A prescriber orders warfarin for a patient who is also taking fluconazole for a vaginal yeast infection. What is the expected clinical outcome and the mechanism responsible?

A prescriber orders warfarin for a patient

Multiple choice — select the best answer

ANo clinically significant interaction; warfarin is not metabolized by hepatic enzymes
BDecreased anticoagulant effect; fluconazole induces CYP2C9, increasing warfarin metabolism
CIncreased anticoagulant effect; fluconazole inhibits CYP2C9, decreasing warfarin metabolism
DDecreased anticoagulant effect; fluconazole displaces warfarin from plasma proteins

✓ Correct answer: C. Increased anticoagulant effect; fluconazole inhibits CYP2C9, decreasing warfarin metabolism Fluconazole is a potent CYP2C9 inhibitor; since S-warfarin (the more active enantiomer) is primarily metabolized by CYP2C9, co-administration raises warfarin plasma levels and significantly increases bleeding risk.

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A prescriber orders warfarin for a patient who is also taking fluconazole for a vaginal yeast infection. What is the expected clinical outcome and the mechanism responsible?

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