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Old 01-10-2019, 12:39 PM
 
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Quote:
Originally Posted by suzy_q2010 View Post
It's not really a "feedback loop". The dextromethorphan and phenergan affect levels of enzymes that break the warfarin down. The levels of those enzymes are also genetically determined, and it is likely that your GF makes less of them than some people do. It is something that can be tested for. My 23AndMe DNA results show that I would be sensitive to the effect of warfarin and might need lower than average doses.

I am surprised that the pharmacist did not catch that, assuming she gets all of her drugs from one pharmacy, which is something we should all consider doing.
Not with these 3 drugs, see my post above

(Also take a look at ePocraties, Medscape and Drugs.com)
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Old 01-10-2019, 12:44 PM
 
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Quote:
Originally Posted by old fed View Post
have well documented interactions with warfarin.
One of the oldest and most studied drugs in use today

Quote:
Further work by Link led in 1948 to the synthesis of warfarin, which was initially approved as a rodenticide in the USA in 1952, and then for human use in 1954. The name warfarin is derived from WARF (Wisconsin Alumni Research Foundation) and –arin from coumarin.
I think that only aspirin and digitalis have been marketed for a longer period of time
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Old 01-10-2019, 03:22 PM
 
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Quote:
Originally Posted by old fed View Post
also, i'm wondering if nausea caused a change in diet. and what was the treatment for pneumonia? some abx. have well documented interactions with warfarin.
Nausea can throw off therapeutic levels of whatever drugs you may be taking. I had a bout of nausea last week and still feel "off", obviously because I didn't know which of the meds I had taken stayed down and which came back up
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Old 01-10-2019, 03:42 PM
 
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OP, I hope your GF is doing better and that you are less stressed.

But I wonder: Is she passive about her medications and treatment to the point where she expects everyone to already know what to do? Does she advocate on her own behalf or expect others to do it for her?
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Old 01-10-2019, 06:53 PM
 
Location: colorado springs, CO
4,289 posts, read 1,935,493 times
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Quote:
Originally Posted by Serious Conversation View Post

She's had a nasty cough/congestion over the last couple of months and was diagnosed with pneumonia. A whooping cough test was done at a local hospital three weeks ago, which had to be set to a major medical facility in Charlotte because the local systems cannot diagnose it. Due to her lupus, she also has significant nausea.
Quote:
Originally Posted by mike1003 View Post
There is no D D interaction listed for promethazine (Phenergan), dextromethorphan and warfarin

I ran the combo through 3 professional database interaction checkers

Only warfarin interaction listed with these meds was Vicks DM and the interaction was with the menthol (mechanism unknown)

That said, any human can react to any substance in any way

My question would be, what changed in her diet? Grapefruit juice? Green leafy vegetables? Liver? Cranberries or cranberry juice?
OP, look at what I bolded. Did she take anything over the counter for her cough?
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Old 01-10-2019, 06:58 PM
 
Location: Georgia, USA
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Quote:
Originally Posted by mike1003 View Post
Not with these 3 drugs, see my post above

(Also take a look at ePocraties, Medscape and Drugs.com)
This is what happens when you make assumptions!

I checked and indeed the enzyme systems are different. I wonder why the OP was told the cough medicine was the culprit?
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Old 01-10-2019, 06:59 PM
 
Location: Georgia, USA
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Quote:
Originally Posted by coschristi View Post
OP, look at what I bolded. Did she take anything over the counter for her cough?
Menthol? Cough drops maybe?
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Old 01-10-2019, 09:48 PM
 
Location: Tennessee
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Quote:
Originally Posted by suzy_q2010 View Post
Menthol? Cough drops maybe?
She was taking menthol cough drops before the syrup was prescribed.

Quote:
Originally Posted by fluffythewondercat View Post
OP, I hope your GF is doing better and that you are less stressed.

But I wonder: Is she passive about her medications and treatment to the point where she expects everyone to already know what to do? Does she advocate on her own behalf or expect others to do it for her?
She's home and doing somewhat better. Her PT-INR is hovering around 6. She is very dependent on her mom and grandmother. She definitely needs to take charge more.
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Old 01-10-2019, 10:57 PM
 
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I would be looking at her antibiotic. Warfarin interacts with MANY antibiotics. I doubt that cough drops could have caused that dramatic a rise in her INR.


I'm assuming, since has lupus, that she is on a number of medications for the disease. It's entirely possible that one of her lupus meds was the problem, or some combination of lupus meds + antibiotic. Warfarin has so many drug interactions that I tell my students to assume a drug interacts with it until they have evidence to the contrary! (Evidence being a good drug guide online or in book form.)


If it was a drug interaction, it should have been caught by the physician or, failing that, the pharmacy. However, did everyone involved know she is taking warfarin?
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Old Yesterday, 12:19 AM
 
Location: colorado springs, CO
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Quote:
Originally Posted by suzy_q2010 View Post
Menthol? Cough drops maybe?
Yes, thatís what I was thinking. Plus, there is an actual over the counter Vickís DM, like what Mike found in his search. Itís ďVickís Dayquil Mucus ControlĒ but the generic is Dextromethorphan-Guaifenesin. Mike said the interaction was menthol-mediated & menthol is a common ingredient in a lot of Vickís products.

I wonder if that caused the confusion? The prescription dextromethorphan probably doesnít have menthol in it but the event could have been caused by the OTC cough medicine.

Quote:
Originally Posted by Serious Conversation View Post
She was taking menthol cough drops before the syrup was prescribed.
Seems like a pretty bad interaction but itís the only thing that matches what Mike found.
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