A nurse is obtaining a medication history from a patient with gastroesophageal reflux disease. The patient claims to take omeprazole and warfarin at bedtime. The nurse should be concerned because:


•Omeprazole is a proton pump inhibitor that decreases gastric acid secretion. When combined with coumadin, omeprazole can actually prolong elimination and increase INR.

•Omeprazole has not been shown to cause encephalopathy when mixed with coumadin.

•Although omeprazole inhibits the absorption of many drugs, it actually increases the effects of coumadin.

•Omeprazole should be taken before breakfast, once a day (72 duration).

•Warfarin should be taken the same time everyday, usually in the evening or at bedtime.

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