Possible Warfarin Interaction with Menthol Cough Drops
Possible Warfarin Interaction with Menthol Cough Drops
复制标题
华法林与薄荷止咳滴剂可能存在相互作用
DOI：
10.1345/aph.1e537
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发表时间：
2005
影响因子：
2.9
通讯作者：
D. Tomich
中科院分区：
文献类型：
--
作者：
Paul J Kassebaum;D. L. Shaw;D. Tomich
目的：报道一例在等待复律的患者中薄荷脑止咳滴剂(霍尔斯)可能与华法林相互作用的病例。病例摘要：一名57岁的白人男性因房颤而等待转律，医生给他开了华法林。他的剂量被调整到每天7毫克，以提供2.28-2.68的稳定的国际标准化比率(INR)值。大约一周后，他的INR降到了1.45。在一次后续采访中，这名患者报告说，他在前一周经历了一场流感样疾病，一直在使用薄荷醇止咳药水。未发现INR降低的其他潜在原因。疾病通常会提高INR；因此，我们得出结论，咳嗽滴剂可能是这种反应的原因，华法林剂量增加到53毫克/周。在停止使用薄荷脑止咳滴剂后，华法林剂量恢复到以前的量，INR保持稳定。讨论：客观的因果关系评估表明，INR的降低可能与华法林治疗期间使用薄荷脑止咳药有关。这些止咳药水中的活性成分是薄荷醇。薄荷醇已被证明通过诱导或抑制细胞色素P450同工酶和减缓药物吸收来影响其他药物的药代动力学。目前尚不清楚这些机制是否在此案中发挥了作用。截至2005年1月5日，这是第一个记录华法林与含有薄荷醇的止咳药片之间相互作用的病例报告。结论：此病例记录了使用薄荷脑止咳滴剂后INR显著降低。患病的患者有几个因素可能会影响他们的INR，应该密切监测。
OBJECTIVE: To report a case of possible interaction of menthol cough drops (Halls) with warfarin in a patient awaiting cardioversion. CASE SUMMARY: A 57-year-old white male awaiting cardioversion for atrial fibrillation was prescribed warfarin. His dosage was adjusted to 7 mg daily to provide stable international normalized ratio (INR) values of 2.28–2.68. Approximately one week later, his INR fell to 1.45. During a follow-up interview, the patient reported that he experienced a flu-like illness during the previous week and had been using menthol cough drops. No other potential causes for the decreased INR were found. Illness will most often elevate the INR; we therefore concluded that the cough drops were the likely cause of this reaction, and the warfarin dose was increased to 53 mg/wk. After discontinuing use of menthol cough drops, the warfarin dose was returned to the previous amount and the INR remained stabilized. DISCUSSION: An objective causality assessment suggests that the decreased INR was possibly related to the use of menthol cough drops during warfarin therapy. The active ingredient in these cough drops is menthol. Menthol has been shown to affect the pharmacokinetics of other drugs by inducing or inhibiting cytochrome P450 isoenzymes and slowing drug absorption. It is not clear whether these mechanisms played a role in this case. As of January 5, 2005 this is the first case report documenting an interaction between warfarin and cough drops containing menthol. CONCLUSIONS: This case documents a significant decrease in the INR following the use of menthol cough drops. Patients who are ill have several factors that can potentially affect their INR and should be monitored closely.