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    The INR was increased to 4. Topical and systemic ocular hypotensive drugs failed to reduce the intraocular pressure and later warranted enucleation due to extreme pain.

    Discussion This case possibly demonstrates a complication arising out of interaction among Warfarin, anti-platelets and anti-microbial agents. Warfarin, a drug that is highly protein bound and is metabolized by the hepatic cytochrome in the liver, acts by reducing the synthesis of vitamin K dependent clotting factors in the liver.

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    Anti-microbial agents are known to alter the gastro-intestinal flora and those like erythromycin also inhibit cytochrome enzyme system.

    Furthermore, macrolides competitively bind plasma proteins and thereby displacing Warfarin from the binding sites producing higher concentration of free Warfarin.

    In all probabilities, all these resulted in prolonged prothrombin time even after discontinuation of Warfarin.

  • You do not intended to avoid any food or symptoms if you're using a eyedrops, eye ointment or eardrops.
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  • Erythromycin is also known to potentiate Warfarin-induced hypo-prothrombinemia by slowing Warfarin clearance. The use of ciplrofloxacin and metronidazole also probably resulted in potentiating the actions of Warfarin. Ciprofloxacin inhibits cytochrome P 450 in a similar manner, and Metronidazole appears to inhibit the activity of the enzyme responsible for oxidation of Warfarin.


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