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Overanticoagulation associated with combined use of lactulose and acenocoumarol or phenprocoumon
Author(s) -
Visser Loes E.,
Penningvan Beest Fernie J. A.,
Wilson J. H. P.,
Vulto Arnold G.,
Kasbergen A. A. Harrie,
De Smet Peter A. G. M.,
Hofman Albert,
Stricker Bruno HCh
Publication year - 2004
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1046/j.1365-2125.2003.02036.x
Subject(s) - lactulose , acenocoumarol , medicine , laxative , phenprocoumon , confidence interval , cohort , drug , population , relative risk , cohort study , warfarin , pharmacology , constipation , environmental health , atrial fibrillation
Some medical textbooks on drug interactions take note of the potential interaction between laxatives and coumarin anticoagulants, but epidemiological evidence that this interaction is of practical importance is lacking. We conducted a follow‐up study in a large population‐based cohort to investigate which laxatives are associated with overanticoagulation during therapy with coumarins. Of the 1124 patients in the cohort, 351 developed an International Normalized Ratio ≥ 6.0. The only laxative with a moderate but significantly increased relative risk of overanticoagulation was lactulose (relative risk 3.4, 95% confidence interval 2.2, 5.3). In view of the widespread use of lactulose, especially among the elderly, awareness of this potential drug interaction is required.