Case Report
Copyright ©2010 Baishideng. All rights reserved.
World J Gastrointest Pharmacol Ther. Feb 6, 2010; 1(1): 40-42
Published online Feb 6, 2010. doi: 10.4292/wjgpt.v1.i1.40
Drug interaction presenting as acute abdomen
Rajesh Pendlimari, Rajeswari Anaparthy, Aravind Sugumar
Rajesh Pendlimari, Division of Colon & Rectal Surgery, Mayo Clinic, Rochester, MN 55905, United States
Rajeswari Anaparthy, Division of Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States
Aravind Sugumar, Division of Gastroenterology & Hepatology, Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: Pendlimari R and Sugumar A designed the research; Pendlimari R did the background search and drafted the manuscript; Anaparthy R and Sugumar A reviewed and edited the manuscript.
Correspondence to: Rajesh Pendlimari, MBBS, Division of Colon & Rectal Surgery, Mayo Clinic, 200 First street SW, Rochester, MN 55905, United States.
Telephone: +1-507-2669164 Fax: +1-507-2841794
Received: December 8, 2009
Revised: January 20, 2010
Accepted: January 27, 2010
Published online: February 6, 2010

Warfarin is the most common oral anticoagulant prescribed around the world. Adverse drug interactions with warfarin are a huge problem especially in the elderly and in patients who take multiple medications. Most adverse drug interactions involve concomitantly prescribed oral or intravenous medications. Occasionally, topical or mucosally absorbed drugs can interact, leading to fluctuations in warfarin levels with adverse consequences. In this case report, we describe a case of intestinal intramural hematoma, a rare but known consequence of a supra therapeutic international normalized ratio (INR). The supra therapeutic INR was a consequence of mucosally absorbed miconazole, prescribed for vaginal candidiasis. We wish to highlight this rare and potentially fatal drug interaction, along with the need for frequent INR monitoring when new drugs are added or removed in patients taking warfarin.

Keywords: Warfarin, Intramural hematoma, Miconazole, Drug interactions, International normalized ratio, Supra therapeutic