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https://doi.org/10.24546/0100492951

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メタデータID
0100492951
アクセス権
open access
出版タイプ
Version of Record
タイトル
Prolonged Prothrombin Time due to Drug–Drug Interaction of Warfarin after the Change from Bosentan to Macitentan: A Case of Pharmacist Intervention in the Outpatient Clinic
著者
Kurimura, Tomoko ; Omura, Tomohiro ; Yamamoto, Kazuhiro ; Tanaka, Hidekazu ; Kimura, Takeshi ; Itohara, Kotaro ; Kitahiro, Yumi ; Habu, Yasushi ; Sakane, Toshiyasu ; Yano, Ikuko
著者名
Kurimura, Tomoko
著者ID
A2517
研究者ID
1000000439035
ORCID
0000-0001-5520-253X
KUID
https://kuid-rm-web.ofc.kobe-u.ac.jp/search/detail.html?systemId=2d29530d752c12b2520e17560c007669
著者名
Omura, Tomohiro
大村, 友博
オオムラ, トモヒロ
所属機関名
医学部附属病院
著者ID
A2417
研究者ID
1000030610349
著者名
Yamamoto, Kazuhiro
山本, 和宏
ヤマモト, カズヒロ
所属機関名
医学部附属病院
著者ID
A1439
研究者ID
1000020590342
KUID
https://kuid-rm-web.ofc.kobe-u.ac.jp/search/detail.html?systemId=f08c30b91aeb7da2520e17560c007669
著者名
Tanaka, Hidekazu
田中, 秀和
タナカ, ヒデカズ
所属機関名
医学部附属病院
著者名
Kimura, Takeshi
著者ID
A3285
研究者ID
1000000870445
ORCID
0000-0002-7982-7881
KUID
https://kuid-rm-web.ofc.kobe-u.ac.jp/search/detail.html?systemId=03c58f8a78293e52520e17560c007669
著者名
Itohara, Kotaro
糸原, 光太郎
イトハラ, コウタロウ
所属機関名
医学部附属病院
著者ID
A3251
著者名
Kitahiro, Yumi
北廣, 優実
キタヒロ, ユミ
所属機関名
医学部附属病院
著者名
Habu, Yasushi
著者名
Sakane, Toshiyasu
著者ID
A0421
研究者ID
1000050273446
KUID
https://kuid-rm-web.ofc.kobe-u.ac.jp/search/detail.html?systemId=c67473c1ec5daab2520e17560c007669
著者名
Yano, Ikuko
矢野, 育子
ヤノ, イクコ
所属機関名
医学部附属病院
言語
English (英語)
収録物名
The Kobe journal of the medical sciences
巻(号)
70(4)
ページ
125-129
出版者
Kobe Journal of Medical Sciences　刊行会
Kobe Journal of Medical Sciences
刊行日
2024
抄録
A woman in her 70s who was taking warfarin 3.75 mg/day had a prothrombin time-international normalized ratio (PT-INR) within the therapeutic range. Her medication for pulmonary hypertension was changed from bosentan to macitentan. After 40 days, she developed respiratory distress, anorexia, and vomiting caused by common cold. When she visited the pharmaceutical outpatient clinic without reservation, the pharmacist suspected that bosentan discontinuation, which cancelled cytochrome P450 (CYP) 2C9 and CYP3A4 enzyme induction, and decreased vitamin K intake due to appetite loss had enhanced warfarin effect, causing PT-INR prolongation. The pharmacist requested the physician to examine the patient’s PT- INR. Results showed that her PT-INR was >7. Hence, she was urgently hospitalized. Warfarin and macitentan were discontinued, and the patient’s PT-INR decreased to 1.77 after the intravenous administration of vitamin K. Her appetite improved, and warfarin 2 mg/day was resumed. Additionally, when she had been administered macitentan, her hemoglobin levels decreased from 10.8 to 6.6 mg/dL. Therefore, the pharmacist and the physician during hospitalization planned to resume treatment with bosentan, but not with macitentan. The pharmacist proposed to increase the warfarin dose to 3.75 mg since the bosentan and warfarin interaction could lower PT-INR. Thereafter, the patient’s PT-INR was controlled within the therapeutic range, and her hemoglobin level was 8–9 mg/dL. The patient was discharged on day 17 of admission. Thus, pharmacist intervention plays a significant role in warfarin control with consideration of drug–drug interaction in patients receiving pulmonary hypertension treatment.
キーワード
Warfarin
Bosentan
PT-INR
Drug–drug interaction
Pharmacist intervention
カテゴリ
医学部附属病院
The Kobe journal of the medical sciences ＞ 70巻 ＞ 70巻4号（2024）
紀要論文
権利
©2024 Kobe Journal of Medical Sciences Publisher.
CC license
This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0).