Is there an interaction between warfarin and proton pump inhibitors?

Tim Meadows, Medicines Information Pharmacist, Midlands and East Medicines Advice Service (East Anglia site)Published 12 August 2019

Esomeprazole
Lansoprazole
Omeprazole
Pantoprazole
Rabeprazole
Warfarin

This updated Medicines Q&A evaluates the evidence for an interaction between warfarin and proton pump inhibitors.

Generally, the evidence for an interaction between warfarin and proton pump inhibitors is poor, but rarely and unpredictably raised INRs and bleeding may occur.
In practice, whilst there is no reason for avoiding concurrent use of any proton pump inhibitor with warfarin, close monitoring of the prothrombin time or INR may be required.
If any increase in the INR is seen, the dose of warfarin should be adjusted as necessary to maintain the desired level of anticoagulation.

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