Rash from Coumadin?

[Robin]

Dear Dr.



I have been on Coumadin for about one month now for DVT's of the Brachiocephalic, Internal Jugular, and Subclavian Veins (From a Groshong Catheter in for IV Nutrition, and various IV Meds~No longer on these as the catheter was pulled).  My Coumadin was increased yesterday from 5.5mg daily to 6mg daily.  I woke up during the night with a red, very itchy rash that looked like welts.  It covered my feet, ankles, legs, and arms.  My Hematologist doesn't seem to think it is the Coumadin, but this is the only change in my meds.



My other Meds are as follows:



1.  Depo Provera Injection 150mg q 3 months(received 10 days ago)first injection ever....used for Endometriosis/Adenomyosis.



2.  Effexor 37.5mg daily for depression  started two weeks ago, but was on it about a year ago for approx. six months.



3.  Coumadin 6mg qd for DVT's  started at 5mg qd in Oct. 1999.  Increased to 5.5mg qd about two weeks ago, and then yesterday, increased to 6mg qd.



4.  Feosol 200mg BID Procrit can cause Iron Deficiency anemia,   so my Hematologist has me on this.



5.  Procrit 40,000U SQ once weekly taken for Anemia of Chronic Illness.



6.  Methadone 40mg TID for Chronic Pain



7.  Phenergan 25mg QID PRN Nausea and Vomiting....I take this two to four times a day.



If it isn't the Coumadin, could it be a combination of some or all of the drugs causing an interaction resulting in the rash?



Thank you for any information you can provide to me.



Robin

[Alan Rockoff, MD]

Robin:



Drug reactions are not related to dose: either the tiny dose will cause one, if you are allergic to the medicine.  Likewise, combinations of drugs do not " add up " to an allergy.



From your description, I can't tell whether what you have is hives, eczema, or some other problem.  It most likely is not a drug reaction, however.  Many itchy rashes appear for no particular reason, coincidental to treatment with various medications.



My advice is to have your hematologist refer you to a dermatologist for diagnosis and treatment.



Best.



Dr. R