{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:43:30Z","timestamp":1761093810581,"version":"build-2065373602"},"reference-count":13,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2013,5,3]],"date-time":"2013-05-03T00:00:00Z","timestamp":1367539200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2013,11]]},"abstract":"<jats:p>Warfarin, an anticoagulant with a narrow therapeutic window, is largely metabolized by cytochrome P450 2C9. Isopropyl alcohol has been shown to inhibit the activity of this enzyme. Use of topical isopropyl alcohol as a rubefacient may place patients at risk for systemic exposure. Isopropyl alcohol's effect on the international normalized ratio (<jats:styled-content style=\"fixed-case\">INR<\/jats:styled-content>) has not been well characterized. We describe five patients who experienced <jats:styled-content style=\"fixed-case\">INR<\/jats:styled-content> elevations after topical application of isopropyl alcohol. Each patient's <jats:styled-content style=\"fixed-case\">INR<\/jats:styled-content> was therapeutic for at least seven visits prior to becoming supratherapeutic. All patients confirmed drug adherence and denied medication or dietary changes. Seventy percent isopropyl alcohol was used in all cases over a large body surface area of intact skin multiple times daily for several days. All patients experienced a 10% or greater increase in their <jats:styled-content style=\"fixed-case\">INR<\/jats:styled-content> compared to previous levels. On discontinuation of isopropyl alcohol, each patient's <jats:styled-content style=\"fixed-case\">INR<\/jats:styled-content> returned to and remained in therapeutic range for the next 2\u00a0months. Prediction of isopropyl alcohol's effect of the <jats:styled-content style=\"fixed-case\">INR<\/jats:styled-content> is confound by several factors, notably the <jats:styled-content style=\"fixed-case\">BSA<\/jats:styled-content> covered, concentration of alcohol in the product, contact time with the skin, and skin integrity. It is important that clinicians inquire about the use of isopropyl alcohol and educate patients about its potential risk in those receiving warfarin therapy.<\/jats:p>","DOI":"10.1002\/phar.1284","type":"journal-article","created":{"date-parts":[[2013,5,3]],"date-time":"2013-05-03T09:35:07Z","timestamp":1367573707000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effect of Transdermal Isopropyl Alcohol on the International Normalized Ratio in Five Warfarin\u2010Treated Patients"],"prefix":"10.1002","volume":"33","author":[{"given":"James J.","family":"Pitcock","sequence":"first","affiliation":[{"name":"The University of Mississippi School of Pharmacy The University of Mississippi Hospitals and Clinics Jackson Mississippi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olubusola O.","family":"Oluyemi","sequence":"additional","affiliation":[{"name":"Department of Pharmacy G.V. (Sonny) Montgomery Veterans Affair Medical Center Jackson Mississippi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margaret B.","family":"Pitcock","sequence":"additional","affiliation":[{"name":"Department of Pharmacy G.V. (Sonny) Montgomery Veterans Affair Medical Center Jackson Mississippi"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2013,5,3]]},"reference":[{"volume-title":"Coumadin (warfarin) package insert","year":"2011","author":"Bristol\u2010Myers Squibb","key":"e_1_2_9_2_1"},{"key":"e_1_2_9_3_1","first-page":"29","article-title":"Drug\u2010alcohol interactions: a review of three therapeutic classes","volume":"35","author":"Noureldin M","year":"2010","journal-title":"US Pharm"},{"key":"e_1_2_9_4_1","first-page":"40","article-title":"Alcohol and medication interactions","volume":"23","author":"Weathermon R","year":"1999","journal-title":"Alcohol Res Health"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.1981.154"},{"key":"e_1_2_9_6_1","unstructured":"United States Department of Labor.Occupational safety and health guideline for isopropyl alcohol. Available fromhttp:\/\/www.osha.gov\/SLTC\/healthguidelines\/isopropylalcohol\/recognition.html. Accessed October 23 2012."},{"key":"e_1_2_9_7_1","unstructured":"POISINDEX\u00aeSystem (electronic version). In: Micromedex\u00ae 2.0 [Internet]. Greenwood Village (CO): Truven Health Analytics. [date unknown] \u2010. Isopropyl alcohol; [updated 2012 Aug 10]; Available from:http:\/\/www.thomsonhc.com. Accessed October 22 2012."},{"volume-title":"UpToDate","year":"2012","author":"Sivilotti ML","key":"e_1_2_9_8_1"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006565-199404000-00008"},{"key":"e_1_2_9_10_1","first-page":"24","article-title":"Acute neuropathy and erythromelalgia following topical exposure to isopropanol","volume":"46","author":"Rajabally YA","year":"2004","journal-title":"Vet Hum Toxicol"},{"key":"e_1_2_9_11_1","first-page":"15","article-title":"Topical absorption of isopropyl alcohol induced cardiac and neurologic deficits in an adult female with intact skin","volume":"42","author":"Leeper SC","year":"2000","journal-title":"Vet Hum Toxicol"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000433-198603000-00020"},{"key":"e_1_2_9_13_1","first-page":"233","article-title":"A comparison of the absorption and metabolism of isopropyl alcohol by oral, dermal, and inhalation routes","volume":"28","author":"Martinez TT","year":"1986","journal-title":"Vet Hum Toxicol"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1124\/dmd.112.047134"}],"container-title":["Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fphar.1284","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fphar.1284","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/phar.1284","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T13:11:55Z","timestamp":1761052315000},"score":1,"resource":{"primary":{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/10.1002\/phar.1284"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,5,3]]},"references-count":13,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2013,11]]}},"alternative-id":["10.1002\/phar.1284"],"URL":"https:\/\/doi.org\/10.1002\/phar.1284","archive":["Portico"],"relation":{},"ISSN":["0277-0008","1875-9114"],"issn-type":[{"type":"print","value":"0277-0008"},{"type":"electronic","value":"1875-9114"}],"subject":[],"published":{"date-parts":[[2013,5,3]]},"assertion":[{"value":"2013-05-03","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}