Drug General Information (ID: DDIWRG7H9Q)
Drug Name			Collagenase clostridium histolyticum		Drug Info		Antithrombin III human		Drug Info
Drug Type		Protein/peptide				Protein/peptide
Therapeutic Class		Collagenase Enzyme				Recombinant Antithrombin

Mechanism of Collagenase clostridium histolyticum-Antithrombin III human Interaction (Severity Level: Moderate)
Increased risk of bleeding Click to Show/Hide Mechanism Graph
Drug Name		Collagenase clostridium histolyticum				Antithrombin III human
Mechanism		Risk of bleeding Antiplatelet/anticoagulant effects				Risk of bleeding Anticoagulant
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 Collagenase clostridium histolyticum and Antithrombin III human

Recommended Action
Management		Collagenase clostridium histolyticum should be used with caution in patients receiving or within 7 days of receiving anticoagulants (except for low-dose aspirin), platelet inhibitors, or thrombolytic agents.

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. Xiaflex (collagenase clostridium histolyticum). Auxilium Pharmaceuticals Inc, Norristown, PA.