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Comments on the Important Drug Interaction of Warfarin and Sulfamethoxazole
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We read with interest the extensive review of drug interactions with warfarin by Holbrook et al.1 We strongly believe that sulfamethoxazole should be listed in the table stratifying warfarin drug interaction as a highly probable clinically significant interaction.
We recognize that in their comments, "azoles," which include sulfamethoxazole, were mentioned as a class of medications inhibiting CYP1A2 or CYP3A4. There was no further discussion of this potentially dangerous drug interaction.
Both our clinical experience and the literature2-4 support the high likelihood that the combined use of sulfamethoxazole with warfarin is dangerous. In our experience it is extremely common to see major international normalized ratio elevations when trimethoprim-sulfamethoxazole is added to warfarin therapy. A nonrandomized observational study also supports our opinion.2
Trimethoprim-sulfamethoxazole (Bactrim) is a very commonly used antibiotic for ear, sinus, lung, and bladder infections. The reality that many physicians may not recognize that sulfamethoxazole is a component of Bactrim . . . [Full Text of this Article]
AUTHOR INFORMATION
John Erwin Campbell, MD;
William H. Carter, MD
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Comments on the Important Drug Interaction of Warfarin and Sulfamethoxazole—Reply
Anne Holbrook and Jennifer Pereira
Arch Intern Med. 2005;165(21):2540.
EXTRACT
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Systematic Overview of Warfarin and Its Drug and Food Interactions
Anne M. Holbrook, Jennifer A. Pereira, Renee Labiris, Heather McDonald, James D. Douketis, Mark Crowther, and Philip S. Wells
Arch Intern Med. 2005;165(10):1095-1106.
ABSTRACT
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