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At high concentrations in vitro, clopidogrel inhibits P450 (C). Accordingly, Plavix may interfere with the metabolism of phenytoin, tamoxifen, tolbutamide, warfarin, torsemide, fluvastatin, and many non-steroidal anti-inflammatory agents, but there are no data with which to predict the magnitude of these interactions. Caution should be used when any of these drugs is co administered with Plavix.
To date there have been no reports of an important interaction in humans between warfarin and clopidogrel. Nonetheless, because warfarin increases the risk of bleeding, blood tests to measure the degree to which the blood is anti-coagulated or thinned (prothrombin time; INR) may be ordered to assess the degree of blood-thinning when warfarin and clopidogrel are used together.
Enhanced hypoprothrombinemic response to warfarin has been reported in patients with acute alcohol intoxication and/or liver disease. The proposed mechanisms are inhibition of warfarin metabolism and decreased synthesis of clotting factors. Binge drinking may exacerbate liver impairment and its metabolic ability in patients with liver dysfunction. The risk of bleeding may be increased. Conversely, reductions in INR/PT have also been reported in chronic alcoholics with liver disease.
Any grapefruit causes the liver to stop producing CYP 450 super-enzymes. These are necesssary to metabolize many drugs. Thus, at a minimum the drug will have no effect. Twenty-four hours later, the drug is still in the blood (unmetabolized) and you take a second dose. At this time the CYP superenzymes again begin to be produced sand you end up with too much of the drug metabolized. One issue is "how much grapefruit is necessary to affect the liver?" A single grapefruit is enough.
What you are talking about are the so-called superenzymes CYP 450 series, heme proteins and catalysts, produced in the liver. If you have been taking the combination together for a long time there is no risk of overdose. The problem with certain drugs is that they reduce the ability of the body to metabolize the drug, usually by oxidation but in some cases by reduction. This, initially the drug does not completely metabolize and has an extended half-life.
Unknown. Warfarin metabolism normally occurs through the cytochrome P450 (CYP450) isoenzyme system, with excretion occurring in the urine as inactive metabolites. It is postulated that large doses of acetaminophen may "exhaust" the capability of the CYP450 system to metabolize warfarin. Additionally, DARVOCET-N 100 TABLETS may reduce functional factor VII.
Management: Monitor coagulation status and adjust the dosage of COUMADIN 4MG TABLETS (BLUE) accordingly.
CYP 3A4 (major) into inactive and active metabolite (30 times less active than telaprevir)
Metabolic Inhibitor: CYP 3A4 - Substrate and inhibitor of P-gp (intestinal rather than systemic and would be saturable)
Buprenorphine Metabolic Substrate: CYP 3A4>2C8 (norbuprenorphine active metabolite), UGT 1A1 and other UGT (norbuprenorphine combination and its metabolites)
===>>>Significance: Non clinically significant interaction.
http://www.hivmedicationguide.com/details.asp?
Given that yesterday he said to not take the warfarin he was changing me from the genertic warfarin and putting me on the brand name of the med coumadin. Said some folks do not tolerate warfarin well but do well on coumadin and i am to start the coumadin today. I would be lying if i didn't say i am a bit gunshy at this point. This med has made me absolutely miserable and today is my 43rd bday...
Scientists know that some-thing in grapefruit inhibits an important enzyme, CYP 3A4, in the wall of the intestine. This enzymes critical for the breakdown of hundreds of medications. When its effectiveness is compromised, blood levels of such drugs can rise and trigger undesirable side effects. The responsible compound in grapefruit remains elusive.
Binge drinking will increase your INR (ie effect of warfarin) and chronic drinking will decrease INR because your liver enzymes are chronically bumped which increases metabolism of warfarin (so your body eliminates it faster and get get less effect). Don't look a scape goat. You were put on a blood thinner to REDUCE your risk of a clot because YOU HAVE an INCREASED risk that outweighs the risk of being on a blood thinner.
Take ownership of your health and take care of yourself.
Does anyone know if having your Gallbladder removed slows down your metabolism? or does it speed it up? What have you experienced?
If you really want to kick-start your metabolism, you may also try dividing your meals up into smaller portions that you eat more often throughout the day. Every time you eat, it helps your metabolism rise, so as strange as it may sound, eating frequently can help you lose weight or maintain a healthy weight.
Take care!
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