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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