Pharmacology
We see here that cimetidine, which is a H2-antagonist for heartburn, is the offending agent in causing the decreased metabolism of the warfarin (and subsequent rise in INR). Heartburn is a fairly common ailment, and it wouldn\’t be unreasonable to need to treat a patient such as this, at least in the short term. Of course we know that we cannot discontinue the warfarin; are there any heartburn medications that we could use that would not interact with any of this patient\’s medications, and if so, what would be an appropriate dose?
