Bleeding Complications in a Patient After the Unexpected Interaction between Valproic Acid and Phenprocoumon.

Autor:	Wieringa A; Department of Clinical Pharmacy, Isala Hospital, Zwolle, The Netherlands.; Department of Clinical Pharmacology, Isala Hospital, Zwolle, The Netherlands., Fiebrich HB; Department of Clinical Pharmacology, Isala Hospital, Zwolle, The Netherlands.; Department of Oncology, Isala Hospital, Zwolle, The Netherlands., Gelder FV; Department of Clinical Pharmacy, Isala Hospital, Zwolle, The Netherlands., Valkenburg AJ; Department of Clinical Pharmacology, Isala Hospital, Zwolle, The Netherlands.; Department of Intensive Care, Isala Hospital, Zwolle, The Netherlands., Maring JG; Department of Clinical Pharmacy, Isala Hospital, Zwolle, The Netherlands.; Department of Clinical Pharmacology, Isala Hospital, Zwolle, The Netherlands., Smolders EJ; Department of Clinical Pharmacy, Isala Hospital, Zwolle, The Netherlands.; Department of Clinical Pharmacology, Isala Hospital, Zwolle, The Netherlands.
Jazyk:	angličtina
Zdroj:	Current drug safety [Curr Drug Saf] 2024; Vol. 19 (1), pp. 142-144.
DOI:	10.2174/1574886318666230310104322
Abstrakt:	Background: Phenprocoumon is a vitamin K antagonist that is widely prescribed in Europe and Latin America for the prophylaxis and treatment of thromboembolic events. Case Presentation: A 90-year-old female was admitted to our hospital with tonic-clonic seizures, possibly due to dementia syndrome. Valproic acid (VPA) was prescribed for the treatment of seizures. VPA is an inhibitor of cytochrome P450 (CYP) 2C9 enzymes. A pharmacokinetic interaction with phenprocoumon occurred, which is a substrate for CYP2C9 enzymes. The interaction resulted in a strong INR increase and subsequent clinically relevant bleeding in our patient. Valproic acid is not specifically mentioned in the phenprocoumon drug label as a CYP2C9 inhibitor, and in the Dutch medication surveillance database, no medication alert is shown when prescribing this combination, and no interaction with phenprocoumon has been reported so far. Conclusion: When prescribing this combination, the prescriber should be warned and advised to intensify INR monitoring if the combination is to be continued. (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)
Databáze:	MEDLINE
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