Fish oil interaction with warfarin
Fish oil interaction with warfarin
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DOI：
10.1345/aph.1d007
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发表时间：
2004-01-01
影响因子：
2.9
通讯作者：
Knapp, WE
中科院分区：
文献类型：
--
作者：
Buckley, MS;Goff, AD;Knapp, WE
目的：报告一例服用鱼油和华法林的患者国际标准化比值（INR）升高。病例总结：一名67岁白人女性因复发性短暂性脑缺血发作服用华法林1年半。病史包括甲状腺功能减退、高脂血症、骨质减少、高血压和冠状动脉疾病。1995年她还经历了下段心肌梗死，需要血管成形术，1995年手术修复她的股动脉，1996年修补疝。该患者在抗凝门诊检查INR，并由临床药师每月随访一次。在相互作用之前，她的INR治疗了5个月，同时服用华法林1.5 mg/d。患者承认将鱼油剂量加倍，从1000毫克/天增加到2000毫克/天。在没有饮食、生活方式或药物改变的情况下，INR在1个月内从2.8上升到4.3。在随后减少鱼油用量一周后，INR降至1.6，需要恢复原来的华法林剂量方案。讨论：补充鱼油可以在华法林治疗中提供额外的抗凝。鱼油是一种omega-3多不饱和脂肪酸，由二十碳五烯酸和二十二碳六烯酸组成。这种脂肪酸可能影响血小板聚集和/或维生素k依赖性凝血因子。Omega-3脂肪酸可以降低血小板内的血栓素A(2)供应，并降低因子VII水平。尽管存在争议，但本病例报告表明，鱼油与华法林一起服用可以提供附加的抗凝血作用。结论：该病例显示，在鱼油剂量加倍后，INR显著升高。接受华法林抗凝治疗的患者应接受有关可能的药物-草药相互作用的教育和监测。药剂师可以通过询问服用华法林的患者有关草药和其他替代药物的使用情况，在确定可能的药物相互作用方面发挥关键作用。
OBJECTIVE: To report a case of elevated international normalized ratio (INR) in a patient taking fish oil and warfarin.CASE SUMMARY: A 67-year-old white woman had been taking warfarin for 1 1/2 years due to recurrent transient ischemic attacks. Her medical history included hypothyroidism, hyperlipidemia, osteopenia, hypertension, and coronary artery disease. She also experienced an inferior myocardial infarction in 1995 requiring angioplasty, surgical repair of her femoral artery in 1995, and hernia repair in 1996. This patient has her INR checked in the anticoagulation clinic and is followed monthly by the clinical pharmacist. Prior to the interaction, her INR was therapeutic for 5 months while she was taking warfarin 1.5 mg/d. The patient admitted to doubling her fish oil dose from 1000 to 2000 mg/d. Without dietary, lifestyle, or medication changes, the INR increased from 2.8 to 4.3 within 1 month. The INR decreased to 1.6 one week after subsequent fish oil reduction, necessitating a return to the original warfarin dosing regimen.DISCUSSION: Fish oil supplementation could have provided additional anticoagulation with warfarin therapy. Fish oil, an omega-3 polyunsaturated fatty acid, consists of eicosapentaenoic acid and docosahexaenoic acid. This fatty acid may affect platelet aggregation and/or vitamin K-dependent coagulation factors. Omega-3 fatty acids may lower thromboxane A(2) supplies within the platelet as well as decrease factor VII levels. Although controversial, this case report illustrates that fish oil can provide additive anticoagulant effects when given with warfarin.CONCLUSIONS: This case reveals a significant rise in INR after the dose of concomitant fish oil was doubled. Patients undergoing anticoagulation therapy with warfarin should be educated about and monitored for possible drug-herb interactions. Pharmacists can play a crucial role in identifying possible drug interactions by asking patients taking warfarin about herbal and other alternative medicine product use.