Análisis de interacciones medicamentosas en paciente anticoagulado que recibe tratamiento concomitante con miconazol y paracetamol automedicado

Abstract

Introduction: There are factors that predispose to the appearance of drug interactions, such as the use of drugs with a narrow therapeutic index, advanced age and self-medication, some interactions are potentially dangerous due to the adverse reactions they trigger. In this investigation, the case of an anticoagulated patient who received miconazole and self-medicated with paracetamol was addressed. Objective: To analyze the possible drug interactions in anticoagulated patients receiving concomitant treatment with miconazole and self-medicated paracetamol through a bibliographic review to identify the appropriate guidelines that allow the improvement of the patient. Methodology: It was based on the search and bibliographic analysis of scientific sources such as high-impact articles, books, manuals and clinical practice guides in order to identify drug interactions presented by the patient. Results: The interactions between the drugs were pharmacokinetic (warfarin-miconazole) and pharmacodynamic (warfarin-paracetamol) in nature, producing a type A adverse reaction. It was recommended to stop pharmacological treatment until INR (International normalized ratio) normalized and then continue with maintenance doses of warfarin. The substitution of miconazole for nystatin was also proposed as a safer alternative and recommendations to prevent subsequent situations. Conclusion: Drug interactions triggered an increase in the anticoagulant effect of warfarin, which caused the appearance of bruising and a high risk of bleeding as a type A adverse reaction. The need to educate the patient about his disease and the care to be taken into account to avoid future complications is emphasized.