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Arthur I. Jacknowitz, PharmD
West Virginia University Medical Center Morgantown

JAMA. 1984;251(16):2084-2085.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

Drs Blumenkopf and Lockhart¹ have documented carefully the relationship of a thoracic level herpes zoster infection and concurrent warfarin sodium therapy with the development of an acute spinal subdural hematoma. In seeking the cause of this rare neurosurgical emergency, the authors indicate that the patient may have suffered a "spontaneous" subarachnoid subdural hemorrhage in the spinal canal as a complication of warfarin therapy. It may be that this "potentially dangerous association of herpes zoster infection and anticoagulant therapy" is due rather to the effect of this infection on the biotransformation of warfarin, which is dependent on the hepatic cytochrome P-450 system for its elimination.

It has recently been demonstrated that a variety of structurally dissimilar inducers of interferon, including viral infections, produced a depression of hepatic P-450 systems in laboratory animals, leading to the suggestion that depression of hepatic P-450 systems might be a specific characteristic of . . . [Full Text PDF of this Article]

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