 2012-02, Vol.37 (1), p.45-48 |
|---|---|
| Hauptverfasser: | , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 48 |
|---|---|
| container_issue | 1 |
| container_start_page | 45 |
| container_title | Journal of clinical pharmacy and therapeutics |
| container_volume | 37 |
| creator | Kovac, M. Mitic, G. Kovac, Z. |
| description | Summary
What is known and Objective: Medline search disclosed 10 case reports of interactions between oral anticoagulants and miconazole oral gel, but none so far between nystatin solution and anticoagulants. We report on change in anticoagulant activity with use of different topical antifungal drugs, miconazole oral gel and vaginal suppositories, and nystatin solution.
Methods: We conducted a retrospective study that included 43 patients on stable anticoagulation before the introduction of topical antifungal drugs. Miconazole oral gel was prescribed for 32 patients, nystatin solution for eight patients and miconazole vaginal suppositories for three patients.
Results and Discussion: Nineteen (44·2%) of the patients reported bleeding complications and some of these were severe. Fifteen of 32 who used miconazole oral gel and four of 8 of those who used nystatin solution were affected. Before use of the antifungal drugs, the mean weekly warfarin dose in the nystatin group was 14·5 mg, and after antifungal drugs, 9 mg, P = 0·038, while the mean international normalized ratio (INR) before antifungal drugs was 2·5 (range 1·9–3·5) and afterwards it was 10·6 (range 4·5–19·3), P = 0·0001. In the miconazole oral gel group the mean weekly warfarin dose was 15·7 mg, and after 10·8 mg, P = 0·008, while the mean INR before antifungal drugs was 2·44 (range 1·92–3·18) and afterwards it was 8·8 (range 4·9–16·9), P |
| doi_str_mv | 10.1111/j.1365-2710.2011.01246.x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_918574443</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1028025274</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5326-bedad52396a2bbd59d0951bcbb19f44cace8c09ec10893bd4452f29d453cbc3d3</originalsourceid><addsrcrecordid>eNqFkl2LEzEYhYMobnf1L8iAiHszNd8zuRGk6Kq0q9iKlzGTZGrqNNNNMrT115vaWsELzU0O73k4kLwHgALBMcrnxWqMCGclrvIAQ4TGEGHKx7t7YHQ27oMRxFyUtMLVBbiMcQUh5BUmD8EFRoRgxvkIfJ053Xv1o-9sobwp_D4mlZwvhmhNoWKR-o3Tqstmcu3gl1maMCxj4XyyQelU2LtBdd2-iCn0fpnF1qVvxVaFVgXnH4EHreqifXy6r8DnN68Xk7fl9MPNu8mraakZwbxsrFGGYSK4wk1jmDBQMNTopkGipVQrbWsNhdUI1oI0hlKGWywMZUQ3mhhyBZ4fczehvxtsTHLtorZdp7zthygFqllFKSWZvP4nieoK1xRziP6PQlxDzHBFM_r0L3TVD8HnJ-dAzhnlNaoz9eREDc3aGrkJbq3CXv5eSAaenQAV87e3QXnt4h-OUYRFDTP38shtXWf3Zx9BeSiIXMlDD-ShB_JQEPmrIHIn308-Lg4yB5THABeT3Z0DVPgueUUqJr_c3sjFfP5pNpveyjn5CWAjvb4</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1866546818</pqid></control><display><type>article</type><title>Miconazole and nystatin used as topical antifungal drugs interact equally strongly with warfarin</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><creator>Kovac, M. ; Mitic, G. ; Kovac, Z.</creator><creatorcontrib>Kovac, M. ; Mitic, G. ; Kovac, Z.</creatorcontrib><description>Summary
What is known and Objective: Medline search disclosed 10 case reports of interactions between oral anticoagulants and miconazole oral gel, but none so far between nystatin solution and anticoagulants. We report on change in anticoagulant activity with use of different topical antifungal drugs, miconazole oral gel and vaginal suppositories, and nystatin solution.
Methods: We conducted a retrospective study that included 43 patients on stable anticoagulation before the introduction of topical antifungal drugs. Miconazole oral gel was prescribed for 32 patients, nystatin solution for eight patients and miconazole vaginal suppositories for three patients.
Results and Discussion: Nineteen (44·2%) of the patients reported bleeding complications and some of these were severe. Fifteen of 32 who used miconazole oral gel and four of 8 of those who used nystatin solution were affected. Before use of the antifungal drugs, the mean weekly warfarin dose in the nystatin group was 14·5 mg, and after antifungal drugs, 9 mg, P = 0·038, while the mean international normalized ratio (INR) before antifungal drugs was 2·5 (range 1·9–3·5) and afterwards it was 10·6 (range 4·5–19·3), P = 0·0001. In the miconazole oral gel group the mean weekly warfarin dose was 15·7 mg, and after 10·8 mg, P = 0·008, while the mean INR before antifungal drugs was 2·44 (range 1·92–3·18) and afterwards it was 8·8 (range 4·9–16·9), P < 0·0001.
What is new and Conclusion: Miconazole oral gel and topically applied nystatin solution have equally strong effects on warfarin activity and can provoke major bleeding. Prospective evaluation of this effect is called for. However, based on our results the warfarin dose adjustment appears necessary when the anticoagulant is used concomitantly with those topical antifungals.</description><identifier>ISSN: 0269-4727</identifier><identifier>EISSN: 1365-2710</identifier><identifier>DOI: 10.1111/j.1365-2710.2011.01246.x</identifier><identifier>PMID: 21332566</identifier><identifier>CODEN: JCPTED</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Administration, Oral ; Adult ; Aged ; Aged, 80 and over ; Anticoagulants ; Anticoagulants - administration & dosage ; Anticoagulants - adverse effects ; Antifungal Agents - administration & dosage ; Antifungal Agents - pharmacology ; Biological and medical sciences ; Bleeding ; Case reports ; CYP2C9 ; Dose-Response Relationship, Drug ; Drug Interactions ; drug-drug interaction ; Drugs ; Female ; Gels ; Hemorrhage - chemically induced ; Humans ; International Normalized Ratio ; Male ; Medical sciences ; Miconazole ; Miconazole - administration & dosage ; Miconazole - pharmacology ; Middle Aged ; Nystatin ; Nystatin - administration & dosage ; Nystatin - pharmacology ; Pharmacology. Drug treatments ; Retrospective Studies ; Suppositories ; topical antifungal drugs ; Vagina ; Warfarin ; Warfarin - administration & dosage ; Warfarin - adverse effects ; warfarin activity ; warfarin interaction ; warfarin-miconazole interaction ; warfarin-nystatin interaction</subject><ispartof>Journal of clinical pharmacy and therapeutics, 2012-02, Vol.37 (1), p.45-48</ispartof><rights>2011 Blackwell Publishing Ltd</rights><rights>2015 INIST-CNRS</rights><rights>2011 Blackwell Publishing Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5326-bedad52396a2bbd59d0951bcbb19f44cace8c09ec10893bd4452f29d453cbc3d3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1365-2710.2011.01246.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1365-2710.2011.01246.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,781,785,1418,27929,27930,45579,45580</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25412980$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21332566$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kovac, M.</creatorcontrib><creatorcontrib>Mitic, G.</creatorcontrib><creatorcontrib>Kovac, Z.</creatorcontrib><title>Miconazole and nystatin used as topical antifungal drugs interact equally strongly with warfarin</title><title>Journal of clinical pharmacy and therapeutics</title><addtitle>J Clin Pharm Ther</addtitle><description>Summary
What is known and Objective: Medline search disclosed 10 case reports of interactions between oral anticoagulants and miconazole oral gel, but none so far between nystatin solution and anticoagulants. We report on change in anticoagulant activity with use of different topical antifungal drugs, miconazole oral gel and vaginal suppositories, and nystatin solution.
Methods: We conducted a retrospective study that included 43 patients on stable anticoagulation before the introduction of topical antifungal drugs. Miconazole oral gel was prescribed for 32 patients, nystatin solution for eight patients and miconazole vaginal suppositories for three patients.
Results and Discussion: Nineteen (44·2%) of the patients reported bleeding complications and some of these were severe. Fifteen of 32 who used miconazole oral gel and four of 8 of those who used nystatin solution were affected. Before use of the antifungal drugs, the mean weekly warfarin dose in the nystatin group was 14·5 mg, and after antifungal drugs, 9 mg, P = 0·038, while the mean international normalized ratio (INR) before antifungal drugs was 2·5 (range 1·9–3·5) and afterwards it was 10·6 (range 4·5–19·3), P = 0·0001. In the miconazole oral gel group the mean weekly warfarin dose was 15·7 mg, and after 10·8 mg, P = 0·008, while the mean INR before antifungal drugs was 2·44 (range 1·92–3·18) and afterwards it was 8·8 (range 4·9–16·9), P < 0·0001.
What is new and Conclusion: Miconazole oral gel and topically applied nystatin solution have equally strong effects on warfarin activity and can provoke major bleeding. Prospective evaluation of this effect is called for. However, based on our results the warfarin dose adjustment appears necessary when the anticoagulant is used concomitantly with those topical antifungals.</description><subject>Administration, Oral</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anticoagulants</subject><subject>Anticoagulants - administration & dosage</subject><subject>Anticoagulants - adverse effects</subject><subject>Antifungal Agents - administration & dosage</subject><subject>Antifungal Agents - pharmacology</subject><subject>Biological and medical sciences</subject><subject>Bleeding</subject><subject>Case reports</subject><subject>CYP2C9</subject><subject>Dose-Response Relationship, Drug</subject><subject>Drug Interactions</subject><subject>drug-drug interaction</subject><subject>Drugs</subject><subject>Female</subject><subject>Gels</subject><subject>Hemorrhage - chemically induced</subject><subject>Humans</subject><subject>International Normalized Ratio</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Miconazole</subject><subject>Miconazole - administration & dosage</subject><subject>Miconazole - pharmacology</subject><subject>Middle Aged</subject><subject>Nystatin</subject><subject>Nystatin - administration & dosage</subject><subject>Nystatin - pharmacology</subject><subject>Pharmacology. Drug treatments</subject><subject>Retrospective Studies</subject><subject>Suppositories</subject><subject>topical antifungal drugs</subject><subject>Vagina</subject><subject>Warfarin</subject><subject>Warfarin - administration & dosage</subject><subject>Warfarin - adverse effects</subject><subject>warfarin activity</subject><subject>warfarin interaction</subject><subject>warfarin-miconazole interaction</subject><subject>warfarin-nystatin interaction</subject><issn>0269-4727</issn><issn>1365-2710</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkl2LEzEYhYMobnf1L8iAiHszNd8zuRGk6Kq0q9iKlzGTZGrqNNNNMrT115vaWsELzU0O73k4kLwHgALBMcrnxWqMCGclrvIAQ4TGEGHKx7t7YHQ27oMRxFyUtMLVBbiMcQUh5BUmD8EFRoRgxvkIfJ053Xv1o-9sobwp_D4mlZwvhmhNoWKR-o3Tqstmcu3gl1maMCxj4XyyQelU2LtBdd2-iCn0fpnF1qVvxVaFVgXnH4EHreqifXy6r8DnN68Xk7fl9MPNu8mraakZwbxsrFGGYSK4wk1jmDBQMNTopkGipVQrbWsNhdUI1oI0hlKGWywMZUQ3mhhyBZ4fczehvxtsTHLtorZdp7zthygFqllFKSWZvP4nieoK1xRziP6PQlxDzHBFM_r0L3TVD8HnJ-dAzhnlNaoz9eREDc3aGrkJbq3CXv5eSAaenQAV87e3QXnt4h-OUYRFDTP38shtXWf3Zx9BeSiIXMlDD-ShB_JQEPmrIHIn308-Lg4yB5THABeT3Z0DVPgueUUqJr_c3sjFfP5pNpveyjn5CWAjvb4</recordid><startdate>201202</startdate><enddate>201202</enddate><creator>Kovac, M.</creator><creator>Mitic, G.</creator><creator>Kovac, Z.</creator><general>Blackwell Publishing Ltd</general><general>Blackwell</general><general>Hindawi Limited</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7T5</scope><scope>7TM</scope><scope>7TO</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>7X8</scope></search><sort><creationdate>201202</creationdate><title>Miconazole and nystatin used as topical antifungal drugs interact equally strongly with warfarin</title><author>Kovac, M. ; Mitic, G. ; Kovac, Z.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5326-bedad52396a2bbd59d0951bcbb19f44cace8c09ec10893bd4452f29d453cbc3d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Administration, Oral</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anticoagulants</topic><topic>Anticoagulants - administration & dosage</topic><topic>Anticoagulants - adverse effects</topic><topic>Antifungal Agents - administration & dosage</topic><topic>Antifungal Agents - pharmacology</topic><topic>Biological and medical sciences</topic><topic>Bleeding</topic><topic>Case reports</topic><topic>CYP2C9</topic><topic>Dose-Response Relationship, Drug</topic><topic>Drug Interactions</topic><topic>drug-drug interaction</topic><topic>Drugs</topic><topic>Female</topic><topic>Gels</topic><topic>Hemorrhage - chemically induced</topic><topic>Humans</topic><topic>International Normalized Ratio</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Miconazole</topic><topic>Miconazole - administration & dosage</topic><topic>Miconazole - pharmacology</topic><topic>Middle Aged</topic><topic>Nystatin</topic><topic>Nystatin - administration & dosage</topic><topic>Nystatin - pharmacology</topic><topic>Pharmacology. Drug treatments</topic><topic>Retrospective Studies</topic><topic>Suppositories</topic><topic>topical antifungal drugs</topic><topic>Vagina</topic><topic>Warfarin</topic><topic>Warfarin - administration & dosage</topic><topic>Warfarin - adverse effects</topic><topic>warfarin activity</topic><topic>warfarin interaction</topic><topic>warfarin-miconazole interaction</topic><topic>warfarin-nystatin interaction</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kovac, M.</creatorcontrib><creatorcontrib>Mitic, G.</creatorcontrib><creatorcontrib>Kovac, Z.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Immunology Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of clinical pharmacy and therapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kovac, M.</au><au>Mitic, G.</au><au>Kovac, Z.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Miconazole and nystatin used as topical antifungal drugs interact equally strongly with warfarin</atitle><jtitle>Journal of clinical pharmacy and therapeutics</jtitle><addtitle>J Clin Pharm Ther</addtitle><date>2012-02</date><risdate>2012</risdate><volume>37</volume><issue>1</issue><spage>45</spage><epage>48</epage><pages>45-48</pages><issn>0269-4727</issn><eissn>1365-2710</eissn><coden>JCPTED</coden><abstract>Summary
What is known and Objective: Medline search disclosed 10 case reports of interactions between oral anticoagulants and miconazole oral gel, but none so far between nystatin solution and anticoagulants. We report on change in anticoagulant activity with use of different topical antifungal drugs, miconazole oral gel and vaginal suppositories, and nystatin solution.
Methods: We conducted a retrospective study that included 43 patients on stable anticoagulation before the introduction of topical antifungal drugs. Miconazole oral gel was prescribed for 32 patients, nystatin solution for eight patients and miconazole vaginal suppositories for three patients.
Results and Discussion: Nineteen (44·2%) of the patients reported bleeding complications and some of these were severe. Fifteen of 32 who used miconazole oral gel and four of 8 of those who used nystatin solution were affected. Before use of the antifungal drugs, the mean weekly warfarin dose in the nystatin group was 14·5 mg, and after antifungal drugs, 9 mg, P = 0·038, while the mean international normalized ratio (INR) before antifungal drugs was 2·5 (range 1·9–3·5) and afterwards it was 10·6 (range 4·5–19·3), P = 0·0001. In the miconazole oral gel group the mean weekly warfarin dose was 15·7 mg, and after 10·8 mg, P = 0·008, while the mean INR before antifungal drugs was 2·44 (range 1·92–3·18) and afterwards it was 8·8 (range 4·9–16·9), P < 0·0001.
What is new and Conclusion: Miconazole oral gel and topically applied nystatin solution have equally strong effects on warfarin activity and can provoke major bleeding. Prospective evaluation of this effect is called for. However, based on our results the warfarin dose adjustment appears necessary when the anticoagulant is used concomitantly with those topical antifungals.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>21332566</pmid><doi>10.1111/j.1365-2710.2011.01246.x</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0269-4727 |
| ispartof | Journal of clinical pharmacy and therapeutics, 2012-02, Vol.37 (1), p.45-48 |
| issn | 0269-4727 1365-2710 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_918574443 |
| source | MEDLINE; Access via Wiley Online Library |
| subjects | Administration, Oral Adult Aged Aged, 80 and over Anticoagulants Anticoagulants - administration & dosage Anticoagulants - adverse effects Antifungal Agents - administration & dosage Antifungal Agents - pharmacology Biological and medical sciences Bleeding Case reports CYP2C9 Dose-Response Relationship, Drug Drug Interactions drug-drug interaction Drugs Female Gels Hemorrhage - chemically induced Humans International Normalized Ratio Male Medical sciences Miconazole Miconazole - administration & dosage Miconazole - pharmacology Middle Aged Nystatin Nystatin - administration & dosage Nystatin - pharmacology Pharmacology. Drug treatments Retrospective Studies Suppositories topical antifungal drugs Vagina Warfarin Warfarin - administration & dosage Warfarin - adverse effects warfarin activity warfarin interaction warfarin-miconazole interaction warfarin-nystatin interaction |
| title | Miconazole and nystatin used as topical antifungal drugs interact equally strongly with warfarin |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-11T12%3A56%3A45IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Miconazole%20and%20nystatin%20used%20as%20topical%20antifungal%20drugs%20interact%20equally%20strongly%20with%20warfarin&rft.jtitle=Journal%20of%20clinical%20pharmacy%20and%20therapeutics&rft.au=Kovac,%20M.&rft.date=2012-02&rft.volume=37&rft.issue=1&rft.spage=45&rft.epage=48&rft.pages=45-48&rft.issn=0269-4727&rft.eissn=1365-2710&rft.coden=JCPTED&rft_id=info:doi/10.1111/j.1365-2710.2011.01246.x&rft_dat=%3Cproquest_pubme%3E1028025274%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1866546818&rft_id=info:pmid/21332566&rfr_iscdi=true |