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Adverse drug reactions in Canada.

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VOL 50: OCTOBER • OCTOBRE 2004d Canadian Family Physician • Le Médecin de famille canadien 1417

FP Watch

Surveillance médicale

Adverse drug

reactions in Canada

Fluoroquinolones and warfarin:

suspected interactions

A

s of January 15, 2004, Health Canada had received 57 reports of suspected coagulation disorders associated with fl uoroquinolones and warfarin. Ten cases involved ciprofl oxacin, 13 gati- fl oxacin, 16 levofl oxacin, 12 moxifl oxacin, and six norfl oxacin. Forty-nine reports were considered serious; 16 involved adverse reactions resulting in hospital admission. Fluoroquinolones might enhance the effects of warfarin or its deriva- tives during concomitant administration of these drugs. Prothrombin time and international nor- malized ratio should be monitored closely, espe- cially in elderly patients, and dose of anticoagulant adjusted accordingly.

Suspected warfarin–

cranberry juice interaction

In September 2003 the United K i n g d o m’s C o m m i t t e e o n Safety of Medicines and the Medicines and Healthcare prod- ucts Regulatory Agency high- lighted a possible interaction between warfarin and cranberry

juice and advised patients taking warfarin to limit or avoid drinking cranberry juice. They had received eight reports since 1999 of a pos- sible interaction that led to changes in the inter- national normalized ratio or bleeding. Given warfarin’s narrow therapeutic margin, patients should be aware of which drugs, natural health products, and food products might be associ- ated with interactions.

Case presentations

• Tutoplast Dura graft: possible association with Creutzfeldt-Jakob disease

• Toxic shock syndrome and tampons: the risk remains

Summary of advisories

A summary of health professional and consumer advisories posted between February 10, 2004, and May 17, 2004, is available in this issue of the Canadian Adverse Reaction Newsletter. To consult the full listing, see http://

www.hc-sc.gc.ca/hpfb-dgpsa/

tpd-dpt/index_advisories_e.html.

Source: Health Canada. Canadian Adverse Reaction Newsletter 2004;14(3):1-3. For the com- plete text of any of these reports, check the website www.hc-sc.gc.ca/

hpfb-dgpsa/tpd-dpt/index_adverse_

newsletter_e.html.

www.hc-sc.gc.ca/hpfb-dgpsa/tpd-dpt/index_adverse_newsletter_e.html www.hc-sc.gc.ca/hpfb-dgpsa/tpd-dpt/index_adverse_newsletter_f.html

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