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KMID : 0869620100270030293
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Journal of Korean Society of Hospital Pharmacists
2010 Volume.27 No. 3 p.293 ~ p.304
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Proposal for Warfarin Dosage Guideline during Capecitabine Therapy
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Choi Seul-Ki
Min Kyoung-A
Chon Myoung-Hun
In Yong-Won
Sohn Kie-Ho
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Abstract
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Several studies have recommended the reduction of warfarin dosage when capecitabine has been added, however, no one has suggested appropriate guidelines. Based on the data, we tried to determine the clinically available warfarin dosage guidelines after this drug combination. A retrospective analysis was done for all patients with capecitabine seen by the anticoagulation service(ACS) at Samsung Medical Center from February 1, 2000 to October 30, 2009. Patients who had stable INR values on warfarin for at least 1 month and who had not received drugs known to alter INR values or interact with warfarin. A total of eight patients met the inclusion criteria. During the first 3 cycle of capecitabine therapy, the requirement for warfarin dose was associated with duration of treatment with capecitabine. Continuous dose reduction is needed every cycles of capecitabine therapy to maintain the INR in therapeutic range. Although no major bleeding was observed in the study group, minor bleeding occurred in 3 patients. We recommend close monitoring of INR on day 0, day 10 of every cycles for a period of 21 days, with an appropriate adjustment of warfarin dose. The reductions of warfarin dose necessary for maintaining therapeutic INR is: 0-20% for 1 cycle, 20-40% for 2 cycle, 40-60% for 3 cycle. This study provide
clinically available dosage guidelines after taking concomitant capecitabine and warfarin.
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KEYWORD
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Capecitabine, warfarin, drug interaction, dosage gui
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