From the Research
Inclisiran does not have any known clinically significant interactions with warfarin (Coumadin), and patients can safely take both medications together without dose adjustments. The mechanism of action of inclisiran, a small interfering RNA that reduces LDL cholesterol by inhibiting PCSK9 protein production in the liver, is completely different from that of warfarin, which inhibits vitamin K-dependent clotting factors 1. Additionally, inclisiran is not metabolized by the cytochrome P450 system, which processes many medications, including warfarin, further reducing the potential for drug interactions.
The provided evidence focuses on the management and monitoring of warfarin therapy, including the importance of international normalized ratio (INR) monitoring and the optimal intensity of INR for secondary prevention of stroke in patients with non-valvular atrial fibrillation 2, 3, 4, 1. However, none of the studies directly address the interaction between inclisiran and warfarin.
Given the difference in mechanisms of action and the lack of evidence suggesting a significant interaction, it is reasonable to conclude that inclisiran and warfarin can be used concomitantly without significant concerns. Inclisiran is administered as subcutaneous injections given initially, at 3 months, and then every 6 months thereafter, while warfarin dosing should continue to be guided by regular INR monitoring as usual 5. Patients should still inform all healthcare providers about all medications they are taking, including inclisiran and warfarin, to ensure comprehensive medication management.
Key points to consider:
- Inclisiran and warfarin have different mechanisms of action
- No significant interaction has been reported between inclisiran and warfarin
- Regular INR monitoring is essential for patients taking warfarin
- Patients should inform all healthcare providers about all medications they are taking, including inclisiran and warfarin.