General Information of Drug (ID: DMPU2WX)

Drug Name
Omacetaxine mepesuccinate
Synonyms Synribo (TN)
Indication
Disease Entry ICD 11 Status REF
Adult acute monocytic leukemia N.A. Approved [1]
Chronic myelogenous leukaemia 2A20.0 Approved [1]
Chronic myeloid leukaemia 2A20 Approved [2]
Leukemia N.A. Approved [1]
Drug Type
Small molecular drug
Structure
3D MOL 2D MOL
#Ro5 Violations (Lipinski): 2 Molecular Weight (mw) 545.6
Logarithm of the Partition Coefficient (xlogp) 0.8
Rotatable Bond Count (rotbonds) 11
Hydrogen Bond Donor Count (hbonddonor) 2
Hydrogen Bond Acceptor Count (hbondacc) 10
ADMET Property
Clearance
The drug present in the plasma can be removed from the body at the rate of 2.96 mL/min/kg [3]
Half-life
The concentration or amount of drug in body reduced by one-half in 6 hours [3]
Metabolism
The drug is metabolized via the hepatic []
Vd
The volume of distribution (Vd) of drug is 141 +/- 93.4 L []
Chemical Identifiers
Formula
C29H39NO9
IUPAC Name
1-O-[(2S,3S,6R)-4-methoxy-16,18-dioxa-10-azapentacyclo[11.7.0.02,6.06,10.015,19]icosa-1(20),4,13,15(19)-tetraen-3-yl] 4-O-methyl (2R)-2-hydroxy-2-(4-hydroxy-4-methylpentyl)butanedioate
Canonical SMILES
CC(C)(CCC[C@@](CC(=O)OC)(C(=O)O[C@H]1[C@H]2C3=CC4=C(C=C3CCN5[C@@]2(CCC5)C=C1OC)OCO4)O)O
InChI
InChI=1S/C29H39NO9/c1-27(2,33)8-5-10-29(34,16-23(31)36-4)26(32)39-25-22(35-3)15-28-9-6-11-30(28)12-7-18-13-20-21(38-17-37-20)14-19(18)24(25)28/h13-15,24-25,33-34H,5-12,16-17H2,1-4H3/t24-,25-,28+,29-/m1/s1
InChIKey
HYFHYPWGAURHIV-JFIAXGOJSA-N
Cross-matching ID
PubChem CID
285033
ChEBI ID
CHEBI:71019
CAS Number
26833-87-4
DrugBank ID
DB04865
TTD ID
D0M4XY
ACDINA ID
D01298
Combinatorial Drugs (CBD) Click to Jump to the Detailed CBD Information of This Drug
Repurposed Drugs (RPD) Click to Jump to the Detailed RPD Information of This Drug

Molecular Interaction Atlas of This Drug


Drug Therapeutic Target (DTT)
DTT Name DTT ID UniProt ID MOA REF
Ribosome A (hRA) TTA4FIU NOUNIPROTAC Modulator [4]

Drug Off-Target (DOT)
DOT Name DOT ID UniProt ID Interaction REF
ADP-ribosyl cyclase/cyclic ADP-ribose hydrolase 1 (CD38) OTG0TTX7 CD38_HUMAN Gene/Protein Processing [5]
Apoptosis regulator BAX (BAX) OTAW0V4V BAX_HUMAN Gene/Protein Processing [6]
Apoptosis regulator Bcl-2 (BCL2) OT9DVHC0 BCL2_HUMAN Gene/Protein Processing [7]
Bcl2-associated agonist of cell death (BAD) OT63ERYM BAD_HUMAN Gene/Protein Processing [6]
Caspase-3 (CASP3) OTIJRBE7 CASP3_HUMAN Protein Interaction/Cellular Processes [6]
Caspase-7 (CASP7) OTAPJ040 CASP7_HUMAN Protein Interaction/Cellular Processes [6]
Caspase-9 (CASP9) OTD4RFFG CASP9_HUMAN Protein Interaction/Cellular Processes [6]
Cellular tumor antigen p53 (TP53) OTIE1VH3 P53_HUMAN Gene/Protein Processing [5]
Cyclin-A2 (CCNA2) OTPHHYZJ CCNA2_HUMAN Gene/Protein Processing [6]
Cyclin-dependent kinase 1 (CDK1) OTW1SC2N CDK1_HUMAN Gene/Protein Processing [6]
Molecular Interaction Atlas (MIA) Jump to Detail Molecular Interaction Atlas of This Drug

Drug-Drug Interaction (DDI) Information of This Drug

Coadministration of a Drug Treating the Same Disease as Omacetaxine mepesuccinate
DDI Drug Name DDI Drug ID Severity Mechanism Disease REF
Fedratinib DM4ZBK6 Major Increased risk of bleeding by the combination of Omacetaxine mepesuccinate and Fedratinib. Myeloproliferative neoplasm [2A20] [8]
Nilotinib DM7HXWT Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Nilotinib. Myeloproliferative neoplasm [2A20] [9]
Ruxolitinib DM7Q98D Major Increased risk of bleeding by the combination of Omacetaxine mepesuccinate and Ruxolitinib. Myeloproliferative neoplasm [2A20] [8]
Coadministration of a Drug Treating the Disease Different from Omacetaxine mepesuccinate (Comorbidity)
DDI Drug Name DDI Drug ID Severity Mechanism Comorbidity REF
Midostaurin DMI6E0R Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Midostaurin. Acute myeloid leukaemia [2A60] [9]
Inotersen DMJ93CT Major Increased risk of bleeding by the combination of Omacetaxine mepesuccinate and Inotersen. Amyloidosis [5D00] [8]
Siltuximab DMGEATB Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Siltuximab. Anemia [3A00-3A9Z] [9]
Dupilumab DMOAD2Y Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Dupilumab. Atopic eczema [EA80] [9]
Eribulin DM1DX4Q Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Eribulin. Breast cancer [2C60-2C6Y] [9]
Talazoparib DM1KS78 Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Talazoparib. Breast cancer [2C60-2C6Y] [9]
LY2835219 DM93VBZ Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and LY2835219. Breast cancer [2C60-2C6Y] [9]
Pralatrexate DMAO80I Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Pralatrexate. Breast cancer [2C60-2C6Y] [9]
Palbociclib DMD7L94 Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Palbociclib. Breast cancer [2C60-2C6Y] [9]
Cabazitaxel DMPAZHC Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Cabazitaxel. Breast cancer [2C60-2C6Y] [9]
Bosutinib DMTI8YE Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Bosutinib. Breast cancer [2C60-2C6Y] [9]
Regorafenib DMHSY1I Major Increased risk of bleeding by the combination of Omacetaxine mepesuccinate and Regorafenib. Colorectal cancer [2B91] [8]
Aflibercept DMT3D5I Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Aflibercept. Colorectal cancer [2B91] [9]
Ardeparin DMYRX8B Major Increased risk of bleeding by the combination of Omacetaxine mepesuccinate and Ardeparin. Coronary thrombosis [BA43] [8]
Danaparoid DM6CLBN Major Increased risk of bleeding by the combination of Omacetaxine mepesuccinate and Danaparoid. Deep vein thrombosis [BD71] [8]
Rivaroxaban DMQMBZ1 Major Increased risk of bleeding by the combination of Omacetaxine mepesuccinate and Rivaroxaban. Deep vein thrombosis [BD71] [8]
Polatuzumab vedotin DMF6Y0L Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Polatuzumab vedotin. Diffuse large B-cell lymphoma [2A81] [9]
Lisocabtagene maraleucel DMP45ME Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Lisocabtagene maraleucel. Diffuse large B-cell lymphoma [2A81] [9]
Axicabtagene ciloleucel DMYHN59 Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Axicabtagene ciloleucel. Diffuse large B-cell lymphoma [2A81] [9]
Bay 80-6946 DMLOS5R Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Bay 80-6946. Follicular lymphoma [2A80] [9]
Tazemetostat DMWP1BH Major Increased risk of bleeding by the combination of Omacetaxine mepesuccinate and Tazemetostat. Follicular lymphoma [2A80] [8]
Avapritinib DMK2GZX Major Increased risk of bleeding by the combination of Omacetaxine mepesuccinate and Avapritinib. Gastrointestinal stromal tumour [2B5B] [8]
177Lu-DOTATATE DMT8GVU Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and 177Lu-DOTATATE. Hepatitis virus infection [1E50-1E51] [9]
Brentuximab vedotin DMWLC57 Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Brentuximab vedotin. Hodgkin lymphoma [2B30] [9]
Teriflunomide DMQ2FKJ Major Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Teriflunomide. Hyper-lipoproteinaemia [5C80] [10]
Olaratumab DMNYOIX Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Olaratumab. Kaposi sarcoma [2B57] [9]
Denosumab DMNI0KO Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Denosumab. Low bone mass disorder [FB83] [11]
Brigatinib DM7W94S Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Brigatinib. Lung cancer [2C25] [9]
Lurbinectedin DMEFRTZ Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Lurbinectedin. Lung cancer [2C25] [9]
Osimertinib DMRJLAT Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Osimertinib. Lung cancer [2C25] [9]
Belimumab DM3OBQF Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Belimumab. Lupus erythematosus [4A40] [9]
Inotuzumab ozogamicin DMAC130 Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Inotuzumab ozogamicin. Malignant haematopoietic neoplasm [2B33] [9]
Ofatumumab DM295PR Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Ofatumumab. Mature B-cell leukaemia [2A82] [9]
Obinutuzumab DM3BVAE Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Obinutuzumab. Mature B-cell leukaemia [2A82] [9]
GDC-0199 DMH0QKA Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and GDC-0199. Mature B-cell leukaemia [2A82] [9]
IPI-145 DMWA24P Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and IPI-145. Mature B-cell leukaemia [2A82] [9]
Acalabrutinib DM7GCVW Major Increased risk of bleeding by the combination of Omacetaxine mepesuccinate and Acalabrutinib. Mature B-cell lymphoma [2A85] [8]
Blinatumomab DMGECIJ Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Blinatumomab. Mature B-cell lymphoma [2A85] [9]
Ibrutinib DMHZCPO Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Ibrutinib. Mature B-cell lymphoma [2A85] [9]
Ponatinib DMYGJQO Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Ponatinib. Mature B-cell lymphoma [2A85] [9]
Arry-162 DM1P6FR Major Increased risk of bleeding by the combination of Omacetaxine mepesuccinate and Arry-162. Melanoma [2C30] [8]
Ipilimumab DMJTIYK Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Ipilimumab. Melanoma [2C30] [9]
LGX818 DMNQXV8 Major Increased risk of bleeding by the combination of Omacetaxine mepesuccinate and LGX818. Melanoma [2C30] [8]
Carfilzomib DM48K0X Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Carfilzomib. Multiple myeloma [2A83] [9]
Selinexor DMBD4K3 Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Selinexor. Multiple myeloma [2A83] [9]
Belantamab mafodotin DMBT3AI Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Belantamab mafodotin. Multiple myeloma [2A83] [9]
Elotuzumab DMEYHG9 Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Elotuzumab. Multiple myeloma [2A83] [9]
Daratumumab DMKCIUZ Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Daratumumab. Multiple myeloma [2A83] [9]
Tecfidera DM2OVDT Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Tecfidera. Multiple sclerosis [8A40] [9]
Siponimod DM2R86O Major Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Siponimod. Multiple sclerosis [8A40] [12]
Fingolimod DM5JVAN Major Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Fingolimod. Multiple sclerosis [8A40] [13]
Ocrelizumab DMEZ2KH Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Ocrelizumab. Multiple sclerosis [8A40] [9]
Ozanimod DMT6AM2 Major Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Ozanimod. Multiple sclerosis [8A40] [14]
Deflazacort DMV0RNS Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Deflazacort. Muscular dystrophy [8C70] [9]
Romidepsin DMT5GNL Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Romidepsin. Mycosis fungoides [2B01] [9]
Prasugrel DM7MT6E Major Increased risk of bleeding by the combination of Omacetaxine mepesuccinate and Prasugrel. Myocardial infarction [BA41-BA43] [8]
Inebilizumab DMI0RHA Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Inebilizumab. Nervous system paraneoplastic/autoimmune disorder [8E4A] [9]
Atezolizumab DMMF8U0 Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Atezolizumab. Non-small cell lung cancer [2C25] [9]
Olaparib DM8QB1D Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Olaparib. Ovarian cancer [2C73] [9]
Rucaparib DM9PVX8 Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Rucaparib. Ovarian cancer [2C73] [9]
MK-4827 DMLYGH4 Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and MK-4827. Ovarian cancer [2C73] [9]
Brodalumab DMASDQ6 Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Brodalumab. Psoriasis [EA90] [9]
Ustekinumab DMHTYK3 Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Ustekinumab. Psoriasis [EA90] [9]
Tildrakizumab DMLW9HG Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Tildrakizumab. Psoriasis [EA90] [9]
Risankizumab DMM32GT Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Risankizumab. Psoriasis [EA90] [9]
Ixekizumab DMXW92T Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Ixekizumab. Psoriasis [EA90] [9]
Temsirolimus DMS104F Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Temsirolimus. Renal cell carcinoma [2C90] [9]
Tocilizumab DM7J6OR Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Tocilizumab. Rheumatoid arthritis [FA20] [9]
Canakinumab DM8HLO5 Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Canakinumab. Rheumatoid arthritis [FA20] [15]
Rilonacept DMGLUQS Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Rilonacept. Rheumatoid arthritis [FA20] [15]
Golimumab DMHZV7X Major Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Golimumab. Rheumatoid arthritis [FA20] [16]
Sarilumab DMOGNXY Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Sarilumab. Rheumatoid arthritis [FA20] [9]
Anthrax vaccine DM9GSWY Moderate Antagonize the effect of Omacetaxine mepesuccinate when combined with Anthrax vaccine. Sepsis [1G40-1G41] [17]
Mogamulizumab DMISH0Z Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Mogamulizumab. Sezary syndrome [2B02] [9]
PDX-101 DM6OC53 Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and PDX-101. Solid tumour/cancer [2A00-2F9Z] [9]
Trabectedin DMG3Y89 Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Trabectedin. Solid tumour/cancer [2A00-2F9Z] [9]
LEE011 DMMX75K Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and LEE011. Solid tumour/cancer [2A00-2F9Z] [9]
Triptorelin DMTK4LS Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Triptorelin. Solid tumour/cancer [2A00-2F9Z] [9]
Pomalidomide DMTGBAX Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Pomalidomide. Systemic sclerosis [4A42] [9]
Plicamycin DM7C8YV Major Increased risk of bleeding by the combination of Omacetaxine mepesuccinate and Plicamycin. Testicular cancer [2C80] [8]
Caplacizumab DMPUKA7 Major Increased risk of bleeding by the combination of Omacetaxine mepesuccinate and Caplacizumab. Thrombocytopenia [3B64] [8]
Apixaban DM89JLN Major Increased risk of bleeding by the combination of Omacetaxine mepesuccinate and Apixaban. Thrombosis [DB61-GB90] [8]
Cangrelor DM8JRH0 Major Increased risk of bleeding by the combination of Omacetaxine mepesuccinate and Cangrelor. Thrombosis [DB61-GB90] [8]
Brilinta DMBR01X Major Increased risk of bleeding by the combination of Omacetaxine mepesuccinate and Brilinta. Thrombosis [DB61-GB90] [8]
Cabozantinib DMIYDT4 Major Increased risk of bleeding by the combination of Omacetaxine mepesuccinate and Cabozantinib. Thyroid cancer [2D10] [18]
Belatacept DMXLYQF Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Belatacept. Transplant rejection [NE84] [9]
Durvalumab DM4PVDY Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Durvalumab. Ureteral cancer [2C92] [9]
Fluticasone DMGCSVF Moderate Additive immunosuppressive effects by the combination of Omacetaxine mepesuccinate and Fluticasone. Vasomotor/allergic rhinitis [CA08] [9]
Betrixaban DM2C4RF Major Increased risk of bleeding by the combination of Omacetaxine mepesuccinate and Betrixaban. Venous thromboembolism [BD72] [8]
⏷ Show the Full List of 89 DDI Information of This Drug

Drug Inactive Ingredient(s) (DIG) and Formulation(s) of This Drug

DIG
DIG Name DIG ID PubChem CID Functional Classification
Mannitol E00103 6251 Diluent; Flavoring agent; Lyophilization aid; Plasticizing agent; Tonicity agent
Pharmaceutical Formulation
Formulation Name Drug Dosage Dosage Form Route
Omacetaxine Mepesuccinate 3.5mg/vial powder 3.5mg/vial Powder Subcutaneous
Jump to Detail Pharmaceutical Formulation Page of This Drug

References

1 Omacetaxine mepesuccinate FDA Label
2 URL: http://www.guidetopharmacology.org Nucleic Acids Res. 2015 Oct 12. pii: gkv1037. The IUPHAR/BPS Guide to PHARMACOLOGY in 2016: towards curated quantitative interactions between 1300 protein targets and 6000 ligands. (Ligand id: 7454).
3 Trend Analysis of a Database of Intravenous Pharmacokinetic Parameters in Humans for 1352 Drug Compounds
4 Drugs@FDA. U.S. Food and Drug Administration. U.S. Department of Health & Human Services. 2015
5 Synergistic killing effects of homoharringtonine and arsenic trioxide on acute myeloid leukemia stem cells and the underlying mechanisms. J Exp Clin Cancer Res. 2019 Jul 15;38(1):308. doi: 10.1186/s13046-019-1295-8.
6 Homoharringtonine suppresses LoVo cell growth by inhibiting EphB4 and the PI3K/AKT and MAPK/EKR1/2 signaling pathways. Food Chem Toxicol. 2020 Feb;136:110960. doi: 10.1016/j.fct.2019.110960. Epub 2019 Nov 11.
7 [Homoharringtonine combined arsenic trioxide induced apoptosis in human multiple myeloma cell line RPMI 8226: an experimental research]. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2013 Jun;33(6):834-9.
8 Product Information. Brukinsa (zanubrutinib). BeiGene USA, Inc, San Mateo, CA.
9 Product Information. Synribo (omacetaxine). Teva Pharmaceuticals USA, North Wales, PA.
10 Product Information. Arava (leflunomide). Hoechst Marion-Roussel Inc, Kansas City, MO.
11 Product Information. Lonsurf (tipiracil-trifluridine). Taiho Oncology, Inc., Princeton, NJ.
12 Cerner Multum, Inc. "Australian Product Information.".
13 Product Information. Gilenya (fingolimod). Novartis Pharmaceuticals, East Hanover, NJ.
14 Cerner Multum, Inc. "UK Summary of Product Characteristics.".
15 Product Information. Arcalyst (rilonacept). Regeneron Pharmaceuticals Inc, Tarrytown, NY.
16 Product Information. Cimzia (certolizumab). UCB Pharma Inc, Smyrna, GA.
17 CDC. Centers for Disease Control and Prevention/ "Recommendations of the advisory committtee on immunization practices (ACIP): use of vaccines and immune globulins in persons with altered immunocompetence." MMWR Morb Mortal Wkly Rep 42(RR-04) (1993): 1-18. [PMID: 20300058]
18 Bodiford AB, Kessler FO, Fermo JD, Ragucci KR "Elevated international normalized ratio with the consumption of grapefruit and use of warfarin." SAGE Open Med Case Rep 0 (2013): 1-3. [PMID: 27489634]