Drug General Information (ID: DDI6MZ29DK)
Drug Name			Diethylstilbestrol		Drug Info		Warfarin		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antineoplastics				Anticoagulants
Structure

Mechanism of Diethylstilbestrol-Warfarin Interaction (Severity Level: Moderate)
Antagonize the effect of antithrombotic agents Click to Show/Hide Mechanism Graph
Drug Name		Diethylstilbestrol				Warfarin
Mechanism		Thrombogenic effects				Anticoagulant
Key Mechanism Factor 1
		Factor Name		Antithrombotic agents
		Factor Description		The beneficial effects of antithrombotic agents are reduced, leading to an increased risk of thromboembolism, stroke and/or myocardial infarction.
Mechanism Description		Antagonize the effect of Warfarin when combined with Diethylstilbestrol

Recommended Action
Management		Use of estrogen-containing drugs should be avoided in patients receiving anticoagulant therapy unless benefits are anticipated to outweigh the risks. Close clinical and laboratory monitoring are recommended if the combination is prescribed. Patients should be advised to promptly notify their physician if they experience potential signs and symptoms of blood clots such as chest pain, shortness of breath, sudden loss of vision, and pain, redness or swelling in an extremity.

References
1	Koch-Weser J, Sellers EM "Drug interactions with coumarin anticoagulants (second of two parts)." N Engl J Med 285 (1971): 547-58. [PMID: 4397794]
2	Ku LL, Ward CO, Durgin SJ "A clinical study of drug interaction and anticoagulant therapy." Drug Intell Clin Pharm 4 (1970): 300-6.
3	Meade TW "Oral contraceptives, clotting factors, and thrombosis." Am J Obstet Gynecol 142 (1982): 758-61. [PMID: 6801980]
4	Notelovitz M "Oral contraception and coagulation." Clin Obstet Gynecol 28 (1985): 73-83. [PMID: 3987135]
5	Schrogie JJ, Solomon HM, Zieve PD "Effect of oral contraceptives on vitamin K-dependent clotting activity." Clin Pharmacol Ther 8 (1967): 670-5. [PMID: 4167917]
6	Stangel JJ, Innerfield I, Reyniak JV, Stone ML "The effect of conjugated estrogens on coagulability in menopausal women." Obstet Gynecol 49 (1977): 314-6. [PMID: 190571]
7	von Kaulla E, Droegemueller W, von Kaulla KN "Conjugated estrogens and hypercoagulability." Am J Obstet Gynecol 122 (1975): 688-92. [PMID: 15850603]