Drug General Information (ID: DDIJH67IUV)
  Drug Name Enoxacin Drug Info Warfarin Drug Info
  Drug Type Small molecule Small molecule
  Therapeutic Class Antiinfective Agents Anticoagulants
  Structure

 Mechanism of Enoxacin-Warfarin Interaction (Severity Level: Major)
     Increased risk of bleeding Click to Show/Hide Mechanism Graph
Could Not Find 2D Structure
      Drug Name Enoxacin Warfarin
      Mechanism Potentiate the hypoprothrombinemic effect of vitamin K antagonist 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 Enoxacin and Warfarin 

Recommended Action
      Management Given the potential for clinically significant interaction and even fatality in the occasional, susceptible patient, close monitoring is recommended if a quinolone antibiotic is prescribed during coumarin anticoagulant therapy. The INR should be checked frequently and coumarin dosage adjusted accordingly, particularly following initiation or discontinuation of quinolone therapy in patients who are stabilized on their anticoagulant regimen. 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. The same precaution may be applicable during therapy with other oral anticoagulants (e.g., indandiones), although clinical data are lacking.

References
1 Arnold LM, Nissen LR, Ng TM "Moxifloxacin and warfarin: additional evidence for a clinically relevant interaction." Pharmacotherapy 25 (2005): 904-7.[PMID: 15927911]
2 Glasheen JJ, Fugit RV, Prochazka AV "Effect of levofloxacin coadministration on the international normalized ratios during warfarin therapy--a comment." Pharmacotherapy 23 (2003): 1079-80 discussion 1080.[PMID: 12921255]
3 Bianco TM, Bussey HI, Farnett LE, Linn WD, Roush MK, Wong YW "Potential warfarin-ciprofloxacin interaction in patients receiving long-term anticoagulation." Pharmacotherapy 12 (1992): 435-9.[PMID: 1492006]