Warfarin interactions with steroids

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When warfarin (or another 4-hydroxycoumarin derivative) is given during the first trimester—particularly between the sixth and ninth weeks of pregnancy—a constellation of birth defects known variously as fetal warfarin syndrome (FWS), warfarin embryopathy, or coumarin embryopathy can occur. FWS is characterized mainly by skeletal abnormalities, which include nasal hypoplasia , a depressed or narrowed nasal bridge , scoliosis , and calcifications in the vertebral column , femur , and heel bone , which show a peculiar stippled appearance on X-rays . Limb abnormalities , such as brachydactyly (unusually short fingers and toes) or underdeveloped extremities, can also occur. [28] [29] Common nonskeletal features of FWS include low birth weight and developmental disabilities . [28] [29]

Warfarin prescribers need to be aware of complementary medicines usage and monitor the INR more frequently if this usage changes. As a precaution, patients on warfarin should have INR measurements about two and seven days after starting or changing any herbal treatment. 18 Prescribers need to alert patients to the clinical symptoms associated with minor and major bleeding and be prepared to cease both warfarin and the complementary medicine. In patients at special risk, such as the elderly and the debilitated, concurrent use of complementary medicines and warfarin should be undertaken with considerable caution. If the complementary medicine is necessary, it should be continued with the same care given to pharmaceutical drugs with a high risk of interaction.

Nutrition and diet can affect your treatment with warfarin. Therefore, it is important to keep your vitamin supplement and food intake steady throughout treatment. For example, increasing vitamin K levels in the body can promote clotting and reduce the effectiveness of warfarin. While there is no need to avoid products that contain vitamin K, you should maintain a consistent level of consumption of these products. Foods rich in vitamin K include beef liver, broccoli, Brussels sprouts, cabbage, collard greens, endive, kale, lettuce, mustard greens, parsley, soy beans, spinach, Swiss chard, turnip greens, watercress, and other green leafy vegetables. Moderate to high levels of vitamin K are also found in other foods such as asparagus, avocados, dill pickles, green peas, green tea, canola oil, margarine, mayonnaise, olive oil, and soybean oil. However, even foods that do not contain much vitamin K may occasionally affect the action of warfarin. There are reports of patients who experienced bleeding complications and increased INR or bleeding times after consuming large quantities of cranberry juice, mangos, or pomegranate juice. Again, you do not need to avoid these foods completely, but it may be preferable to limit their consumption, or at least maintain the same level of use while you are receiving warfarin. Talk to a healthcare provider if you are uncertain about what foods or medications you take that may interact with warfarin. It is important to tell your doctor about all medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor. When warfarin is given with enteral (tube) feedings, you may interrupt the feeding for one hour before and one hour after the warfarin dose to minimize potential for interaction. Feeding formulas containing soy protein should be avoided.

Warfarin interactions with steroids

warfarin interactions with steroids

Warfarin prescribers need to be aware of complementary medicines usage and monitor the INR more frequently if this usage changes. As a precaution, patients on warfarin should have INR measurements about two and seven days after starting or changing any herbal treatment. 18 Prescribers need to alert patients to the clinical symptoms associated with minor and major bleeding and be prepared to cease both warfarin and the complementary medicine. In patients at special risk, such as the elderly and the debilitated, concurrent use of complementary medicines and warfarin should be undertaken with considerable caution. If the complementary medicine is necessary, it should be continued with the same care given to pharmaceutical drugs with a high risk of interaction.

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