Co-prescription of H2 receptor blockers and proton pump inhibitors with warfarin in general practice
A Pali S Hungina, Greg P Rubinb, Hilda O'Flanaganc
a Centre for Health
Studies, Elvet Riverside, University of Durham, Durham DH1 3JT, UK, b Department of Primary
Health Care, The Medical School, University of Newcastle upon Tyne,
NE2, UK, c The Health Centre,
Eaglescliffe, Stockton on Tees TS16 9EA, UK
Accepted 5 July 1999
Acid-suppressing drugs and anticoagulants are used
increasingly in general practice. Warfarin is potentiated by some
acid-suppressing drugs, notably cimetidine and omeprazole, through
interference of the cytochrome P450 system. This study aimed to
ascertain the extent of co-prescribing of warfarin and acid-suppressing
drugs in general practice. We conducted a retrospective survey of the records of all patients prescribed acid-suppressing drugs over a 2-year
period to ascertain those who had also taken warfarin; we also made a
cross-sectional survey of all patients on warfarin to ascertain those
who had taken acid-suppressing drugs. From a general practice
population of 45 574 patients in northern England, 3423 (7.5%) had
been prescribed acid-suppressing drugs during the previous 24 months.
Of 274 patients who had been on warfarin, 44 (16.1%) had also taken
acid-suppressing drugs (26 H2 receptor blockers and 18 proton-pump
inhibitors). The commonest reasons for anticoagulation were
thrombo-embolic disease (40.9%), atrial fibrillation (36.4%),
valvular heart disease (18.2%), and surgical prophylaxis (4.5%). The
indications for concurrent acid-suppressing drugs were: `dyspepsia'
38.6%, reflux 22.7%, oesophagitis 13.6%, duodenal ulcer 13.6%,
gastric ulcer 4.5%, unknown 6.8%. There have been no studies from
primary care to evaluate the possible clinical effects of the
concomitant use of acid-suppressing drugs and warfarin; some
fluctuations in coagulation control, particularly in patients taking
the combinations intermittently, may be due to this.
Keywords: H2 receptor blockers; acid-suppressing drugs; warfarin; proton pump inhibitors
© 1999 by The Fellowship of Postgraduate Medicine
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