Drug General Information (ID: DDIXB2HOK5)
Drug Name			Dicoumarol		Drug Info		Flutamide		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Anticoagulants				Antineoplastics
Structure

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

Recommended Action
Management		Patients should be monitored for altered anticoagulation and advised to report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, nosebleeds, bleeding of gums from brushing, bruising, red or brown urine, or red or black stools.

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. Eulexin (flutamide). Schering Laboratories, Kenilworth, NJ.