Drug General Information (ID: DDIW1CGHRF)
Drug Name			Dicoumarol		Drug Info		Methyl salicylate (topical)		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Anticoagulants				Topical Anti-Irritants
Structure

Mechanism of Dicoumarol-Methyl salicylate (topical) Interaction (Severity Level: Moderate)
Increased risk of bleeding Click to Show/Hide Mechanism Graph
Drug Name		Dicoumarol				Methyl salicylate (topical)
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 Methyl salicylate (topical)

Recommended Action
Management		Patients treated with oral anticoagulants should avoid or limit self-medication with these products. Systemic absorption of topical medication may be increased with frequent applications use of large quantities or over large areas of skin use of ointment-based formulations and use of occlusive dressings or heating pads over application areas. 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. Patients should also be counseled to avoid any other over-the-counter salicylate products.

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	Joss JD, LeBlond RF "Potentiation of warfarin anticoagulation associated with topical methyl salicylate." Ann Pharmacother 34 (2000): 729-33. [PMID: 10860133]
3	Chan TY "Adverse interactions between warfarin and nonsteroidal antiinflammatory drugs: mechanisms, clinical significance, and avoidance." Ann Pharmacother 29 (1995): 1274-83. [PMID: 8672833]