Warfarin Coumadin

Many antibiotics interfere with Warfarin (Coumadin) metabolism and should be used, if at all, with extreme caution in patients on anticoagulation therapy. These antibiotics include

• ciprofloxacin (many consider this interaction negligible)—potentiates warfarin activity

• dicloxacillin and nafcillin—inhibit warfarin activity

• erythromycin—potentiates warfarin activity

• fluconazole—potentiates warfarin activity

• ketoconazole—potentiates warfarin activity

• metronidazole—potentiates warfarin activity

• miconazole—potentiates warfarin activity

• rifampin—inhibits warfarin activity

• tetracycline/doxycycline—potentiates warfarin activity

• trimethoprim/sulfamethoxazole (Bactrim, Septra)—potentiates warfarin activity

Antiobiotics compatible with warfarin include most oral cephalosporins, penicillins (except dicloxacillin and nafcillin), and clindamycin. Consider ciprofloxacin with monitoring of PT/INR.

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