Drug General Information (ID: DDI1D5Z8G6)
Drug Name			Dicoumarol		Drug Info		Clozapine		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Anticoagulants				Antipsychotic Agents
Structure

Mechanism of Dicoumarol-Clozapine Interaction (Severity Level: Moderate)
Competitive binding of plasma proteins Click to Show/Hide Mechanism Graph
Drug Name		Dicoumarol				Clozapine
Mechanism		Competition for plasma protein binding sites				Competition for plasma protein binding sites
Key Mechanism Factor 1
		Factor Name		Plasma protein binding
		Factor Description		Plasma protein binding refers to the degree of binding of a drug to proteins in the blood, and the lower the degree of binding, the more efficiently the drug can cross cell membranes or diffuse. Plasma protein binding alters the distribution and therapeutic characteristics of the drugs.
Mechanism Description		Increased plasma concentration of Clozapine and Dicoumarol due to competitive binding of plasma proteins

Recommended Action
Management		If clozapine and an anticoagulant must be used together, caution is recommended, as is close monitoring for clinical and laboratory evidence of altered anticoagulant effect. Patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools.

References
1	Gilman AG, Rall TW, Nies AS, Taylor P, eds. "Goodman and Gilman's the Pharmacological Basis of Therapeutics. 8th ed." New York, NY: Pergamon Press Inc. (1990):.
2	Product Information. Clozaril (clozapine). Novartis Pharmaceuticals, East Hanover, NJ.
3	Product Information. Fycompa (perampanel). Eisai Inc, Teaneck, NJ.