Abstract
To the Editor: Ciclopirox, a synthetic hydroxypyridine antifungal agent, has a high affinity for trivalent metal cations, resulting in an inhibition of the metal-dependent enzymes that are responsible for the peroxide degradation within the fungal cells [1]. It is metabolized by hepatic glucuronidation and excreted renally [2]. Acenocoumarol exhibits its anticoagulant effect by inhibiting vitamin K epoxide reductase and it is metabolized by cytochrome P450 isoenzyme. Even though this interaction between topical antifungal drugs and oral anticoagulant agents could increase the risk of bleeding, few cases have been reported so far [3]. We describe two cases of interaction between ciclopirox used topically and acenocoumarol.
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