ANTIDEPRESSANT INTERACTIONS WITH WARFARIN

The interactions between warfarin and antidepressants can have potenti ally serious consequences resulting from enhanced or reduced anticoagu lant activity. Information about such interactions was obtained from a Medline and hand search of the published literature, and by directly contacting manufacturers. The different classes of antidepressants are discussed in turn. The possible mechanisms are considered with partic ular reference to the cytochrome p450 system. From currently available data on the newer antidepressants our conclusions are that citalopram , nefazodone and sertraline may be relatively less likely to interact with warfarin. Fluoxetine, fluvoxamine, paroxetine and moclobemide app ear to have the highest potential of the antidepressants for interacti ons. There is insufficient data on venlafaxine to make a prediction. T he clinical implications of these findings are discussed and specific recommendations for International Normalized Ratio monitoring are sugg ested. (C) 1998 Rapid Science Ltd.