Cimetidine Potentiation of the Hypoprothrombinemic Effect of Warfarin

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Oral anticoagulants of the coumarin class are subject to both potentiating and inhibitory drug interactions, some of which are clinically significant (1, 2). We report the case of a patient in whom the combined use of warfarin sodium (Coumadin®, Endo Laboratories, Garden City, New Jersey) and cimetidine (Tagamet®, Smith Kline & French Laboratories, Philadelphia, Pennsylvania) led to excessive hypoprothrombinemia, resulting in soft-tissue and urinary tract hemorrhage. Such an adverse effect of the recently marketed cimetidine has not been reported previously.A 70-year-old white woman presented on 4 October 1978 complaining of pain behind the left knee and gross hematuria. She

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