คำอธิบาย
Fluoxetine increases warfarin plasma levels via CYP2C9 inhibition and may independently impair platelet function, raising hemorrhagic risk.
กลไก
Fluoxetine and its active metabolite norfluoxetine inhibit CYP2C9, reducing S-warfarin clearance; SSRI-mediated platelet serotonin depletion further impairs hemostasis.
ความสำคัญทางคลินิก
Case series document significant INR elevations and bleeding events (GI hemorrhage, bruising) when fluoxetine is added to stable warfarin regimens.
การจัดการ
Monitor INR within 1–2 weeks of starting or stopping fluoxetine; the long half-life of norfluoxetine means effects persist for weeks after fluoxetine discontinuation.
ข้อจำกัดความรับผิดชอบทางการแพทย์
This content is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before making medication decisions.