Warfarin therapy: how the less interesting half just got interesting.

摘要

Coumadin (.R/S-warfarin) is the standard medication in anticoagulant therapy for 20 million Americans [1] as well as patients in Japan, the UK, and elsewhere. Warfarin treatment is highly efficacious, but susceptible to complex drug interactions that potentiate health risks. Consequently, an understanding of drug interaction mechanisms for warfarin is critical. Although coumadin is prescribed as an equal mixture of enantiomers, S-warfarin is more potent than R-warfarin [2], so drugs targeting S-warfarin metabolism have constituted the focus of interaction studies. In fact, most drug interactions occur through either direct competition or regulation of 5-warfarin metabolism by CYP2C9 [3].