COUMADIN is contraindicated in women who are pregnant except in pregnant women with mechanical heart valves, who are at high risk of thromboembolism, and for whom the benefits of COUMADIN may outweigh the risks [see WARNINGS AND PRECAUTIONS ]. COUMADIN can cause fetal harm. Exposure to warfarin during the first trimester of pregnancy caused a pattern of congenital malformations in about 5% of exposed offspring. Because these data were not collected in adequate and well-controlled studies, this incidence of major birth defects is not an adequate basis for comparison to the estimated incidences in the control group or the . general population and may not reflect the incidences observed in practice. Consider the benefits and risks of COUMADIN and possible risks to the fetus when prescribing COUMADIN to a pregnant woman.
Aminoglutethimide has more recently found use as a recreational CYP2D6 inducer, resulting in an increased conversion of codeine to morphine when the former is taken concomitantly with aminoglutethimide. This increases the effect of codeine per dose and increases the ceiling effect threshold, allowing smaller doses of codeine to achieve the same effect as a larger dose taken alone as well as increasing the metabolic limit on the effect of codeine (normally codeine doses above 400 mg stop producing any significant increase in opioid effects due to depletion of the CYP2D6 enzyme which essentially halts the conversion process until the enzyme has replenished). A similar effect is seen with tramadol due to an increased conversion to O-desmethyltramadol and an increased availability of the CYP2D6 enzyme.
Prescribing data from Medicare’s prescription drug benefit, known as Part D, was compiled and released by the Centers for Medicare and Medicaid Services, the federal agency that oversees the program. The data for 2015 includes more than billion prescriptions written by nearly million doctors, nurses and other providers. This database lists about 447,000 of those providers who wrote 50 or more prescriptions for at least one drug that year. More than three-fourths of these prescriptions went to patients 65 and older; the rest were for disabled patients. Methodology »