scholarly journals Case report: Medical cannabis—warfarin drug-drug interaction

2022 ◽  
Vol 4 (1) ◽  
Author(s):  
Tyan F. Thomas ◽  
Evdokia S. Metaxas ◽  
Thu Nguyen ◽  
Whitni Bennett ◽  
Kathryn V. Skiendzielewski ◽  
...  
Keyword(s):  
Elderly Patient ◽  
Drug Interaction ◽  
Case Report ◽  
Case Reports ◽  
Warfarin Dose ◽  
Medical Cannabis ◽  
Once Daily ◽  
Anticoagulation Treatment ◽  
Concurrent Use ◽  
Recent Addition

Abstract Aim A case of an 85-year-old patient with concurrent use of warfarin and medical cannabis containing delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) is described. Warfarin continues to be a cornerstone of anticoagulation treatment despite the recent addition of FDA-approved anticoagulant agents. It is well known that warfarin has numerous drug interactions; however, much remains unknown about its interaction with THC and CBD. A literature review was conducted to identify documented cases of possible interactions between cannabis and warfarin. The case reports we identified noted that cannabis may potentially increase warfarin’s effect. Therefore, we aimed to determine why an effect was not seen on our patient’s warfarin dose despite daily use of medical cannabis. Case This case report describes an 85-year-old patient who despite starting an oromucosal medical cannabis regimen of THC and CBD (which provided 0.3 mg of THC and 5.3 mg CBD once daily and an additional 0.625 mg of THC and 0.625 mg CBD once daily as needed) had minimal INR fluctuations from October 2018 to September 2019. Conclusion Despite the introduction and use of medical cannabis therapy, with both THC and CBD components, an elderly patient with concurrent warfarin use did not see major INR fluctuations, in contrast to published literature. The potential for warfarin and THC/CBD interactions may be dependent on route of administration and dose of the cannabis product.

scholarly journals Herb–Drug Interactions: Worlds Intersect with the Patient at the Center

Medicines ◽  
2021 ◽  
Vol 8 (8) ◽  
pp. 44
Author(s):  
Mary Beth Babos ◽  
Michelle Heinan ◽  
Linda Redmond ◽  
Fareeha Moiz ◽  
Joao Victor Souza-Peres ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Case Report ◽  
Drug Interactions ◽  
Clinical Studies ◽  
Drug Information ◽  
Case Reports ◽  
Full Information ◽  
Information Need ◽  
Herbal Products ◽  
Reduce Risk

This review examines three bodies of literature related to herb–drug interactions: case reports, clinical studies, evaluations found in six drug interaction checking resources. The aim of the study is to examine the congruity of resources and to assess the degree to which case reports signal for further study. A qualitative review of case reports seeks to determine needs and perspectives of case report authors. Methods: Systematic search of Medline identified clinical studies and case reports of interacting herb–drug combinations. Interacting herb–drug pairs were searched in six drug interaction resources. Case reports were analyzed qualitatively for completeness and to identify underlying themes. Results: Ninety-nine case-report documents detailed 107 cases. Sixty-five clinical studies evaluated 93 mechanisms of interaction relevant to herbs reported in case studies, involving 30 different herbal products; 52.7% of these investigations offered evidence supporting reported reactions. Cohen’s kappa found no agreement between any interaction checker and case report corpus. Case reports often lacked full information. Need for further information, attitudes about herbs and herb use, and strategies to reduce risk from interaction were three primary themes in the case report corpus. Conclusions: Reliable herb–drug information is needed, including open and respectful discussion with patients.

Possible Drug Interaction between Warfarin and Combination of Levamisole and Fluorouracil

1994 ◽  
Vol 28 (4) ◽  
pp. 464-467 ◽  
Author(s):  
Mary A. Scarfe ◽  
Marc K. Israel
Keyword(s):  
Atrial Fibrillation ◽  
Elderly Patient ◽  
Colon Cancer ◽  
Drug Interaction ◽  
Chemotherapy Regimen ◽  
Hepatic Metabolism ◽  
Chronic Atrial Fibrillation ◽  
Close Monitoring ◽  
Chemotherapeutic Regimen ◽  
Concurrent Use

OBJECTIVE: To report a possible drug interaction between the combination of fluorouracil (5-FU), levamisole, and warfarin. CASE SUMMARY: An elderly patient with chronic atrial fibrillation and prosthetic valve replacements had been taking warfarin 22.5 mg/wk. Following the diagnosis of colon cancer (Duke's classification D), a chemotherapy regimen of 5-FU and levamisole was started. Within four weeks after initiation of chemotherapy, the International Normalization Ratio (INR) increased from 3.04 to 39.56. Warfarin was discontinued and restarted at 7.5 mg/wk. Discontinuation of levamisole and 5-FU for a five-week period resulted in the INR falling to a subtherapeutic level. Reinstitution of the chemotherapeutic regimen once again led to an increase in INR. DISCUSSION: A literature search showed no reports of an interaction between warfarin and levamisole. However, prolongation of 5-FU half-life and an increase in INR have been reported with the concurrent use of 5-FU and warfarin. Inhibition of the hepatic metabolism of warfarin by 5-FU and levamisole is the postulated mechanism of this drug interaction. CONCLUSIONS: This case describes the clinically significant increase of INR in an elderly patient after adding a chemotherapy regimen of levamisole and 5-FU to a previous regimen of warfarin alone. The increasing incidence of both atrial fibrillation and colon cancer with age could potentially require the concomitant use of 5-FU, levamisole, and warfarin. Because of the potential severity of this interaction, close monitoring of INR and warfarin dosage adjustment is recommended in patients receiving warfarin along with levamisole and 5-FU.

scholarly journals Meropenem-induced Valproic Acid Elimination: A Case Report of Clinically Relevant Drug Interaction

2017 ◽  
Vol 118 (2-3) ◽  
pp. 105-109 ◽  
Author(s):  
Martin Šíma ◽  
Jan Hartinger ◽  
Jan Rulíšek ◽  
Robert Šachl ◽  
Ondřej Slanař
Keyword(s):  
Valproic Acid ◽  
Drug Interaction ◽  
Case Report ◽  
Serum Concentration ◽  
Dose Escalation ◽  
Treated Patient ◽  
Case Reports ◽  
Concomitant Administration ◽  
Serum Levels ◽  
Population Kinetic

We present two case reports of drug interaction between valproic acid and meropenem. In comparison with expected population-kinetic based serum levels, we observed 90.8 and 93.5% decrease in valproic acid serum levels during concomitant administration with meropenem. If carbapenems need to be administered to valproic acid treated patient, other anticonvulsant addition seems to be the appropriate as most probably the valproic acid dose escalation would not be sufficient to achieve therapeutic serum concentration.

scholarly journals Medical Cannabis for Adult Attention Deficit Hyperactivity Disorder: Sociological Patient Case Report of Cannabinoid Therapeutics in Finland

2018 ◽  
Vol 1 (2) ◽  
pp. 112-118 ◽  
Author(s):  
Aleksi Mikael Markunpoika Hupli
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Case Report ◽  
Attention Deficit ◽  
Case Reports ◽  
Endocannabinoid System ◽  
Immediate Release ◽  
Medical Cannabis ◽  
Patient Case ◽  
Hyperactivity Disorder ◽  
Medical Benefits

This paper presents a detailed patient case report of a male patient who was diagnosed in adulthood (aged 33) with attention deficit hyperactivity disorder (ADHD) and treated initially with immediate-release methylphenidate (Ritalin® 10 mg twice daily). After experiencing adverse effects from prolonged use of this medication and afterwards other medications that were prescribed as alternatives, the patient discovered that cannabinoid therapeutics (CT) had been experimented inside the EU area to treat patients with ADHD. Subsequently, he was evaluated by a physician in Germany (June 2010) who prescribed CT (Bedrocan®, Bediol®). A Finnish neurologist later confirmed the two prescribed medicines (Bedrocan®, October 2010; Bediol®, May 2011) in the patient’s own country of permanent residence (Finland). During a 5-year period of access, Bedrocan®, which mainly contains Δ9-tetrahydrocannabinol (Δ9-THC), was found to be helpful in alleviating the patient’s ADHD symptoms, in particular poor tolerance to frustration, outbursts of anger, boredom, and problems related to concentration. The second CT medication, Bediol®, which contains both Δ9-THC and the phytocannabinoid cannabidiol, was found to neutralize the excessive dronabinol effects of Bedrocan® as well as zo offer other medical benefits (e.g., improved sleep). In addition to the case report, this paper also offers a brief review of the literature surrounding the medical benefits of CT for AD(H)D, which includes observational studies, clinical case reports, and one randomized clinical experiment. This paper also briefly discusses the endocannabinoid system in relation to ADHD, although more preclinical and clinical research is warranted to establish the optimal levels of cannabinoids, terpenes, and dosing regimens, which vary between different ADHD patients.

Phenelzine and Morphine Drug-Drug Interaction? A Literature Review

2020 ◽  
pp. 089719002097075
Author(s):  
Ryan J. Beechinor ◽  
Rachel Tyson ◽  
Mary E. Roth
Keyword(s):  
Drug Interaction ◽  
Case Report ◽  
Single Case ◽  
Case Reports ◽  
Signs And Symptoms ◽  
Human Studies ◽  
Close Monitoring ◽  
Review Articles ◽  
Drug Drug Interaction

The objectives of this manuscript are to describe a case report of a patient whose phenelzine maintenance therapy was discontinued due to concern for a phenelzine-morphine drug interaction, to review the available literature regarding the potential for this drug-drug interaction, and provide recommendations for this clinical scenario. A PubMed/MEDLINE literature search was conducted and all publications determined to be relevant to this case report were included. Literature describing in vitro data, case reports/human studies, and review articles concerning the interaction between morphine and monoamine oxidase inhibitors (MAOIs) were included. A total of 14 publications pertinent to the potential phenelzine-morphine interaction were included in this review including 5 in vitro studies, 4 human studies, and 6 review articles detailing the drug interaction profile between opioids and antidepressants. Of these publications, only a single case report of a potential drug interaction between morphine and phenelzine was identified. The literature suggesting a drug interaction between morphine and phenelzine is limited. The combination of phenelzine and morphine, with close monitoring for signs and symptoms of serotonin syndrome, is reasonable for patients with appropriate indications for both agents.

scholarly journals Olanzapine-induced leucopaenia and thrombocytopaenia in an elderly patient: a case report and review of the evidence

2018 ◽  
Vol 31 (2) ◽  
pp. e000013 ◽  
Author(s):  
Yogender Kumar Malik ◽  
Swapnajeet Sahoo ◽  
Ajit Avasthi
Keyword(s):  
Elderly Patient ◽  
Case Report ◽  
Side Effects ◽  
Case Reports ◽  
The Elderly ◽  
Elderly Individual ◽  
Psychotic Symptoms ◽  
Elderly Individuals ◽  
Second Generation Antipsychotics ◽  
Life Threatening

Haematological adverse effects of antipsychotics are rare but life threatening. Existing literature is limited to case reports, which are mostly reported on second generation antipsychotics (clozapine, olanzapine, risperidone, quetiapine). Elderly individuals are at risk of developing side effects with any psychotropics. Olanzapine is commonly used for the management of psychotic symptoms as well as for the management of behavioural and psychological problems with dementia in the elderly. In this case report, we report thrombocytopaenia and leucopaenia in an elderly individual with schizophrenia which developed after initiation of olanzapine and reverted back after stoppage of the drug. This case report highlights that the elderly are susceptible to develop haematological side effects with olanzapine and hence monitoring may be essential.

scholarly journals Phenytoin toxicity as a forgoer of schizophrenia like psychosis: a case report

2019 ◽  
Vol 7 (7) ◽  
pp. 2853
Author(s):  
Prasanta Dihingia ◽  
Anshu Kumar Jha
Keyword(s):  
Case Report ◽  
Epileptic Patient ◽  
Case Reports ◽  
Once Daily ◽  
Time Period ◽  
Anti Epileptic Drug ◽  
Drug History ◽  
Triggering Factor ◽  
To Come ◽  
Phenytoin Toxicity

This is a case report describing the toxicity of phenytoin overdose. It is very uncommon to find an anti-epileptic drug causing psychosis and till date only a few studies have found such a co-relation. A psychiatric patient was admitted in our department of medicine with the complain of ingestion of 30 tablets of phenytoin. On examination he was found to have auditory and visual hallucinations. He was restless and had an ill sustained concentration. First and foremost, thing was to stop the prescribed phenytoin tablets and sedate the patient with haloperidol and promethazine. Then, he was switched over to Levetiracetam 500 mg i.v. thrice daily, Clobazam 10 mg once daily and Resperidone 3 mg twice daily. On investigation we found serum phenytoin level >40 mg/dl. This was sufficient to support our diagnosis as after stopping the drug his symptoms improved. There have been case reports of epileptic patient presenting with psychosis but usually after 10-15 years, unlike our case. In our case this time period was reduced to 12 hours as there was a triggering factor present. So, if a known epilepsy patient develops psychosis, the drug history should be given a big importance and if required serum phenytoin level should be assessed to come to the diagnosis of “phenytoin induced schizophrenia like psychosis.

scholarly journals Combination of venlafaxine and phentermine/topiramate induced psychosis: A case report

2018 ◽  
Vol 8 (2) ◽  
pp. 95-99 ◽  
Author(s):  
Jaclyn Homola ◽  
Robin Hieber
Keyword(s):  
Case Report ◽  
Extended Release ◽  
Case Reports ◽  
Individual Case ◽  
Once Daily ◽  
Pubmed Search ◽  
Self Harm ◽  
Irritable Bowel ◽  
Mental Health Unit ◽  
The Brain

Abstract Background: Various publications have noted increases in dopamine, specifically in the mesolimbic region of the brain, to have a direct correlation to psychotic-like symptoms. Venlafaxine, a first-line medication for depression, inhibits the reuptake of both serotonin and norepinephrine. Additionally, venlafaxine weakly inhibits the reuptake of dopamine. Phentermine/topiramate (Qsymia®), specifically the phentermine component, functions by blocking the dopamine and norepinephrine transporter, similar to amphetamine. Case Report: A 40-year-old Hispanic woman was admitted to the inpatient mental health unit based on reports of delusional thinking and several attempts of self-harm. Past medical history was significant for major depressive disorder, posttraumatic stress disorder, anxiety, irritable bowel syndrome, and migraines. The patient was started on venlafaxine (75 mg extended-release by mouth once daily) for depression approximately 1 month prior to admission. Furthermore, the patient was restarted on a previously prescribed medication, oral phentermine/topiramate for weight loss, in combination with venlafaxine, approximately 1 week prior to the bizarre behavior. The patient denied any psychosis or changes in behavior when medications were taken individually prior to the combination. The patient was treated with lurasidone (40 mg by mouth daily) with resolution of psychosis. Discussion: A PubMed search revealed no current literature or case reports on psychosis induced by the combination of venlafaxine and phentermine/topiramate. Individual case reports of psychosis in patients on venlafaxine alone and the phentermine component of phentermine/topiramate alone have been reported.

scholarly journals Intra-articular horizontal dislocation of the patella: a rare injury and review of the literature

2020 ◽  
Vol 13 (7) ◽  
pp. e232249
Author(s):  
Vasileios Despotidis ◽  
Johannes Weihs ◽  
Zacharia Joseph ◽  
Lampros Gousopoulos
Keyword(s):  
Elderly Patient ◽  
Case Report ◽  
Closed Reduction ◽  
Case Reports ◽  
Rare Injury ◽  
Orthopaedic Practice ◽  
Patella Dislocations ◽  
Language Of Publication ◽  
Superior Pole ◽  
Dislocation Of The Patella

Acute traumatic intra-articular dislocation of the patella is not a common presentation in orthopaedic practice; less frequently observed than extra-articular dislocation of the patella. In some of these cases, closed reduction is not possible and an open reduction in the operating theatre must be performed. In this case report, we present an elderly patient with an intra-articular horizontal dislocation of the patella without any other bony or ligamentous lesions seen in a postreduction MRI. We conducted a literature review looking at intra-articular patella dislocations, identifying 64 published studies (articles, case reports and papers). The following sources of data were searched until December 2017: PubMed, OVID, Google Scholar, Scopus, using the search strategy of (intra-articular dislocation of patella, horizontal patellar dislocation) with no limitation on the year or language of publication. The patient presented in this case report was managed with a closed reduction under general anaesthesia, without the need of any surgical intervention. As proposed in the literature, the hypothesis of an intra-articular entrapment of the patella due to the trapped osteophytes of the superior pole of the patella into the intercondylar notch was thought to be the cause of intra-articular dislocation in this elderly patient.

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