Probable interaction between warfarin and antitumor agents used in R-ESHAP chemotherapy.
BACKGROUND
The pharmacologic effects of warfarin might be altered by various factors, including drug-drug interaction.


METHODS
A 49-year-old Japanese man (height, 174 cm; weight, 68 kg) presented with a 20-month history of malignant lymphoma (diffuse large B cell lymphoma, clinical stage IV). He was treated with a combination of rituximab chemotherapy and etoposide, cisplatin, high-dose cytarabine, and methyl-prednisolone (R-ESHAP). He had been receiving warfarin for the secondary prevention of pulmonary embolism with deep venous thrombosis. When R-ESHAP was started, international normalized ratio (INR) increased from 1 to 5. This phenomenon was observed again in the second R-ESHAP. The INR was increased from 2.44 to 4.71 during chemotherapy but was returned to within the normal range (1.05; normal range: 0.81-1.009) 5 days after chemotherapy was completed.


CONCLUSIONS
In this patient, R-ESHAP chemotherapy might have affected warfarin anticoagulation sensitivity; thus, careful monitoring of INR is essential, particularly in patients receiving warfarin who undergo R-ESHAP chemotherapy.
Suzuki
Takaaki
T
Division of Pharmacy, Chiba University Hospital, Department of Clinical Cell Biology, Chiba University Graduate School of Medicine, Chiba, Japan.
Koga
Hitomi
H
Yamazaki
Shingo
S
Saeki
Hiromi
H
Tanaka
Hiroaki
H
Nishimura
Miki
M
Nakaseko
Chiaki
C
Nakasa
Hiromitsu
H
Nakamura
Hiroyoshi
H
Ariyoshi
Noritaka
N
Kitada
Mitsukazu
M
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000627:therapeutic use; D003561:Cytarabine / Q000627:therapeutic use; D004347:Drug Interactions; D005047:Etoposide / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000209:etiology / Q000517:prevention & control; D020246:Venous Thrombosis / Q000150:complications / Q000188:drug therapy*; D014859:Warfarin / Q000627:therapeutic use*
D003561:Cytarabine; D014859:Warfarin; D005047:Etoposide; D002945:Cisplatin; D008775:Methylprednisolone