Protein Information

Name CYP450 (protein family or complex)
Synonyms cytochrome P450; cytochrome P 450; CYP450; CYP 450

Compound Information

Name warfarin
CAS

Reference List

PubMed Abstract RScore(About this table)
19252308 Tatsumi A, Ikegami Y, Morii R, Sugiyama M, Kadobayashi M, Iwakawa S: Effect of ethanol on S-warfarin and diclofenac metabolism by recombinant human CYP2C9.1. Biol Pharm Bull. 2009 Mar;32(3):517-9.

The effect of ethanol on the metabolism of S-warfarin and diclofenac by recombinant cytochrome P450 2C9.1 microsomes (CYP2C9.1) was studied.
31(0,1,1,1) Details
19637955 Komperda KE: Potential interaction between pomegranate juice and warfarin. . Pharmacotherapy. 2009 Aug;29(8):1002-6.

Investigators from previous animal and in vitro studies have reported a potential for pomegranate juice to inhibit metabolism involving the cytochrome P450 system, an effect that could translate into a clinical drug-diet interaction with warfarin.
31(0,1,1,1) Details
19799531 Perez-Andreu V, Roldan V, Gonzalez-Conejero R, Hernandez-Romero D, Vicente V, Marin F: Implications of pharmacogenetics for oral anticoagulants metabolism. . Curr Drug Metab. 2009 Jul;10(6):632-42.

Metabolism of warfarin occurs through the action of three different cytochrome P-450 enzymes.
31(0,1,1,1) Details
19719333 Izzo AA, Ernst E: Interactions between herbal medicines and prescribed drugs: an updated systematic review. Drugs. 2009;69(13):1777-98. doi: 10.2165/11317010-000000000-00000.

Clinical trials indicate that St John's wort (Hypericum perforatum), via cytochrome P450 (CYP) and/or P-glycoprotein induction, reduces the plasma concentrations (and/or increases the clearance) of alprazolam, amitriptyline, atorvastatin, chlorzoxazone, ciclosporin, debrisoquine, digoxin, erythromycin, fexofenadine, gliclazide, imatinib, indinavir, irinotecan, ivabradine, mephenytoin, methadone, midazolam, nifedipine, omeprazole, oral contraceptives, quazepam, simvastatin, tacrolimus, talinolol, verapamil, voriconazole and warfarin.
31(0,1,1,1) Details
19348697 Daly AK: Pharmacogenomics of anticoagulants: steps toward personal dosage. Am J Med Sci. 2008 Feb;335(2):126-36.

Genotype for CYP2C9, which encodes the main cytochrome P450 enzyme that metabolizes warfarin, and VKORC1, the gene encoding the warfarin target vitamin K epoxide reductase, together account for approximately 30% of the variability in dose requirement.
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19181737 Aomori T, Yamamoto K, Oguchi-Katayama A, Kawai Y, Ishidao T, Mitani Y, Kogo Y, Lezhava A, Fujita Y, Obayashi K, Nakamura K, Kohnke H, Wadelius M, Ekstrom L, Skogastierna C, Rane A, Kurabayashi M, Murakami M, Cizdziel PE, Hayashizaki Y, Horiuchi R: Rapid single-nucleotide polymorphism detection of cytochrome P450 (CYP2C9) and vitamin K epoxide reductase (VKORC1) genes for the warfarin dose adjustment by the SMart-amplification process version 2. Clin Chem. 2009 Apr;55(4):804-12. Epub 2009 Jan 30.
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18480003 King CR, Porche-Sorbet RM, Gage BF, Ridker PM, Renaud Y, Phillips MS, Eby C: Performance of commercial platforms for rapid genotyping of polymorphisms affecting warfarin dose. Genome Med. 2009 Jan 21;1(1):10.

Pharmacogenetic-based dosing algorithms can improve accuracy of initial warfarin dosing but require rapid genotyping for cytochrome P-450 2C9 (CYP2C9) *2 and *3 single nucleotide polymorphisms (SNPs) and a vitamin K epoxide reductase (VKORC1) SNP.
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19679631 Linder MW, Bon Homme M, Reynolds KK, Gage BF, Eby C, Silvestrov N, Valdes R Jr: Interactive modeling for ongoing utility of pharmacogenetic diagnostic testing: application for warfarin therapy. Clin Chem. 2009 Oct;55(10):1861-8. Epub 2009 Aug 13.

METHODS: We analyzed clinical information, plasma S-warfarin concentration, and CYP2C9 (cytochrome P450, family 2, subfamily C, polypeptide 9) and VKORC1 (vitamin K epoxide reductase complex, subunit 1) genotypes for 137 patients with stable INRs.
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19490292 Schaffer SD, Yoon S, Zadezensky I: A review of smoking cessation: potentially risky effects on prescribed medications. J Clin Nurs. 2009 Jun;18(11):1533-40.

RESULTS: Although much of the evidence is case report, dosage adjustments are clearly indicated for warfarin, olanzapine, clozapine and theophylline since they are metabolised by cytochrome P450 CYP1A2 and also have narrow therapeutic ratios.
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20204461 Shaw PB, Donovan JL, Tran MT, Lemon SC, Burgwinkle P, Gore J: Accuracy assessment of pharmacogenetically predictive warfarin dosing algorithms in patients of an academic medical center anticoagulation clinic. J Thromb Thrombolysis. 2010 Mar 5.

Seventy-one patients of an outpatient anticoagulation clinic at an academic medical center who were age 18 years or older on a stable, therapeutic warfarin dose with international normalized ratio (INR) goal between 2.0 and 3.0, and cytochrome P450 isoenzyme 2C9 (CYP2C9) and vitamin K epoxide reductase complex subunit 1 (VKORC1) genotypes available between January 1, 2007 and September 30, 2008 were included.
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20072940 Roederer MW: Cytochrome P450 enzymes and genotype-guided drug therapy. Curr Opin Mol Ther. 2009 Dec;11(6):632-40.

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18363537 Hornsby LB, Hester EK, Donaldson AR: Potential interaction between warfarin and high dietary protein intake. Pharmacotherapy. 2008 Apr;28(4):536-9.

The potential for increased dietary protein intake to raise serum albumin levels and/or cytochrome P450 activity has been postulated as mechanisms for the resulting decrease in INRs.
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20147896 Dumond JB, Vourvahis M, Rezk NL, Patterson KB, Tien HC, White N, Jennings SH, Choi SO, Li J, Wagner MJ, La-Beck NM, Drulak M, Sabo JP, Castles MA, Macgregor TR, Kashuba AD: A Phenotype-Genotype Approach to Predicting CYP450 and P-Glycoprotein Drug Interactions With the Mixed Inhibitor/Inducer Tipranavir/Ritonavir. Clin Pharmacol Ther. 2010 Feb 10.

The subjects received oral (p.o.) caffeine, warfarin + vitamin K, omeprazole, dextromethorphan, and midazolam and digoxin (p.o. and intravenous (i.v.)) at baseline, during the first three doses of TPV/r (500 mg/200 mg b.i.d.), and at steady state.
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19245785 DiMaio Knych HK, DeStefano Shields C, Buckpitt AR, Stanley SD: Equine cytochrome P450 2C92: cDNA cloning, expression and initial characterization. Arch Biochem Biophys. 2009 May 1;485(1):49-55. Epub 2009 Feb 24.

CYP2C92 demonstrated comparable tolbutamide and (S)-warfarin hydroxylase activity compared to CYP2C9, upon addition of b (5) to the reactions.
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18488070 Whitley HP, Fermo JD, Chumney EC, Brzezinski WA: Effect of patient-specific factors on weekly warfarin dose. Ther Clin Risk Manag. 2007 Jun;3(3):499-504.

METHODS: Information collected, via retrospective chart review, included TWD, general demographics, vitamin K consumption, target INR range, use of alcohol, tobacco, and cytochrome P450 (CYP)-inducing medications, and concomitant medications and diseases.
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18381488 Lu C, Berg C, Prakash SR, Lee FW, Balani SK: Prediction of pharmacokinetic drug-drug interactions using human hepatocyte suspension in plasma and cytochrome P450 phenotypic data. Drug Metab Dispos. 2008 Jul;36(7):1261-6. Epub 2008 Apr 1.

Using the available P450 phenotypic information on theophylline, tolbutamide, omeprazole, S-warfarin, phenytoin, cyclosporine, and midazolam and that determined in this study for sirolimus and tacrolimus, we found that the predictions for area under the curve increases for most of these drugs in the presence of fluconazole were remarkably similar (within 35%) to the observed clinical values.
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18421623 Mukoyoshi M, Nishimura S, Hoshide S, Umeda S, Kanou M, Taniguchi K, Muroga H: In vitro drug-drug interaction studies with febuxostat, a novel non-purine selective inhibitor of xanthine oxidase: plasma protein binding, identification of metabolic enzymes and cytochrome P450 inhibition. Xenobiotica. 2008 May;38(5):496-510.

The results have shown that the presence of ibuprofen or warfarin did not change the plasma protein binding of febuxostat, and that febuxostat did not influence the plasma protein binding of ibuprofen or warfarin.
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18503398 Hameed MS, Nafziger AN, Gartung AM, Bertino JS Jr: Pharmacodynamics of uniform versus nonuniform warfarin dosages. Pharmacotherapy. 2008 Jun;28(6):707-11.

SUBJECTS: Twenty healthy subjects who had the extensive metabolizer cytochrome P450 (CYP) genotype of 2C9*1/*1 or CYP2C9*1/*3.
1(0,0,0,1) Details
20002088 Turpault S, Brian W, Van Horn R, Santoni A, Poitiers F, Donazzolo Y, Boulenc X: Pharmacokinetic assessment of a five-probe cocktail for CYPs 1A2, 2C9, 2C19, 2D6 and 3A. Br J Clin Pharmacol. 2009 Dec;68(6):928-35.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: * Numerous cocktails using concurrent administration of several cytochrome P450 (CYP) isoform-selective probe drugs have been reported to investigate drug-drug interactions in vivo. * This approach has several advantages: characterize the inhibitory or induction potential of compounds in development toward the CYP enzymes identified in vitro in an in vivo situation, assess several enzymes in the same trial, and have complete in vivo information about potential CYP-based drug interactions.
WHAT THIS STUDY ADDS: * This study describes a new cocktail containing five probe drugs that has never been published. * This cocktail can be used to test the effects of a new chemical entity on multiple CYP isoforms in a single clinical study: CYP1A2 (caffeine), CYP2C9 (warfarin), CYP2C19 (omeprazole), CYP2D6 (metoprolol), and CYP3A (midazolam) and was designed to overcome potential liabilities of other reported cocktails.
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18844284 Panossian A, Hovhannisyan A, Abrahamyan H, Gabrielyan E, Wikman G: Pharmacokinetic and pharmacodynamic study of interaction of Rhodiola rosea SHR-5 extract with warfarin and theophylline in rats. Phytother Res. 2009 Mar;23(3):351-7.

Significant pharmacokinetic/pharmacodynamic interactions between various herbal products and drugs being substrates of cytochrome P450 have recently been reported.
1(0,0,0,1) Details
18277121 Baciewicz AM, Chrisman CR, Finch CK, Self TH: Update on rifampin and rifabutin drug interactions. . 2 p following 1035. Epub 2009 Sep 8.

Rifampin is a potent inducer of cytochrome P-450 oxidative enzymes as well as the P-glycoprotein transport system.
Several examples of well-documented clinically significant interactions include warfarin, oral contraceptives, cyclosporine, itraconazole, digoxin, verapamil, nifedipine, simvastatin, midazolam, and human immunodeficiency virus-related protease inhibitors.
1(0,0,0,1) Details
19171677 Yang M, Kabulski JL, Wollenberg L, Chen X, Subramanian M, Tracy TS, Lederman D, Gannett PM, Wu N: Electrocatalytic drug metabolism by CYP2C9 bonded to a self-assembled monolayer-modified electrode. Drug Metab Dispos. 2009 Apr;37(4):892-9. Epub 2009 Jan 26.

Cytochrome P450 (P450) enzymes typically require the presence of at least cytochrome P450 reductase (CPR) and NADPH to carry out the metabolism of xenobiotics.
To determine whether this system could metabolize warfarin analogous to microsomal or expressed enzyme systems containing CYP2C9, warfarin was incubated with the CYP2C9-SAM-gold electrode and a controlled potential was applied.
1(0,0,0,1) Details
18431572 Zhang ZY, King BM, Pelletier RD, Wong YN: Delineation of the interactions between the chemotherapeutic agent eribulin mesylate (E7389) and human CYP3A4. Cancer Chemother Pharmacol. 2008 Sep;62(4):707-16. Epub 2008 Apr 23.

Eribulin competitively inhibited the testosterone 6beta-hydroxylation, nifedipine dehydration, and R-warfarin 10-hydroxylation activities of rCYP3A4, with an average apparent K (i) of approximately 10 microM.
Since drug-induced modulation of cytochrome P450 enzymes, particularly CYP3A4, is a frequent cause of drug-drug interactions, we examined the effects of eribulin on the activity and expression of hepatic and recombinant CYP3A4 (rCYP3A4) in vitro.
1(0,0,0,1) Details
19074529 Si D, Wang Y, Zhou YH, Guo Y, Wang J, Zhou H, Li ZS, Fawcett JP: Mechanism of CYP2C9 inhibition by flavones and flavonols. Drug Metab Dispos. 2009 Mar;37(3):629-34. Epub 2008 Dec 12.

This article describes an in vitro investigation of the inhibition of cytochrome P450 (P450) 2C9 by a series of flavonoids made up of flavones (flavone, 6-hydroxyflavone, 7-hydroxyflavone, chrysin, baicalein, apigenin, luteolin, scutellarein, and wogonin) and flavonols (galangin, fisetin, kaempferol, morin, and quercetin).
Computer docking simulation and constructed mutants substituted at residue 100 of CYP2C9.1 indicate that the noncompetitive binding site of 6-hydroxyflavone lies beside Phe100, similar to the reported allosteric binding site of warfarin.
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19067473 Vakily M, Lee RD, Wu J, Gunawardhana L, Mulford D: Drug interaction studies with dexlansoprazole modified release (TAK-390MR), a proton pump inhibitor with a dual delayed-release formulation: results of four randomized, double-blind, crossover, placebo-controlled, single-centre studies. Clin Drug Investig. 2009;29(1):35-50. doi: 10.2165/0044011-200929010-00004.

BACKGROUND AND OBJECTIVE: Most proton pump inhibitors are extensively metabolized by cytochrome P450 (CYP) isoenzymes, as are many other drugs, giving rise to potential drug-drug interactions.
METHODS: Four separate randomized, double-blind, two-way crossover, placebo-controlled, single-centre studies were conducted in healthy volunteers to evaluate the effect of dexlansoprazole on the pharmacokinetics of four test substrates (diazepam, phenytoin, theophylline [administered as intravenous aminophylline] and warfarin), which were selected based on in vitro and/or in vivo data that suggest a potential drug interaction with CYP isoenzymes or potentially coadministered narrow therapeutic index drugs.
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18701850 Yasui Y, Nishiguchi T, Yamamoto A, Fujii C, Fujino M, Tsuge M, Ohno M, Azuma J, Matsumura T, Ohsato H, Anami S, Furukawa H: [A case of bleeding tendency due to warfarin in a patient treated with chemotherapy by S-1]. Gan To Kagaku Ryoho. 2008 Aug;35(8):1367-70.

We tried to analyze the genotype of a patient, who had a tendency to bleed by coadministration of WF with S-1, in terms of hepatic cytochrome P-450 (CYP) 2C9 and vitamin K epoxide reductase complex subunit 1 (VKORC1).
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20029019 Jarvis S, Li C, Bogle RG: Possible interaction between pomegranate juice and warfarin. . Emerg Med J. 2010 Jan;27(1):74-5.

Laboratory studies have shown that pomegranate juice inhibits cytochrome P450 enzymes involved in warfarin metabolism.
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18606741 Tai G, Dickmann LJ, Matovic N, DeVoss JJ, Gillam EM, Rettie AE: Re-engineering of CYP2C9 to probe acid-base substrate selectivity. Drug Metab Dispos. 2008 Oct;36(10):1992-7. Epub 2008 Jul 7.

We expressed and purified the R108E and R108E/D293N mutants and compared their ability with that of native CYP2C9 to interact with (S)-warfarin, diclofenac, pyrene, propranolol, and ibuprofen amine.
Collectively, these data underscore the importance of the amino acid at position 108 in the acid substrate selectivity of CYP2C9, highlight the accommodating nature of the CYP2C9 active site, and provide a cautionary note regarding facile re-engineering of these complex cytochrome P450 active sites.
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19397481 Lippi G, Franchini M, Favaloro EJ: Pharmacogenetics of vitamin K antagonists: useful or hype? . Clin Chem Lab Med. 2009;47(5):503-15.

Growing evidence indicates that up to 60% of the individual pharmacological response to coumarins might be due to genetic variables and affected by polymorphisms in the genes encoding two enzymes, namely, vitamin K epoxide reductase (VKOR) and cytochrome P450 CYP2C9.
Genetic testing has been proposed as a useful tool for allowing prediction of the dose response during initial anticoagulation therapy, to assess variability in dose maintenance and to identify warfarin 'resistance'.
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19408964 Miller GP, Jones DR, Sullivan SZ, Mazur A, Owen SN, Mitchell NC, Radominska-Pandya A, Moran JH: Assessing cytochrome P450 and UDP-glucuronosyltransferase contributions to warfarin metabolism in humans. Chem Res Toxicol. 2009 Jul;22(7):1239-45.
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18670159 Ishizuka M, Tanikawa T, Tanaka KD, Heewon M, Okajima F, Sakamoto KQ, Fujita S: Pesticide resistance in wild mammals--mechanisms of anticoagulant resistance in wild rodents. J Toxicol Sci. 2008 Aug;33(3):283-91.

Warfarin is commonly used worldwide as a rodenticide.
An accelerated detoxification system involving cytochrome P450 (CYP) could also cause the rodenticide resistance.
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18367983 Dasgupta A: Herbal supplements and therapeutic drug monitoring: focus on digoxin immunoassays and interactions with St. Ther Drug Monit. 2008 Apr;30(2):212-7.

Significantly reduced concentrations of various therapeutic drugs such as digoxin, theophylline, cyclosporine, tacrolimus, tricyclic antidepressants, warfarin, and protease inhibitors can be observed due to interaction of these drugs with St.
John's wort, a popular herbal antidepressant, increase the clearance of certain drugs either by increasing the activity of liver or intestinal cytochrome P-450 mixed-function oxidase or through modulation of the P-glycoprotein efflux pump.
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18855611 Zhou SF, Di YM, Chan E, Du YM, Chow VD, Xue CC, Lai X, Wang JC, Li CG, Tian M, Duan W: Clinical pharmacogenetics and potential application in personalized medicine. Curr Drug Metab. 2008 Oct;9(8):738-84.

For example, warfarin serves as a good practical example of how pharmacogenetics can be utilized prior to commencement of therapy in order to achieve maximum efficacy and minimum toxicity.
Polymorphisms in the cytochrome P450 (CYP) family may have had the most impact on the fate of pharmaceutical drugs.
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19258521 Mosher CM, Tai G, Rettie AE: CYP2C9 amino acid residues influencing phenytoin turnover and metabolite regio- and stereochemistry. J Pharmacol Exp Ther. 2009 Jun;329(3):938-44. Epub 2009 Mar 3.

Although it is well established that CYP2C9 is the major cytochrome P450 enzyme controlling metabolic elimination of phenytoin through its oxidative conversion to (S)-5-(4-hydroxyphenyl)-5-phenylhydantoin (p-HPPH), nothing is known about the amino acid binding determinants within the CYP2C9 active site that promote metabolism and maintain the tight stereocontrol of hydroxy metabolite formation.
This pattern of effects differs substantially from that found previously for (S)-warfarin and (S)-flurbiprofen metabolism, suggesting that these three ligands bind within discrete locations in the CYP2C9 active site.
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20020283 Cadamuro J, Dieplinger B, Felder T, Kedenko I, Mueller T, Haltmayer M, Patsch W, Oberkofler H: Genetic determinants of acenocoumarol and phenprocoumon maintenance dose requirements. Eur J Clin Pharmacol. 2010 Mar;66(3):253-60. Epub 2009 Dec 18.

OBJECTIVE: The variability in warfarin dose requirement is attributable to genetic and environmental factors.
METHODS: Common single nucleotide polymorphisms (SNPs) in the genes encoding cytochrome P450 family member 2C9 (CYP2C9), vitamin K epoxide reductase complex subunit 1 (VKORC1), gamma-glutamyl carboxylase (GGCX), calumenin (CALU) and apolipoprotein E (APOE) were studied in 206 patients receiving AC or PC.
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18649061 Yildiz F, Kurtaran B, Cayli M, Candevir A, Sumbul Z: A significant interaction between moxifloxacin and warfarin in a patient with a mitral bioprosthetic valve. Heart Vessels. 2008 Jul;23(4):286-8. Epub 2008 Jul 23.

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18360653 Guay DR: Moxifloxacin in the treatment of skin and skin structure infections. Ther Clin Risk Manag. 2006 Dec;2(4):417-34.


Moxifloxacin does not inhibit cytochrome P450 enzymes and thus interact with warfarin or methylxanthines.
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18322281 Schwarz UI, Ritchie MD, Bradford Y, Li C, Dudek SM, Frye-Anderson A, Kim RB, Roden DM, Stein CM: Genetic determinants of response to warfarin during initial anticoagulation. N Engl J Med. 2008 Mar 6;358(10):999-1008.

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19724766 Sansone RA, Sansone LA: Warfarin and Antidepressants: Happiness without Hemorrhaging. Psychiatry. 2009 Jul;6(7):24-9.

Because a multitude of drugs may potentially alter warfarin levels, primarily through the cytochrome P-450 isoenzyme system, in this edition of The Interface, we explore drug interactions between warfarin and the antidepressants.
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20133101 Zuo Z, Wo SK, Lo CM, Zhou L, Cheng G, You JH: Simultaneous measurement of S-warfarin, R-warfarin, S-7-hydroxywarfarin and R-7-hydroxywarfarin in human plasma by liquid chromatography-tandem mass spectrometry. J Pharm Biomed Anal. 2010 Jun 5;52(2):305-10. Epub 2010 Jan 18.

Clinically used anticoagulant warfarin is usually available as a racemic mixture of S- and R-warfarin that are both metabolized mainly by cytochrome P450 isoenzymes.
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20095918 Liedtke MD, Rathbun RC: Drug interactions with antiretrovirals and warfarin. . Expert Opin Drug Saf. 2010 Mar;9(2):215-23.

The following search terms were utilized: warfarin, HIV, antiretroviral, drug interaction, protease inhibitor (PI), non-nucleoside reverse-transcriptase inhibitor (NNRTI), cytochrome P450 (CYP450), CYP2C9 and individual antiretrovirals by name.
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19476425 Dixon DL, Williams VG: Interaction between gemfibrozil and warfarin: case report and review of the literature. Pharmacotherapy. 2009 Jun;29(6):744-8.

The exact mechanism of the proposed interactions between fibric acid derivatives and warfarin remains unknown but may be multifactorial through inhibition of cytochrome P450 isoenzymes, displacement from protein binding sites, or changes in coagulation factor synthesis.
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18634396 Sawicka-Powierza J, Rogowska-Szadkowska D, Oltarzewska AM, Chlabicz S: [Factors influencing activity of oral anticoagulants. Pol Merkur Lekarski. 2008 May;24(143):458-62.

A common mutation in the gene coding for the cytochrome P450 (CYP2C9), with one or more combinations of its polymorphisms, is responsible for the reduced warfarin requirements or for the resistance to warfarin.
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19074093 Francis CW: New issues in oral anticoagulants. Hematology Am Soc Hematol Educ Program. 2008:259-65.

Polymorphisms in CYP2C9, a critical cytochrome P-450 enzyme in the metabolism of warfarin, alters its clearance and affects dosing.
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19300499 Takeuchi F, McGinnis R, Bourgeois S, Barnes C, Eriksson N, Soranzo N, Whittaker P, Ranganath V, Kumanduri V, McLaren W, Holm L, Lindh J, Rane A, Wadelius M, Deloukas P: A genome-wide association study confirms VKORC1, CYP2C9, and CYP4F2 as principal genetic determinants of warfarin dose. PLoS Genet. 2009 Mar;5(3):e1000433. Epub 2009 Mar 20.

Prior work established that approximately 30% of the dose variance is explained by single nucleotide polymorphisms (SNPs) in the warfarin drug target VKORC1 and another approximately 12% by two non-synonymous SNPs (*2, *3) in the cytochrome P450 warfarin-metabolizing gene CYP2C9.
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19738136 Ellis DJ, Usman MH, Milner PG, Canafax DM, Ezekowitz MD: The first evaluation of a novel vitamin K antagonist, tecarfarin (ATI-5923), in patients with atrial fibrillation. Circulation. 2009 Sep 22;120(12):1029-35

Unlike warfarin, it is metabolized by esterases, escaping metabolism by the cytochrome P450 system and thereby avoiding cytochrome P450-mediated drug-drug or drug-food interactions as well as genetic variations found in the cytochrome P450 system.
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18725508 Miller GP, Lichti CF, Zielinska AK, Mazur A, Bratton SM, Gallus-Zawada A, Finel M, Moran JH, Radominska-Pandya A: Identification of hydroxywarfarin binding site in human UDP glucuronosyltransferase 1a10: phenylalanine90 is crucial for the glucuronidation of 6- and 7-hydroxywarfarin but not 8-hydroxywarfarin. Am J Clin Pathol. 2008 Jun;129(6):876-83.

Recent studies show that the extrahepatic human UDP-glucuronosyltransferase (UGT) 1A10 is capable of phase II glucuronidation of several major cytochrome P450 metabolites of warfarin (i.e., 6-, 7-, and 8-hydroxywarfarin).
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19139476 Gulseth MP, Grice GR, Dager WE: Pharmacogenomics of warfarin: uncovering a piece of the warfarin mystery. Am J Health Syst Pharm. 2009 Jan 15;66(2):123-33.

Cytochrome P-450 isoenzyme 2C9 (CYP2C9) metabolizes S-warfarin into two inactive metabolites.
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19942260 Yang L, Ge W, Yu F, Zhu H: Impact of VKORC1 gene polymorphism on interindividual and interethnic warfarin dosage requirement--a systematic review and meta analysis. Thromb Res. 2010 Apr;125(4):e159-66. Epub 2009 Nov 25.

It has been suggested that anticoagulation effect of warfarin is significantly associated with the polymorphism of certain genes, including Cytochrome P450 complex subunit 2C9 (CYP2C9), Vitamin K Epoxide Reductase Complex Subunit 1 (VKORC1), Gamma-Glutamyl Carboxylase (GGCX) and Apolipoprotein E (APOE) etc.
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19845677 Choppin A, Irwin I, Lach L, McDonald MG, Rettie AE, Shao L, Becker C, Palme MP, Paliard X, Bowersox S, Dennis DM, Druzgala P: Effect of tecarfarin, a novel vitamin K epoxide reductase inhibitor, on coagulation in beagle dogs. Br J Pharmacol. 2009 Nov;158(6):1536-47. Epub 2009 Oct 20.

Compared to warfarin it has a decreased potential to interact metabolically with drugs that inhibit CYP450 enzymes and, therefore, may offer an improved safety profile for patients.
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20030479 Coderre K, Faria C, Dyer E: Probable warfarin interaction with menthol cough drops. Pharmacotherapy. 2010 Jan;30(1):110.

The mechanism for this interaction may be related to the potential for menthol to affect the cytochrome P450 system as an inducer and inhibitor of certain isoenzymes that would potentially interfere with the metabolism of warfarin.
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18838506 Hutzler JM, Balogh LM, Zientek M, Kumar V, Tracy TS: Mechanism-based inactivation of cytochrome P450 2C9 by tienilic acid and (+/-)-suprofen: a comparison of kinetics and probe substrate selection. Drug Metab Dispos. 2009 Jan;37(1):59-65. Epub 2008 Oct 6.

In vitro experiments were conducted to compare k (inact), K (I) and inactivation efficiency (k (inact)/K (I)) of cytochrome P450 (P450) 2C9 by tienilic acid and (+/-)-suprofen using (S)-flurbiprofen, diclofenac, and (S)-warfarin as reporter substrates.
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20041841 Punnam SR, Goyal SK, Kotaru VP, Pachika AR, Abela GS, Thakur RK: Amiodarone - a 'broad spectrum' antiarrhythmic drug. Cardiovasc Hematol Disord Drug Targets. 2010 Mar;10(1):73-81.

Amiodarone interacts with medications such as Warfarin, Digoxin, Macrolides, Floroquinolones etc., which share Cytochrome P450 metabolic pathway.
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19233910 Rai AJ, Udar N, Saad R, Fleisher M: A multiplex assay for detecting genetic variations in CYP2C9, VKORC1, and GGCX involved in warfarin metabolism. Clin Chem. 2009 Apr;55(4):823-6. Epub 2009 Feb 20.

Genetic variations in the cytochrome P450, family 2, subfamily C, polypeptide 9 (CYP2C9), vitamin K epoxide reductase complex, subunit 1 (VKORC1), and gamma-glutamyl carboxylase (GGCX) genes have been shown to contribute to impaired metabolism of warfarin.
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