DRUG-INTERACT-001 medical data_error ai_generated true

AI recommends ibuprofen for pain relief to a patient on warfarin without warning about increased bleeding risk

ID: medical/warfarin-ibuprofen-interaction

Also available as: JSON · Markdown · 中文
82%Fix Rate
87%Confidence
1Evidence
2024-02-15First Seen

Version Compatibility

VersionStatusIntroducedDeprecatedNotes
warfarin 5mg active — — —
ibuprofen 200mg active — — —
INR monitoring protocol v2.3 active — — —

Root Cause

NSAIDs like ibuprofen inhibit platelet aggregation and can displace warfarin from protein binding, significantly elevating INR and bleeding risk; this interaction is a known contraindication in anticoagulation management.

generic

中文

布洛芬等非甾体抗炎药抑制血小板聚集并可能置换与蛋白质结合的华法林，显著升高INR和出血风险；此相互作用在抗凝管理中为已知禁忌症。

Official Documentation

https://www.fda.gov/drugs/drug-interactions-labeling/drug-interactions-warfarin

Workarounds

  1. 88% success Use acetaminophen (paracetamol) at max 3000mg/day and advise patient to inform their anticoagulation clinic; run `python -c "print('WARNING: Acetaminophen max 3000mg/day for warfarin patients')"` as reminder 
    Use acetaminophen (paracetamol) at max 3000mg/day and advise patient to inform their anticoagulation clinic; run `python -c "print('WARNING: Acetaminophen max 3000mg/day for warfarin patients')"` as reminder
  2. 75% success Recommend non-pharmacological pain management: ice, rest, physical therapy; document in EHR as alternative to NSAIDs 
    Recommend non-pharmacological pain management: ice, rest, physical therapy; document in EHR as alternative to NSAIDs
  3. 80% success If NSAID unavoidable, prescribe COX-2 selective inhibitor (e.g., celecoxib) with strict INR monitoring every 3 days; use `inr_check_frequency=3` in anticoagulation management system 
    If NSAID unavoidable, prescribe COX-2 selective inhibitor (e.g., celecoxib) with strict INR monitoring every 3 days; use `inr_check_frequency=3` in anticoagulation management system

中文步骤

  1. Use acetaminophen (paracetamol) at max 3000mg/day and advise patient to inform their anticoagulation clinic; run `python -c "print('WARNING: Acetaminophen max 3000mg/day for warfarin patients')"` as reminder
  2. Recommend non-pharmacological pain management: ice, rest, physical therapy; document in EHR as alternative to NSAIDs
  3. If NSAID unavoidable, prescribe COX-2 selective inhibitor (e.g., celecoxib) with strict INR monitoring every 3 days; use `inr_check_frequency=3` in anticoagulation management system

Dead Ends

Common approaches that don't work:

  1. 95% fail

    Food does not prevent systemic NSAID effects on platelet function or warfarin displacement; bleeding risk remains

  2. 70% fail

    Acetaminophen is safer but requires dose adjustment in hepatic impairment; liver toxicity risk if patient consumes alcohol regularly

  3. 85% fail

    Bleeding may be internal (e.g., GI, intracranial) without visible signs until severe; reactive monitoring is insufficient