Potentiation of Warfarin Associated with Salsalate Therapy Resulting in Bleeding

Title:Potentiation of Warfarin Associated with Salsalate Therapy Resulting in Bleeding

Volume: 13 Issue: 2

Author(s): Joseph P. Rindone*Chadwick K. Mellen

Affiliation:

• Clinical Pharmacy Section, Northern Arizona VA Health Care System, Hwy 89, Prescott, AZ 86313,United States

Keywords: Warfarin, salsalate therapy, interaction, INR, NSAIDS, antibiotic.

Abstract: Background: Salsalate may offer many advantages over other non-steroidal antiinflammatory agents in patients taking warfarin, however a drug-drug interaction may occur which has not been reported in the medical literature or by the manufacturer of salsalate.

Objective: To report a case of warfarin potentiation associated with salsalate treatment, which resulted in bleeding.

Method: Clinical review of the course of a patient, who was stable on warfarin when salsalate therapy was added for chronic pain.

Case Report: A patient taking stable doses of warfarin for over 1 year (with good control) was prescribed salsalate 3 g/day for pain in his knee and lower back. Approximately 1 month later he presents to the anticoagulation clinic with bruising and an International Normalized Ratio (INR) of 6.8. The patient had a good response to his salsalate therapy and wanted to continue it. The warfarin was held for 3 days and dose lowered by 50 %. His bruising then subsided and he had good control of his warfarin therapy with INRs ranging from 1.9 to 2.2 over the next 4 months. The patient was then lost to follow up.

Conclusion: This case illustrates a strong association between starting salsalate and subsequent potentiation of warfarin, which heretofore has not been reported in the medical literature.

Cite this article as:

Rindone P. Joseph *, Mellen K. Chadwick , Potentiation of Warfarin Associated with Salsalate Therapy Resulting in Bleeding, Current Drug Safety 2018; 13 (2) . https://dx.doi.org/10.2174/1574886313666180219165742