Coumadin

Coumadin (Warfarin Sodium) is prescribed for the prophylaxis and/or treatment of venous thrombosis and its extension, and pulmonary embolism. Coumadin is an anticoagulant. It works by blocking the formation of ceratin blood clotting factors. It is also indicated for the prophylaxis and/or treatment of the thromboembolic complications associated with atrial fibrillation and/or cardiac valve replacement, reducing the risk of death, recurrent myocardial infarction, and thromboembolic events such as stroke or systemic embolization after myocardial infarction.

Before use

Some medical conditions may interact with Coumadin. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

• if you are planning to become pregnant or are breast-feeding
• if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
• if you have allergies to medicines or other substances
• if you have recently been injured, fallen, given birth, or had surgery
• if you have a history of stomach or bowel problems (eg, bleeding, ulcer, inflammation), heart problems (eg, heart failure, infection), blood clots, anemia or other blood problems (eg, protein C deficiency, high red blood cell levels), blood vessel problems, or high blood pressure
• if you have a history of liver, kidney, or thyroid problems; yellowing of the skin or eyes; mental or mood problems; high cholesterol; arthritis; diabetes; or cancer
• if you have poor nutrition, celiac disease, nutrient or fat absorption problems, or low levels of vitamin K or vitamin C in the blood, or if you drink alcohol
• if you have a fever, very poor health, diarrhea, fluid buildup, excessive fat in the stools (steatorrhea), a recent or current infection, or tuberculosis, or if you will be exposed to high temperatures for a prolonged period of time
• if you have a heart valve replacement, an intrauterine device (IUD), or a catheter

Do not use Coumadin

• If you are allergic to any ingredient in Coumadin
• If you have bleeding tendencies, bleeding problems (eg, hemophilia), severe or uncontrolled high blood pressure, certain blood problems (eg, low white blood cell or platelet levels), or leukemia
• If you have active serious bleeding, bleeding in the brain, certain blood vessel problems (eg, aneurysm, dissecting aorta), or inflammation or infection of the heart
• If you have active ulcer or bleeding of the stomach or bowel, urinary tract, genitals, or respiratory tract
• If you have recently had or will be having eye, brain, or spinal cord surgery; spinal puncture; spinal anesthesia; or any type of major surgery
• If you are pregnant or may become pregnant
• If you are unable to have routine blood clotting tests
• If you are unable to follow your doctor's instructions properly and do not have someone to help you take your medicine
• If you are taking mifepristone, streptokinase, or urokinase

Directions

The dosage and administration of Coumadin must be individualized for each patient according to the particular patient's PT/INR response to the drug and his / her condition. The starting dose is usually 2 to 5 milligrams (mg) per day for two to four days which may later be adjusted depending on the condition and blood test results.

How it works

While taking Coumadin, it is very important to avoid sports and activities that may cause injury. Any falls, blows to the body or head or other injuries should be reported to the doctor immediately since serious internal bleeding may occur without the patient becoming aware of it. Patients should also be careful to avoid cutting themselves. This includes special care to be taken in brushing teeth and shaving. It is better to use a soft brush and floss gently as well as to use an electric shave and avoid a blade. Drinking too much alcohol may change the way this anticoagulant affects the body. It is advisable to avoid drinking on a daily basis and also take no more than one or two drinks at any time.

Coumadin Side effects

Like all other medicines, Coumadin also has its side effects which include hypersensitivity/allergic reactions, systemic cholesterol microembolization, purple toes syndrome, hepatitis, cholestatic hepatic injury, jaundice, elevated liver enzymes, vasculitis, edema, fever, rash, dermatitis including bulbous eruptions, urticaria, abdominal pain including cramping, flatulence/bloating, fatigue, lethargy, malaise, asthenia, nausea, vomiting, diarrhea, pain, headache, dizziness, taste perversion, pruritus, alopecia, cold intolerance, and paresthesia including feeling cold and chills. Any bleeding while the PT/INR is within therapeutic range should be diagnostically investigated since it could mean a previously unsuspected lesion like a tumor or ulcer. The anticoagulant effect of the medication may also cause fatal or nonfatal hemorrhage from any tissue or organ. The possibility of hemorrhage should be always considered in evaluating the condition of any anticoagulated patient with complaints which do not indicate an obvious diagnosis.

More information about Coumadin

Bleeding during anticoagulant therapy does not always correlate with PT/INR. After the medicine is stopped, the body needs time to recover before it can return to its normal blood clotting ability. It is necessary that the same care be taken during this period as during the treatment in order to ensure that no unexpected complications occur.

Tell your doctor or dentist that you take Coumadin before you receive any medical or dental care, emergency care, or surgery.

Carry an ID card at all times that says you take Coumadin.

Do NOT take more than the recommended dose or use for longer than prescribed without checking with your doctor. Contact your doctor right away if you may have taken too much of Coumadin. Do not drink alcohol while you are taking Coumadin; it may increase the risk of Coumadin's side effects.

Do not change you activity level or weight without checking with your doctor; the risk of Coumadin's side effects may be increased.

Do not change your eating habits without checking with your doctor. Eat a normal, balanced diet. Foods that have high levels of vitamin K in them (eg, green leafy vegetables, broccoli, liver, certain vegetable oils) may change the effect of Coumadin. Ask your doctor for a list of foods that may affect this medicine. Tell your doctor if any foods on the list are a part of your diet.

Do not eat cranberry products or drink cranberry juice while you are taking Coumadin. Tell your doctor if these products are already part of your diet.

Elevated body temperature may increase the effect of Coumadin. Be careful to avoid becoming overheated, especially during hot weather.

Coumadin decreases blood clotting. Use caution while doing activities such as brushing your teeth, flossing, or shaving. Avoid activities that may cause bruising or injury. Seek immediate medical attention if you fall or injure yourself. Tell your doctor if you have unusual bruising or bleeding. Tell your doctor if you have dark, tarry, or bloody stools.

Do not take aspirin while you take Coumadin unless your doctor tells you to. If you already take aspirin for a heart or other condition, talk with your doctor about whether or not you should continue to take it with Coumadin.

Tell your doctor if you will be traveling or if you will be confined to a bed or chair for a long period of time (eg, car or airplane ride). This may increase your risk of developing a blood clot.

If therapy with Coumadin is stopped, the blood thinning effects may last for 2 to 5 days after you stop taking it. Discuss any questions or concerns with your doctor. Do not suddenly stop taking Coumadin without checking with your doctor.

Lab tests, including certain blood clotting tests (eg, PT, INR), may be performed while you use Coumadin. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.

Use Coumadin with caution in Asian patients; they may be more sensitive to its effects, especially bleeding.

Use Coumadin with caution in the ELDERLY; they may be more sensitive to its effects, especially bleeding.

Coumadin should be used with extreme caution in CHILDREN; safety and effectiveness in children have not been confirmed. Children may need more frequent lab tests if they use Coumadin.

If you may become pregnant, you must use an effective form of birth control while you take Coumadin. If you have questions about effective birth control, talk with your doctor.

PREGNANCY and BREAST-FEEDING: Do not use Coumadin if you are pregnant. It has been shown to cause harm to the fetus. Avoid becoming pregnant while you are taking it. If you think you may be pregnant, contact your doctor right away. It is not known if Coumadin is found in breast milk. If you are or will be breast-feeding while you use Coumadin, check with your doctor. Discuss any possible risks to your baby.