A case of PT-INR prolongation in a patient taking warfarin while using imidazole antifungal topical drugs who was able to continue the use of medication with home management

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  • イミダゾール系抗真菌外用薬使用中にPT-INR延長を来したワルファリン服用患者において在宅管理上で投薬継続が可能となった一例
  • イミダゾールケイ コウシンキン ガイヨウヤク シヨウ チュウ ニ PT-INR エンチョウ オ キタシタ ワルファリン フクヨウ カンジャ ニ オイテ ザイタク カンリ ジョウ デ トウヤク ケイゾク ガ カノウ ト ナッタ イチレイ

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Abstract

<p>A male in his 80s presented to our clinic. The physician instructed us to discontinue warfarin and change to direct oral anticoagulant (Direct oral anticoagulant ; DOAC) for prolongation to PT-INR 3.5. As 1% lanoconazole cream had been prescribed 14 days prior to patient presentation, it was suspected that the drug enhanced the action of warfarin by inhibition of CYP2C9. We informed the physician that the case of PT-INR prolongation might be due to the combination of warfarin and imidazole antifungal topical drugs. The physician announced that warfarin will be resumed after confirming the discontinuation of the use of 1% lanoconazole cream and warfarin withdrawal at the next physician's house call date. Later, when we provided information to the physician regarding the appropriate period of withdrawal of warfarin, the physician instructed us to resume the use of warfarin on the same day. Since then, PT-INR has remained in the appropriate range, and it was confirmed that extension has not been approved. In this case, it is thought that it is possible to provide appropriate drug treatment by conducting home visits under the instruction of a physician and providing necessary information on drug use.</p>

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