{"title":"Very High Warfarin Dosing Requirements in a Patient With Tuberculosis and a Pulmonary Embolism: A Case Report.","authors":"Marcus Mize, Carrie Baker, Riley D Bowers","doi":"10.1177/08971900241285226","DOIUrl":null,"url":null,"abstract":"<p><p><b>Purpose:</b> To describe a case of significantly increased warfarin requirements in a patient receiving rifampin for the management of tuberculosis. <b>Summary:</b> A 76-year-old male was admitted due to altered mentation, cough, and weight loss. He was diagnosed concurrently with tuberculosis and a pulmonary embolism. Given the profound effect of rifampin on CYP450 enzymes, direct oral anticoagulants were avoided and warfarin therapy was selected. Management was further complicated by a gastrointestinal bleed during admission, history of cancer, and low body weight. After several weeks of daily international normalized ratio monitoring, a stable regimen of 14 mg of warfarin daily was established, allowing for the patient's safe discharge. <b>Practice Implications:</b> This report underscores the significance of tailored treatment plans, vigilant monitoring, and interdisciplinary collaboration which are necessary to navigate the complexities associated with these medications and optimize patient outcomes.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"8971900241285226"},"PeriodicalIF":1.0000,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of pharmacy practice","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/08971900241285226","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: To describe a case of significantly increased warfarin requirements in a patient receiving rifampin for the management of tuberculosis. Summary: A 76-year-old male was admitted due to altered mentation, cough, and weight loss. He was diagnosed concurrently with tuberculosis and a pulmonary embolism. Given the profound effect of rifampin on CYP450 enzymes, direct oral anticoagulants were avoided and warfarin therapy was selected. Management was further complicated by a gastrointestinal bleed during admission, history of cancer, and low body weight. After several weeks of daily international normalized ratio monitoring, a stable regimen of 14 mg of warfarin daily was established, allowing for the patient's safe discharge. Practice Implications: This report underscores the significance of tailored treatment plans, vigilant monitoring, and interdisciplinary collaboration which are necessary to navigate the complexities associated with these medications and optimize patient outcomes.
期刊介绍：
The Journal of Pharmacy Practice offers the practicing pharmacist topical, important, and useful information to support pharmacy practice and pharmaceutical care and expand the pharmacist"s professional horizons. The journal is presented in a single-topic, scholarly review format. Guest editors are selected for expertise in the subject area, who then recruit contributors from that practice or topic area.
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