🚨 NHS England Alert: Tramadol and Warfarin Interaction- Update for practice pharmacists and PCN pharmacists

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• A coroner's report emphasizes the need for NHS England to inform prescribers about the interaction between tramadol and warfarin following a patient's death.
  

• 📅 Timeline of Events:

• After Susan Gladstone's death due to a brain bleed in January 2021, a coroner issued a report in December 2023 urging action to prevent similar future incidents.
  

• 📈 Case Details:

• Susan was prescribed tramadol for back pain while on long-term warfarin treatment. Her INR spiked to 11.6, indicating severe blood thinning, leading to her death.
  

• 🚫 Lack of Awareness:

• The interaction between warfarin and tramadol was not widely known or listed in the British National Formulary (BNF) at the time of Susan's treatment.
  

• 🔄 BNF Update:

• Following the coroner's report, the BNF announced it would include the tramadol-warfarin interaction in its January 2024 update.
  

• 🏥 MHRA and NHS Response:

• The Medicines and Healthcare products Regulatory Agency (MHRA) and NHS England are expected to respond to the coroner's recommendations, emphasizing the interaction's risks in their communications.
  

• 👩‍⚕️ Healthcare Trust's Reaction:

• East and North Hertfordshire NHS Trust acknowledges the need for awareness but did not identify systemic care issues in Susan's case
  

• References: https://pharmaceutical-journal.com/article/news/coroner-advises-nhs-england-to-warn-prescribers-about-interaction-of-tramadol-and-warfarin