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Obstetrics & Gynecology 2006;107:310-313
© 2006 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Single-Dose Fluconazole for Vulvovaginal Candidiasis

Impact on Prothrombin Time in Women Taking Warfarin

Mark A. Turrentine, MD1

From the 1Department of Obstetrics & Gynecology, Kelsey-Seybold Clinic, Houston, Texas.

OBJECTIVE: To estimate the effect of a single oral 150-mg dose of fluconazole on the prothrombin time of women on long-term warfarin therapy.

METHODS: Women on warfarin therapy for 6 months or more with no change in dose within 4 weeks of the study, and a prothrombin time (PT) with an International Normalized Ratio (INR) between 2 and 3 were invited to participate. Two consecutive baseline PTs were obtained (days –1 and 0), and women were given 150 mg of fluconazole. Prothrombin times were measured on days 2, 5, and 8 of the study. The change in PT was calculated from the difference between the baseline PT on day 0 and the PT during the study period. To detect a 10% difference in a PT (approximately 2.1 seconds) of a patient with an INR of 2.0, at P < .05 and a power of 90%, 5 subjects are required.

RESULTS: Six women participated. The mean (± standard deviation) PT for day 0 was 27.7 ± 4.1 seconds or INR 2.6 ± 0.4. The PT increased 11% at day 2, 34% at day 5, and 2% at day 8; these differences were not statistically significant. However, one half of the women had either a clinically relevant increase of the INR greater than 4, or bleeding that required their dosage of warfarin to be decreased.

CONCLUSION: A single 150-mg oral dose of fluconazole may increase the PT to a clinically relevant level in a woman on chronic warfarin therapy. Clinicians should monitor the PT carefully after a single dose of fluconazole.

LEVEL OF EVIDENCE: II-2






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Copyright © 2006 by the American College of Obstetricians and Gynecologists.