Key result
Addition of fluvastatin to stable warfarin therapy resulted in increased international normalized ratios (INRs) requiring a reduction in weekly warfarin dosage in three patients.
Why the study?
Does the addition of fluvastatin increase INR in patients on stable warfarin therapy?
Case Report (n=3)
Does the addition of fluvastatin increase INR in patients on stable warfarin therapy?
Fluvastatin may interact with warfarin to increase INR, necessitating closer monitoring and potential warfarin dose reduction.
Fluvastatin may raise INR on stable warfarin; leaves open need for prospective confirmation before practice change.
OBJECTIVE: To report three cases of a suspected interaction between warfarin and fluvastatin. CASE SUMMARIES: Three patients receiving stable warfarin dosages with therapeutic international normalized ratios (INRs) exhibited increased INRs when fluvastatin was added to their maintenance regimens. While none of the patients experienced a bleeding episode, they did require a reduction in their weekly warfarin dosage to achieve an appropriate level of anticoagulation. DISCUSSION: Reports of an interaction between warfarin and lovastatin have been described previously; however, to our knowledge, this is the first published report of a possible interaction between warfarin and fluvastatin. These cases were chosen because other factors that could potentially increase the INR were ruled out as significant contributors. CONCLUSIONS: The exact mechanism for the potential interaction between warfarin and fluvastatin is unknown. Until more is known, it is advisable to monitor patients more frequently when fluvastatin is initiated, discontinued, or adjusted in patients taking warfarin.
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Trilli et al. (1996) conducted a case report in Patients receiving stable warfarin therapy (n=3). Fluvastatin was evaluated on Increased international normalized ratio (INR). Addition of fluvastatin to stable warfarin therapy resulted in increased international normalized ratios (INRs) requiring a reduction in weekly warfarin dosage in three patients.
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