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The onset of CYP3A4 induction by nafcillin occurs within the first 7 days, but maximal effects may take up to 2 weeks. Once nafcillin is discontinued, the effects persist for several weeks. A 79-year-old male with a history of atrial fibrillation and a 53-year-old male with a history of recurrent venous thromboembolism required significantly higher weekly warfarin doses during courses of nafcillin therapy. Both patients required a 2.5\u20133.5-fold increase from their baseline weekly warfarin dose to achieve therapeutic international normalized ratios (INRs) while on nafcillin. Traditional protocol-driven warfarin management can result in suboptimal anticoagulation in patients on warfarin and nafcillin.<\/jats:p>","DOI":"10.1177\/2042098618796186","type":"journal-article","created":{"date-parts":[[2018,8,31]],"date-time":"2018-08-31T07:42:12Z","timestamp":1535701332000},"page":"667-671","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":10,"title":["Significant drug\u2013drug interaction between warfarin and nafcillin"],"prefix":"10.1177","volume":"9","author":[{"given":"Cynthia A.","family":"King","sequence":"first","affiliation":[{"name":"MetroHealth System, Clinical Pharmacy, 2500 MetroHealth Drive, Cleveland, OH 44109, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen M.","family":"Babcock","sequence":"additional","affiliation":[{"name":"Summa Health System, Summa Anticoagulation Management Service, Akron, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rhianna J.","family":"Godios","sequence":"additional","affiliation":[{"name":"Summa Health System, Summa Anticoagulation Management Service, Akron, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin S.","family":"King","sequence":"additional","affiliation":[{"name":"MetroHealth System, Clinical Pharmacy, Cleveland, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2018,8,31]]},"reference":[{"key":"bibr1-2042098618796186","unstructured":"AuroMedics Pharma LLC. 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