No clinically significant interaction occurred between ezetimibeand warfarin in one study. However,raised INRs have been seenin patients taking warfarin after they were also given ezetimibe.
Clinical evidence,mechanism, importance and management
In a two-way,crossover study, 12 healthy subjects were given ezetimibe 10mg or placebo daily for 11 days, with a single 25mg dose of warfarin on day 7. The pharmacokinetics and pharmacodynamics (prothrombin time) of warfarin were not significantly altered by ezetimibe. In addition, pharmacokinetics of ezetimibe were similar to those previously seen with drug alone (See reference number 1). However, manufacturers of ezetimibe state that raised INRs have been seen in patients taking warfarin after they were also given ezetimibe. They therefore advise that INR should be monitored if ezetimibe is given with any coumarin or fluindione,(See reference number 2) (this is probably a prudent precaution for any indanedione).
Bauer KS,Kosoglou T, Statkevich P, Calzetta A, Maxwell SE, Patrick JE, Batra V. Ezetimibedoes not affect the pharmacokinetics or pharmacodynamics of warfarin. Clin Pharmacol Ther (2001) 69, P5.
Ezetrol (Ezetimibe). MSD-SP Ltd. UK Summary of product characteristics,December 2006.