Drug General Information (ID: DDIDEACNR9)
Drug Name			Dicoumarol		Drug Info		Thyroid, porcine		Drug Info
Drug Type		Small molecule				Hormones
Therapeutic Class		Anticoagulants				Thyroid Drugs

Mechanism of Dicoumarol-Thyroid, porcine Interaction (Severity Level: Moderate)
Increased risk of bleeding Click to Show/Hide Mechanism Graph
Drug Name		Dicoumarol				Thyroid, porcine
Mechanism		Vitamin K antagonist				Potentiate the hypoprothrombinemic effect of vitamin K antagonist
Key Mechanism Factor 1
		Factor Name		Bleeding
		Factor Description		Patients may be at risk for bleeding when the outcome of a disease or disease treatment confounds the standard mechanisms for maintaining hemostasis. Signs or symptoms of abnormal bleeding include: bleeding that takes a long time to stop (including nosebleeds, bleeding gums, bleeding from cuts and abrasions, and menstrual bleeding); severe unexplained bruising, or bruising that becomes larger; blood in the urine or stool, etc.
Mechanism Description		Increased risk of bleeding by the combination of Dicoumarol and Thyroid, porcine

Recommended Action
Management		INR or prothrombin time should be monitored closely when initiating, discontinuing, or changing the dosage of thyroid hormone therapy in patients stabilized on their oral anticoagulant regimen. Patients should be advised to notify their physician if they develop signs and symptoms of excessive anticoagulation, such as unusual or prolonged bleeding, bruising, vomiting, change in stool or urine color, headache, dizziness, or weakness.

References
1	Product Information. Synthroid (levothyroxine). Abbott Pharmaceutical, Abbott Park, IL.
2	Rice AJ, McIntosh TJ, Fouts JR, et al "Decrease sensitivity to warfarin in patients with myxedema." Am J Med Sci 262 (1971): 211-5. [PMID: 5142577]
3	Vagenakis AG, Cote R, Miller ME, et al "Enhancement of warfarin-induced hypoprothrombinemia by thyrotoxicosis." Johns Hopkins Med J 131 (1972): 69-73. [PMID: 4114451]