RESUMEN
Interactions between warfarin and penicillins have been infrequently reported. A case report of a single patient who experienced the effects of a warfarin-nafcillin interaction as well as a warfarin-dicloxacillin interaction is presented. Clinical effects of this interaction were documented primarily through changes in prothrombin time (PT) and the need for higher warfarin dosing. While the patient received nafcillin, warfarin doses were increased to as much as 4.5 times the previous amounts needed to provide adequate anticoagulation. During dicloxacillin therapy, warfarin doses were gradually decreased, but stabilized to a maintenance dose higher than the patient's pre-nafcillin dose. The dicloxacillin-warfarin interaction appears similar to that noted during nafcillin-warfarin combination.
Asunto(s)
Dicloxacilina/uso terapéutico , Endocarditis Bacteriana/tratamiento farmacológico , Prótesis Valvulares Cardíacas/efectos adversos , Nafcilina/uso terapéutico , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Warfarina/uso terapéutico , Adulto , Válvula Aórtica , Dicloxacilina/farmacocinética , Interacciones Farmacológicas , Monitoreo de Drogas , Quimioterapia Combinada , Endocarditis Bacteriana/sangre , Humanos , Masculino , Nafcilina/farmacocinética , Infecciones Relacionadas con Prótesis/sangre , Tiempo de Protrombina , Warfarina/farmacocinéticaRESUMEN
BACKGROUND: Many patients with depression are seen only by family physicians, yet it is unknown how their physicians prescribe newer antidepressants. METHODS: Charts of family practice patients receiving fluoxetine were reviewed using a standardized format. Information reviewed included patient demographics, diagnosis, prescriptions, and course of treatment. RESULTS: Depression was documented in 92.5% of the 40 patients studied. There were significantly more female patients in the fluoxetine sample than in the base sample of depressed patients (P < .04). Fluoxetine patients weighed significantly more than the base sample, with a mean difference of 20.8 pounds (P < .03). Side effects were documented in the charts of 12 (30%) patients. Prescription practice was considered optimal in 43% of patients who were told to take fluoxetine in the morning. No differences in improvement or side effects were found based on optimal prescribing behavior. Improvement was documented in 68% of patients. Fluoxetine was discontinued in 6 (15%) cases because of adverse side effects. CONCLUSIONS: An improvement rate of 68% among patients taking 20 to 40 mg of fluoxetine per day indicates that an adequate response can be achieved without the risk of side effects that typically accompany higher doses. In this study, fluoxetine was prescribed more often to obese patients. This prescribing pattern may indicate that primary care physicians perceive overweight patients as good candidates for fluoxetine regardless of inconclusive evidence about the effectiveness of this drug for weight loss.