any one have severe bleeding with warfarin and apalutamide. I am now off of warfarin after the nose bleed from hell.

[rogerwegner]

The bleed occurred after a septoplasty to improve my breathing. I was doing fine for the first four days after surgery and then I just started bleeding heavily. It took an ER visit with a stay in the hospital for four days to get it stopped. My INR has been erratic since I started Apalutamide 6 months ago. I wound up taking triple the dose of warfarin that I was taking before Apalutamide.

[rogerwegner]

I have been on warfarin for 12 years . It all started with a massive DVT below my clavicle that was caused by my prostate cancer which they discovered when my PSA came back at 150. My warfarin was very steady until the apalutamide when it took triple the dose to achieve the INR level of 2.5.

[rogerwegner]

The DVT has been resolved by interventional radiology and has not returned. What have you found to prevent any further DVT 's

[tango65]

Significant drug interactions with apalutamide:

rxlist.com/erleada-drug.htm...

Interaction apalutamide and warfarin:

Monitor Closely

apalutamide will decrease the level or effect of warfarin by affecting hepatic enzyme CYP2C9/10 metabolism. Coadministration of apalutamide, a weak CYP2C9 inducer, with drugs that are CYP2C9 substrates can result in lower exposure to these medications. Evaluate for loss of therapeutic effect if medication must be coadministered.

You could discuss the possibility of changing warfarin by one of the new oral anticoagulants which do not require INR monitoring or special diet. One of them, Pradaxa does not interact with apalutamide and it has been approved for reduction of DVT.

boehringer-ingelheim.us/pre...

[rogerwegner in reply to tango65]

Thanks I will do that. Roger

[j-o-h-n]

Actually a lot of us are glad you're not a doctor. You're better than one, we can talk to you and get a straight answer and you're available most of the time (and you don't bill us).

Thank you, from your brother j-o-h-n.

p.s. See you at the family picnic...

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 04/17/2019 2:59 PM DST

[ITCandy in reply to j-o-h-n]

Speaking of family, I think I'm his illegitimate son. My mother described in detail of a handsome young body builder that she hooked up with at Silver Sands Beach in the summer of 64.

Things that make you go hmmmm...

[j-o-h-n in reply to ITCandy]

Gonedarnit...You're my nephew.....

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 04/17/2019 5:46 PM DST

[ITCandy in reply to j-o-h-n]

Uncle John!!!!!!

[j-o-h-n in reply to ITCandy]

I know.... I can't believe it either... A nephew in I T too. I'm in heaven I can almost go back to my days in I T when it was always "analysis paralysis" delaying the project.

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 04/17/2019 7:01 PM EDT

[j-o-h-n]

Oh for the family reunion? I thought it was at your palace in NC on Thursday July 4, 2019 @ 11:00 AM DST. Main course Roast Pig. BYOM (bring your own meds). Don't forget to invite ITCandy.

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 04/17/2019 7:25 PM EDT

[j-o-h-n]

Of course I remember, I ordered a kosher Pig... (Remember I was born in the Bronx, that automatically makes me 25% Jewish, - I was/am a Shabbos Goy).

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 04/17/2019 8:27 PM EDT

[j-o-h-n]

25%. Now you know where I get my humor from...You don't thing it was from growing up in a Chinese neighborhood?

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 04/17/2019 8:42 PM EDT