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  • Title: Hyperprothrombinemia as a result of a possible warfarin and intravaginal miconazole interaction.
    Author: Thomas JL, Dunn D, Pelletier A, Franks AS.
    Journal: South Med J; 2010 Oct; 103(10):1063-5. PubMed ID: 20802381.
    Abstract:
    Warfarin, a commonly prescribed anticoagulant, has many potential drug interactions. We describe a case of intravaginal miconazole potentiating the effects of warfarin in a patient previously stable on a consistent dose of 8.5 mg warfarin daily. Following a course of intravaginal miconazole and a dosage increase to 9 mg daily, her international normalized ratio (INR) increased from 2.0 to 5. After the course of miconazole was complete, the patient was stable with a therapeutic INR (mean INR 2.9) on 9 mg warfarin daily. Clinicians should consider the possibility of systemic absorption of intravaginal miconazole, and a resultant increase in warfarin's anticoagulant effect.
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