Drug General Information (ID: DDIOD4R65A)
Drug Name			Dicoumarol		Drug Info		Obeticholic acid		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Anticoagulants				Gi Agents
Structure

Mechanism of Dicoumarol-Obeticholic acid Interaction (Severity Level: Moderate)
Antagonize the effect of antithrombotic agents Click to Show/Hide Mechanism Graph
Drug Name		Dicoumarol				Obeticholic acid
Mechanism		Vitamin K antagonist				Decrease the hypoprothrombinemic effect of vitamin K antagonist
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 Dicoumarol when combined with Obeticholic acid

Recommended Action
Management		The International Normalized Ratio (INR) should be monitored more closely following initiation, discontinuation, or change of dosage of obeticholic acid, and the warfarin dosage adjusted as necessary. The same precaution may be applicable during therapy with other vitamin K antagonists, although clinical data are lacking.

References
1	Bodiford AB, Kessler FO, Fermo JD, Ragucci KR "Elevated international normalized ratio with the consumption of grapefruit and use of warfarin." SAGE Open Med Case Rep 0 (2013): 1-3. [PMID: 27489634]
2	Guo LQ, Yamazoe Y "Inhibition of cytochrome P450 by furanocoumarins in grapefruit juice and herbal medicines." Acta Pharmacol Sin 25 (2004): 129-36. [PMID: 14769198]
3	Product Information. Ocaliva (obeticholic acid). Intercept Pharmaceuticals, Inc., New York, NY.