Letter to the Editor

In Response to “Further Evidence of a Clinically Significant Levofloxacin-Warfarin Interaction”

Authors: Roger D. Smalligan, MD, MPH, Raja Vadlamudi, MD, MPH, Hassan M. Ismail, MD, MPH

Abstract

To the Editor:


We would like to thank Dr. Glasheen and colleagues for their comments regarding our case series of bleeding complications encountered when levofloxacin and warfarin were combined. It appears that their important retrospective cohort study of the effect of the addition of antibiotics on the international normalized ratio of ill patients who are on stable doses of warfarin was not included in our literature search; however, they did indeed have a subgroup (n = 32) of patients treated with levofloxacin who showed a statistically significant international normalized ratio rise of 0.85.1 We agree that this is supportive evidence to our strong recommendation to monitor patients closely who are given these two common medications concomitantly.

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References

1. Glasheen JJ, Fugit RV, Prochazka AV. The risk of overanticoagulation with antibiotic use in outpatients on stable warfarin regimens. J Gen Intern Med 2005;20:653–656.
 
2. Glasheen JJ, Fugit RV, Prochazka AV. Effect of levofloxacin coadministration on the international normalized ratios during warfarin therapy—a comment [letter]. Pharmacotherapy 2003;23:1079–1080.
 
3. Yamreudeewong W, Lower DL, Kilpatrick DM, et al. Effect of levofloxacin coadministration on the international normalized ratios during warfarin therapy. Pharmacotherapy 2003;23:333–338.