The answer to question 1

Although you cannot stop the Coumadin, you can request a reduction in the dosage. The dosage reduction should be sufficient to bring the PT time to 1.5 to 2.0 times normal or the INR to 2.5 to 3.0 times normal. This level of reduction will permit adequate clotting for routine dental procedures while still providing anticoagulant effect. Good surgical technique and adjunctive clotting aids, like Gelfoam, should be used.

The answer to question 2.

Erythromycin due to possible Digoxin (Digitalis) toxicity. Also limit the use of the epinephrine to 0.036 mg or levonordephrin to 0.20 mg. These vasoconstrictors in combination with the digoxin may precipitate an arrhythmia.

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