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In November 3 patients under the care of the Leeds Anticoagulant Service had INR's > 8 due to the interaction between Daktarin (miconazole) oral gel and warfarin. One patient was admitted bleeding with an INR of 22.
This interaction is well documented and is flagged up on EMIS and System One. The combination SHOULD NOT be used together. The interaction is due to miconazole inhibiting the enzymes responsible for warfarin metabolism leading to high levels of warfarin and an increased risk of bleeding.
An alternative is Nystatin."

Thanks for your help,
Katherine

Katherine Stirling
Consultant Pharmacist - Anticoagulation and Thrombosis Gledhow Wing, SJUH
0113 2065170
0113 2433144 bleep 2316

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