Taking warfarin and antibiotics at the same time

Posted by sayaboleh @sayaboleh, Apr 16, 2019

I was wondering if anyone is taking both warfarin and antibiotics like Bactrim? I tested positive for Stenotrophomonas Maltophilia recently – really rare it seems. At first they prescribed Bactrim and then changed their mind. That let me to wonder if the big 3 also interacts with warfarin and how to deal with that. Is anyone familiar with that particular bacteria? They found it in the sputum culture. I have not been able to see my pulmonologist since the results came back 2 weeks ago and it is giving me a great deal of concern.
Mary

Hi @sayaboleh that must be nerve-wracking to have multiple medications for different reasons.

I wanted to tag fellow Connect members @predictable and @tresjur as they have experience with Warfarin and may be able to offer their experience with that medication and if they ever were on an antibiotic at the same time.

Back to you @sayaboleh have you discussed your concerns with your doctor?

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Hello @sayaboleh, I'm responding at Ethan's invitation and from the perspective of a long-time user of Warfarin. I haven't heard of any caution about interactions between Warfarin and antibiotics, and I have not taken an antibiotic since I started taking Warfarin 5 years ago. The infective agent you mentioned is contracted from water-borne bacteria, is rare among humans, and is known usually as a agent found in hospitals. Literature also says it is resistant to antibiotics in a significant percentage of cases. I take Warfarin to prevent blood clots forming in my heart and blocking small arteries carrying oxygenated blood around my body. Do you have access to a primary care physician (in addition to your pulmonologist) who could evaluate your antibiotic and your Warfarin prescriptions? Can you communicate with your doctors by phone or email?

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@predictable

Hello @sayaboleh, I'm responding at Ethan's invitation and from the perspective of a long-time user of Warfarin. I haven't heard of any caution about interactions between Warfarin and antibiotics, and I have not taken an antibiotic since I started taking Warfarin 5 years ago. The infective agent you mentioned is contracted from water-borne bacteria, is rare among humans, and is known usually as a agent found in hospitals. Literature also says it is resistant to antibiotics in a significant percentage of cases. I take Warfarin to prevent blood clots forming in my heart and blocking small arteries carrying oxygenated blood around my body. Do you have access to a primary care physician (in addition to your pulmonologist) who could evaluate your antibiotic and your Warfarin prescriptions? Can you communicate with your doctors by phone or email?

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Hi Martin and Ethan — thanks for the response. There are major interactions bet. warfarin and almost all antibiotics which interfere with vitamin K. The one he prescribed was so severe that the pharmacist refused to fill it. I find that I always have to adjust my dose (been on warfarin for 20 yrs) when I take any antibiotic. Unfortunately, short of showing up at the various clinics I have been leaving phone and email messages to all my providers and no one is getting back to me. I realize they probably have many other patients who are much sicker than me… Still. Even worse, I am unable to make an appointment to see my pulmonologist just because they have none. This is UCSF – a big hospital. I am really at a loss. I read the same things you did about S. maltophilia (no idea where I got it – have not been hospitalized for several years) and it is pretty scary. I did have a brief conversation with my pulmonologist a few days ago and he did not seem very concerned other than prescribing an antibiotic that I should not take. He is aware now but has yet to offer any other alternatives. I have an appt. to see another pulmonologist at Stanford but that's not for 3 weeks. Hoping he has a cancellation and I can see him sooner. I wish there was another MAC expert closer to me but I can't seem to locate any. My main concern is to stop producing bloody sputum. I was told it was the Bronchietasis and I did read some of the posts pertaining. Again, it is usually treated with antibiotics and my providers are reluctant to prescribe.
Mary

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Hello @sayaboleh,

I would also like to invite, @windwalker, to this discussion. Terri has been mentoring the group on MAC/Bronchiectasis for a while now and she might have some other thoughts for you.

Just wondering, have ever seen an infectious disease specialist?

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@hopeful33250

Hello @sayaboleh,

I would also like to invite, @windwalker, to this discussion. Terri has been mentoring the group on MAC/Bronchiectasis for a while now and she might have some other thoughts for you.

Just wondering, have ever seen an infectious disease specialist?

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Hi Teresa — no I haven't. I finally saw my pulmonologist yesterday and was told the S. maltophilia was not a big deal. okay… Mainly because I have no symptoms other than the hemoptysis. I was asked to stop nebulizing for a few days since that might be causing the bleeding. Being on warfarin doesn't help obviously. No antibiotics for now. What I heard yesterday was reassuring. They did say that their scheduling was a big messed up and that I can page the doctor if I can't reach him any other way.
Mary

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Hello @sayaboleh,

I'm glad that you posted an update. I am also glad that you were able to get some supportive help from your doctor as well as some reassurance.

Please remember that it is always your option to get a second opinion if you are still not comfortable with your present health situation.

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@hopeful33250. Hi Terri…Yes. there is that option and fortunately I do have an appt. with the only other doctor in California listed on the NTM list. I've often wondered if it is worth the effort going to either Tyler (will be in Texas next month so can pose that question there) or Denver. It is a little difficult to decide since I have very mild symptoms. I was quite sick several weeks ago but am a lot better now other than hemoptysis. Have stopped nebulizing after reading that it was likely causing a problem with the irritation. If that goes away I should be fine otherwise it will be another course of antibiotics which may or may not help but will definitely interact with the warfarin I am taking….All manageable but a pain nonetheless.
Mary

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@hopeful33250

Hello @sayaboleh,

I would also like to invite, @windwalker, to this discussion. Terri has been mentoring the group on MAC/Bronchiectasis for a while now and she might have some other thoughts for you.

Just wondering, have ever seen an infectious disease specialist?

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@sayabola & @hopeful332, Seeing an Infectious Disease dr isn't a bad idea.

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@sayaboleh

@hopeful33250. Hi Terri…Yes. there is that option and fortunately I do have an appt. with the only other doctor in California listed on the NTM list. I've often wondered if it is worth the effort going to either Tyler (will be in Texas next month so can pose that question there) or Denver. It is a little difficult to decide since I have very mild symptoms. I was quite sick several weeks ago but am a lot better now other than hemoptysis. Have stopped nebulizing after reading that it was likely causing a problem with the irritation. If that goes away I should be fine otherwise it will be another course of antibiotics which may or may not help but will definitely interact with the warfarin I am taking….All manageable but a pain nonetheless.
Mary

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@sayabola There is another member in our group whose mom was just diagnosed with that same kind of bacteria. Her drs don't want to put her on antibiotics to treat it either.Iam not familiar with this bug, but from what I have read; it is common for Cystic Fibrosis patients to get this. You can always contact the CF Foundation and ask for more info on that.

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