Influenza Vaccination and Warfarin or Theophylline Toxicity in Nursing-Home Residents

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Abstract
To the Editor: Kramer and McClain (Nov. 19, 1981, issue)1 and others2 , 3 have reported that influenza vaccination can be associated with severe drug toxicity in patients taking warfarin or theophylline. These reactions may result from vaccine-induced depression in the metabolic activity of the hepatic cytochrome P-450 enzyme system, possibly by stimulating interferon synthesis. On the basis of [14C]aminopyrine breath tests in normal volunteers, it appears that the depression in enzyme activity may persist for at least 21 days after vaccination.1 The importance of these reports, however, is uncertain; it is unknown how frequently such reactions may occur, particularly in . . .

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