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Publication Type: OBS Messages
Single or Multiple Incident: Multiple
Date: 6/30/2017 12:00:00 AM
Country: Denmark
This alert highlights the drug-drug interaction between an anticoagulant, warfarin, and an anti-fungal, miconazole. The interaction between warfarin and miconazole increases the effect of warfarin, so that the blood-thinning ability (INR) is increased, which in turn can cause severe bleeding. The risk of interaction also applies to miconazole oral gel, as a large proportion of this is absorbed systemically. Other antifungals such as fluconazole and voriconazole have the same effect on warfarin. A recommendation to prevent adverse events when it is necessary to use warfarin and an antifungal concomitantly is provided.

Additional Details

Medication/Gas/Fluid:
anticoagulants, warfarin (Marevan®), antifungals, miconazole, miconazole oral gel (Brentan®), fluconazole, voriconazole, nystatin
Medication/IV List:
antithrombotic agents (anticoagulants),

Rules / Policies / Procedures
  1. If Brentan oral gel is to be used concomitantly with warfarin, the Interaction Database recommends frequent monitoring of INR at initiation and discontinuation of concomitant treatment (with warfarin and miconazole) as well as attention to increased bleeding tendency. Temporary dose reduction of warfarin during miconazole treatment may be considered. Alternatively, another antifungal agent can be used, eg nystatin.

Be aware of the interaction between warfarin and miconazole oral gel