Extermely prolognged INR associated with warfarin in combination with both trazodone and omega 3 fatty acids: a case report

To report a case of case of excessive anticogulation in patient taking fish oil, trazodone and warfain. CASE SUMMARY: A 65-year – old white man had been taking warfarin for 6 months after an episode ofpost – operative pulmonary thrombombolism (PTE) .His past medical history was otherwise insignificant. He recivied a prescription oftrazodone and fish oil fon not – very – well defined complaint.two weeks after taking these medications.when he routinely checked his international normalized ratio (INR) he came to the emergency department (ED) with a test result showing and INR of 8.06 he was admitted for abservation and all medications were then re-started . two wekks later his coagulation profile was within the desried therapeutic range. DISCUSSION: Co-administraion of warfarin wigh mega -3 farty acids can lead to additional anticoagularion. This can result from changes chither in platelet aggregation or vitamin K-dependent coagulation factors.trazodone also has interactions with warfarin through not well – underesttod mechanisms. Although as late – onset and clinically insignificant,this has been questioned in other studies. This particular case illustrates possibl;e interactions between warfarin and these two medication. CONSLUSIONS: This case emphasizes the need for patient educaion about potential drug interactions with warfarin,especially with the emergence and popularity of herbal druges and supplements.

Keywords:

fish oil , omega -3 polyunstarated fatty acid , trazodone , warfarin , drug interaction.