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Coumadin

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Treatment & Uses
Side Effects
Treating Overdose
Safety Information
Before Using

Generic Name: warfarin (WAR far in)
Brand Names: Coumadin, Jantoven

What is Coumadin?

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Coumadin is an anticoagulant (blood thinner). It reduces the formation of blood clots. It works by blocking the synthesis of certain clotting factors. Without these clotting factors, blood clots are unable to form.

Coumadin is used to prevent heart attacks, strokes, and blood clots in veins and arteries.

Coumadin may also be used for purposes other than those listed in this medication guide.

Important information about Coumadin

This medication can cause birth defects in an unborn baby. Do not use if you are pregnant. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment. Never take a double dose of Coumadin.

If you need to have a lumbar puncture (spinal tap) or any type of surgery, you may need to temporarily stop using Coumadin. Be sure the surgeon knows ahead of time that you are using this medication.

Carry an ID card or wear a medical alert bracelet stating that you are taking Coumadin, in case of emergency. Any doctor, dentist, or emergency medical care provider who treats you should know that you are taking Coumadin. Coumadin interacts with many other drugs, and these interactions can be dangerous, even fatal. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. You should not take acetaminophen (Tylenol), aspirin, or NSAIDs (non-steroidal anti-inflammatory drugs) unless your doctor has told you to. NSAIDs include celecoxib (Celebrex), diclofenac (Voltaren), ibuprofen (Motrin, Advil), indomethacin, naproxen (Aleve, Naprosyn), piroxicam (Feldene), and others. These medicines may affect blood clotting and could cause serious bleeding in your stomach or intestines.

Avoid sudden changes in your diet. Vitamin K decreases the effects of Coumadin. Large amounts of vitamin K are found in foods such as liver, broccoli, brussels sprouts, spinach, Swiss chard, coriander, collards, cabbage, and other green leafy vegetables. Do not change the amount of these foods in your diet without first talking to your doctor.

Avoid eating cranberries, drinking cranberry juice, or taking cranberry herbal products.

Avoid drinking alcohol, which can increase some of the side effects of Coumadin.

Before taking Coumadin

Do not take this medicine if you have:

a bleeding disorder such as hemophilia;
a blood cell disorder such as anemia;
a stomach ulcer or bleeding in the stomach;
a history of aneurysm, blood clot, or bleeding in your brain; or
an infection of your heart, fluid or swelling around your heart.

FDA pregnancy category X. Coumadin can cause miscarriage, stillbirth, birth defects, or fatal bleeding in an unborn baby. Do not use Coumadin if you are pregnant. Tell your doctor right away if you become pregnant during treatment. Use an effective form of birth control while you are using this medication.

Before taking Coumadin, tell your doctor if you have:

kidney disease;
liver disease;
celiac sprue (an intestinal disorder);
a recent injury, surgery, or medical emergency;
high blood pressure;
severe or uncontrolled diabetes;
polycythemia vera;
congestive heart failure;
cancer;
overactive thyroid;
a seizure disorder for which you take an anticonvulsant such as phenytoin (Dilantin) or phenobarbital (Luminal); or
a connective tissue disorder such as Marfan Syndrome, Sjogren syndrome, scleroderma, rheumatoid arthritis, or lupus.

If you have any of these conditions, you may not be able to use Coumadin, or you may need a dosage adjustment or special tests during treatment.

Coumadin may pass into breast milk and cause bleeding problems in the nursing baby. Do not use Coumadin without telling your doctor if you are breast-feeding a baby. Older adults and people who are severely ill or debilitated may have a greater risk of bleeding while taking Coumadin. Talk with your doctor about your individual risk. Coumadin should not be given to anyone younger than 18 years old.

Tell your doctor (or dentist) that you are taking Coumadin before you take an antibiotic or before having surgery.

How should I take Coumadin?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from this medication. Follow the directions on your prescription label.

Take each dose with a full glass of water. Take Coumadin at the same time every day. Coumadin can be taken with or without food.

Your body's response to Coumadin can be affected by your diet, environment, physical well-being, and other medicines or herbal (botanical) products you use.

Avoid dieting to lose weight while taking Coumadin. Tell your doctor if your body weight changes for any reason.

It is important to take Coumadin regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

To be sure this medication is helping your condition, your blood will need to be tested on a regular basis. Do not miss any scheduled visits to your doctor.

If you need to have a lumbar puncture (spinal tap) or any type of dental work or surgery, you may need to temporarily stop using Coumadin. Be sure your doctors know ahead of time that you are using this medication.

What happens if I miss a dose?

Take the missed dose as soon as you remember, and call your doctor as soon as possible. Do not take two doses at the same time to make up a missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include bruising, broken blood vessels under the skin, excessive bleeding from cuts or wounds, blood in the urine or stools, and heavy menstrual periods in women.

What should I avoid while taking Coumadin?

You should not take acetaminophen (Tylenol), aspirin, or NSAIDs (non-steroidal anti-inflammatory drugs) unless your doctor has told you to. NSAIDs include celecoxib (Celebrex), diclofenac (Voltaren), ibuprofen (Motrin, Advil), indomethacin, naproxen (Aleve, Naprosyn), piroxicam (Feldene), and others. These medicines may affect blood clotting and could cause serious bleeding in your stomach or intestines.

Avoid eating cranberries, drinking cranberry juice, or taking cranberry herbal products.

Avoid drinking alcohol, which can increase some of the side effects of this medication.

Avoid sports or activities that could result in a bruising or bleeding injury. Use extra caution to avoid cuts when brushing your teeth or shaving.

Coumadin side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:

skin changes or discoloration anywhere on your body;
purple toes or fingers;
pain in your stomach, back, or sides;
low fever, loss of appetite, dark urine, jaundice (yellowing of the skin or eyes);
diarrhea, fever, chills, body aches, flu symptoms;
easy bruising or bleeding that will not stop;
blood in your urine;
black, bloody, or tarry stools;
nosebleeds, bleeding gums, coughing up blood;
feeling weak or light-headed;
sudden headache, confusion, problems with vision, speech, or balance;
sudden leg or foot pain; or
sudden numbness or weakness, especially on one side of the body.

Less serious side effects may include:

nausea, vomiting, stomach pain;
gas and bloating; or
hair loss.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

What other drugs will affect Coumadin?

Coumadin interacts with many other drugs, and these interactions can be dangerous, even fatal. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.

Coumadin can interact with the following herbal (botanical) products:

bromelains;
coenzyme Q10;
danshen;
dong quai;
garlic;
ginkgo biloba;
ginseng; or
St. John's wort.

Do not use any of these products without first asking your doctor. Some of these herbal products can cause you to bleed while you are also taking Coumadin.

Where can I get more information?

Your pharmacist can provide more information about Coumadin.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.