title: Utilization review of concomitant use of potentially interacting drugs in Thai patients using warfarin therapy.
abstract: OBJECTIVE
  In Thailand, there has been no study determining the concomitant use of medications, known to potentially interact with warfarin, in patients receiving warfarin therapy. This paper examined the frequency of which specific interacting drugs were concomitantly used in warfarin users.
  
  
  METHODS
  We retrospectively examined the database of warfarin outpatient medical records from a regional 756-bed hospital located in the north of Thailand. All patients receiving warfarin from 10 June 1999 to 4 August 2004 were reviewed to identify all drugs possessing interaction potential with warfarin. The potential of significant interactions were divided into high, moderate and low, according to the extent of evidence documented in textbooks and literature.
  
  
  RESULTS
  Among 1093 patients receiving warfarin therapy, 914 (84%) patients received at least one potentially interacting drug and half of them (457 patients) received at least one drug with high potential for interaction. The most frequently concomitant drug that increased INR was acetaminophen (63%, 316/457). Propylthiouracil was the most frequently concomitant drug that decreased INR response (4%, 19/457), while diclofenac was the most frequently concomitant drug that increased bleeding risk (16%, 73/457).
  
  
  CONCLUSIONS
  About a half of patients receiving warfarin therapy was prescribed concomitant drug(s) that has a high potential of interactions with warfarin. These patients should be closely monitored and counselled to watch for signs and symptoms of bleeding and thrombosis to avoid adverse events associated with drug interactions.
authors.affiliation: Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
authors.forename: Surachai
authors.initials: S
authors.lastname: Kotirum
authors.forename: Nathorn
authors.initials: N
authors.lastname: Chaiyakunapruk
authors.forename: Katechan
authors.initials: K
authors.lastname: Jampachaisri
authors.forename: Supharat
authors.initials: S
authors.lastname: Wattanasombat
authors.forename: Ponlapat
authors.initials: P
authors.lastname: Rojnuckarin
mesh_terms: D000082:Acetaminophen; D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D018712:Analgesics, Non-Narcotic; D000925:Anticoagulants; D013956:Antithyroid Agents; D001241:Aspirin; D004008:Diclofenac; D004347:Drug Interactions; D016903:Drug Monitoring; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D017723:Drug Utilization Review / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019934:International Normalized Ratio / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019338:Polypharmacy; D011441:Propylthiouracil; D012189:Retrospective Studies; D013785:Thailand; D014859:Warfarin
chemical_list: D018712:Analgesics, Non-Narcotic; D000925:Anticoagulants; D013956:Antithyroid Agents; D004008:Diclofenac; D000082:Acetaminophen; D014859:Warfarin; D011441:Propylthiouracil; D001241:Aspirin