Other safety alerts
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| The United Kingdom: Warfarin and other blood thinners: reminder on safe use during COVID-19 pandemic |
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The Medicines and Healthcare products Regulatory Agency (MHRA) announces that it has issued advice to healthcare professionals and patients on the monitoring of patients taking blood thinning tablets (also known as anticoagulants) during the COVID-19 pandemic.
The advice includes a reminder for doctors to continue regular blood tests in patients taking warfarin or any other vitamin K antagonist such as acenocoumarol (‘Sinthrome’) or phenindione (‘Dindevan’) and who have developed an additional illness. The blood test will indicate if patients need to change the dose of their anticoagulant. In particular, it is important these regular blood tests are done in any patients with symptoms of COVID-19 or who have tested positive so that they can be given the right care at an early stage to reduce the risk of bleeding. It is therefore important that patients or their carers let their general practitioner and anticoagulation clinic know if they have tested positive for COVID-19 or are ill with COVID-19 symptoms (high temperature, new continuous cough, loss of sense of smell or taste).
The advice also includes a reminder of the potential for drug interactions between some anticoagulant tablets and medicines used to treat infections, for example antivirals or antibiotics (such as doxycycline, amoxicillin or clarithromycin, which may interact with warfarin or other vitamin K antagonists). Other anticoagulants tablets, including apixaban (‘Eliquis’), dabigatran (‘Pradaxa’), edoxaban (‘Lixiana’) or rivaroxaban (‘Xarelto’), can also interact with certain medicines. These drug interactions can potentially increase the blood-thinning effect of some anticoagulants and lead to a higher risk of bleeding. Further information on these interactions can be found in the patient information leaflet which accompanies each pack of medicine.
If patients are taking warfarin or any other vitamin K antagonist, it is important to be consistent with what they eat and drink because this may affect how well this medicine works. They should not drink large amounts of alcohol while taking warfarin or any other vitamin K antagonist. Always take the daily dosage at the same time of day swallowed whole with a glass of water. Additionally, patients or their carers should let their general practitioner and anticoagulation clinic know if they:
- have sickness or diarrhoea or have lost their appetite;
- have started taking any new medicines, including antibiotics, antivirals, over the counter medicines, herbal remedies or vitamin supplements;
- have recently stopped smoking or are drinking more, or less, alcohol than usual;
- are taking warfarin or any other vitamin K antagonist and are unable to attend their next scheduled blood test for any reason, including because they feel unwell.
Please refer to the following website in MHRA for details:
http://www.gov.uk/government/news/warfarin-and-other-blood-thinners-reminder-on-safe-use-during-covid-19-pandemic
http://www.gov.uk/government/publications/warfarin-and-other-anticoagulants-monitoring-of-patients-during-the-covid-19-pandemic
In Hong Kong, there are registered pharmaceutical products containing warfarin (8 products), apixaban (2 products), dabigatran (3 products), edoxaban (3 products) and rivaroxaban (7 products). All products are prescription-only medicines. There is no registered pharmaceutical products containing acenocoumarol or phenindione. So far, the Department of Health (DH) has received adverse drug reaction related to warfarin (13 cases), apixaban (31 cases), dabigatran (12 cases), edoxaban (20 cases) and rivaroxaban (19 cases).
Recommendations on international normalised ratio (INR) measurements and allowances for any events that might influence the activity of warfarin, and drug interactions between warfarin and antibacterials and antivirals are documented in reputable drug references such as the “Martindale: The Complete Drug Reference”. Information on drug interactions for apixaban, dabigatran, edoxaban and rivaroxaban are also included in the local product insert of the products. The DH will remain vigilant on safety update of the drugs issued by other overseas drug regulatory authorities.
Ends/Wednesday, Oct 14, 2020
Issued at HKT 15:00
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