Drug-induced Bleeding

Johnathan W. Hamrick, PharmD; Diane Nykamp, PharmD


US Pharmacist. 2015;40(12):17-21. 

In This Article

Drug-drug Interactions

Medication reconciliation and patient education prevent moderate or significant drug-drug interactions. Selected drug-drug interactions are given in Table 4.[11,15–22] Notable drug-drug interactions involve antibiotics and antifungals, which have been reported to increase bleeding when used in combination with drugs that are known to cause bleeding. It is recommended to check the international normalized ratio (INR) 5 days after initiation of an antimicrobial or antibiotic in patients taking warfarin.[23] Another combination that is important to monitor for bleeding is that of proton pump inhibitors (PPIs) with clopidogrel, owing to their inhibition of CYP2C19. Pantoprazole seems to inhibit CYP2C19 less than other PPIs and is likely the safest option if concomitant PPI therapy is necessary.[24]