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, Warfarin interactions FLAMES
o Fluconazole
o Levofloxacin (really increase INR)
o Amiodarone (worse interaction - decrease warfarin dose by 50%)
o Metronidazole (decrease warfarin dose by 1/3)
o Erythromycin (macrolides in general but this one is the worse)
o Sulf-TMP
CYP Inducers PS PORCS
o Phenytoin
o Smoking
o Phenobarbital
o Oxcarbazepine (and eslicarbamazepine)
o Rifampin
o Carbamazepine (and its auto-inducer)
o St. John's wort
CYP Inhibitors G PACMAN
o Grapefruit
o Protease Inhibitors
o Azoles
o C - cyclosporine, cimetidine, cobicistat
o Macrolides
o Amiodarone
o Non-DHP CCBs (diltiazem and verapamil)
5 G's (natural products) that increase bleeding risk o Gingko
o Garlic
o Ginger
o Glucosamine
o Gingseng