Drug General Information (ID: DDIXWL0H2A)
Drug Name			Warfarin		Drug Info		Chenodeoxycholic acid		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Anticoagulants				Gallstone Solubilizing Agents
Structure

Mechanism of Warfarin-Chenodeoxycholic acid Interaction (Severity Level: Moderate)
Increased risk of bleeding Click to Show/Hide Mechanism Graph
Drug Name		Warfarin				Chenodeoxycholic acid
Mechanism		Hemorrhages				Hepatotoxicity
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 Warfarin and Chenodeoxycholic acid

Recommended Action
Management		Patients on concomitant therapy with chenodeoxycholic acid and coumarin derivatives should be closely monitored. If prolongation of prothrombin time is observed, the coumarin dosage should be adjusted to give a prothrombin time 1.5 to 2 times normal. Discontinuation of chenodeoxycholic acid may be required in some cases. Patients should be advised to promptly report any signs of bleeding to their doctor, 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.

References
1	Product Information. Chenodal (chenodeoxycholic acid). Manchester Pharmaceutical, Fort Collins, CO.