2023 Volume 10 Issue 1 Pages 55-60
A male in his 80s presented to our clinic. The physician instructed us to discontinue warfarin and change to direct oral anticoagulant (Direct oral anticoagulant ; DOAC) for prolongation to PT-INR 3.5. As 1% lanoconazole cream had been prescribed 14 days prior to patient presentation, it was suspected that the drug enhanced the action of warfarin by inhibition of CYP2C9. We informed the physician that the case of PT-INR prolongation might be due to the combination of warfarin and imidazole antifungal topical drugs. The physician announced that warfarin will be resumed after confirming the discontinuation of the use of 1% lanoconazole cream and warfarin withdrawal at the next physician's house call date. Later, when we provided information to the physician regarding the appropriate period of withdrawal of warfarin, the physician instructed us to resume the use of warfarin on the same day. Since then, PT-INR has remained in the appropriate range, and it was confirmed that extension has not been approved. In this case, it is thought that it is possible to provide appropriate drug treatment by conducting home visits under the instruction of a physician and providing necessary information on drug use.
