Critical
Capecitabine × Warfarin
Antineoplastic, oral prodrug of 5-FU×Vitamin K antagonist anticoagulants
Mechanism
Capecitabine raises INR 4-fold or more via CYP2C9 inhibition – EMA Xeloda Section 4.4 boxed warning.
Symptoms
Severe bleeding within first weeks of course.
Management
Check INR every 3-4 days. Switch to LMWH preferred.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Sources
- EMA: Xeloda (capecitabine) SmPC (2024)– EMA EPAR Xeloda