EVALUATION OF THE PHARMACOCINETICS OF WARFARIN IN THE TRIANGLE OF FOOD, DRUG AND WARFARIN

Öz

Well managed and planned warfarin treatment has been an important anticoagulation alternative and guidance of anticoagulant providers has been a promoter for obtaining optimum results. Warfarin is currently one of the most widely used oral anticoagulants despite its complex pharmacokinetic and pharmacodynamic profile. It is clinically difficult to reach optimal anticoagulation with this agent due to its multiple food and medicine interactions. Drug therapy has to be individualized for each patient and the possibility of enhancement, intoxication or decrease in the efficacy of concomitantly used appropriate herbal and other medicines by warfarin must always be kept in mind. Inappropriate control and monitorization of anticoagulation may expose patients to excess or ineffective anticoagulation leading to hemorrhage or thromboembolic complication risks respectively. Especially fluctuations in the ingestion of vitamin K has a significant effect on the degree of anticoagulation in patients receiving varfarin treatment. Additionally, various dietary supplements and recent increase in herbal medicinal products may lead to unwanted results in levels of anticoagulation. The aim of this review is to discuss the effects of most frequently used drugs, food and dietary supplements on the pharmacokinetics of warfarin.

Anahtar Kelimeler

• Drug-food interactions
• anticoagülants
• warfarin
• pharmacokinetic
• bioavailability

BESİN, İLAÇ VE VARFARİN ÜÇGENİNDE, VARFARİNİN FARMAKOKİNETİĞİNİN DEĞERLENDİRİLMESİ

Öz

İyi yönetilen ve planlanan varfarin tedavisi önemli bir antikoagülan seçenek olmuştur ve antikoagülasyon sağlayıcılarının rehberliği optimum sonuçları elde etmeyi kolaylaştırmıştır. Karmaşık farmakokinetik ve farmakodinamik profiline rağmen, varfarin, günümüzde de en yaygın kullanılan oral antikoagülan ajanlardan biridir. Bu ajan ile optimal antikoagülasyona ulaşmak, birçok gıda ve ilaç etkileşimi nedeniyle klinik olarak zordur. İlaç tedavisi her bir hastaya uyacak şekilde özel olarak uyarlanmalı ve uygun şekilde birlikte kullanılabilecek bitkisel ilaçların ve diğer ilaçların etkinliğini artırabileceği veya ilaç toksisitesini azaltabileceği mutlaka göz önünde bulundurulmalıdır. Uygunsuz antikoagülasyon kontrolü, hastaları sırasıyla aşırı ve yetersiz koagülasyon nedeniyle kanama veya tromboembolik komplikasyon riskinde artışa maruz bırakabilmektedir. Özellikle K vitamini alımındaki dalgalanmaların, varfarin ile tedavi edilen hastalarda antikoagülasyon derecesi üzerinde önemli bir etkisi bulunmaktadır. Ek olarak, çeşitli diyet takviyeleri ve bitkisel ürünlerin kullanımındaki artış da antikoagülan seviyelerinde istenmeyen sonuçlara yol açabilmektedir. Bu derlemenin amacı, en sık kullanılan ilaçlar, besin ve diyet takviyelerinin varfarinin farmakokinetiği üzerindeki etkilerini tartışmaktır.

Anahtar Kelimeler

• İlaç-besin etkileşimleri
• antikoagülanlar
• varfarin
• farmakokinetik
• biyoyararlanım

Kaynakça

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