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Coumadin

Pronunciation

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

What is warfarin?

Warfarin is an anticoagulant (blood thinner). Warfarin reduces the formation of blood clots.

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

Warfarin may also be used for purposes not listed in this medication guide.

What is the most important information I should know about warfarin?

You should not take warfarin if you have a bleeding or blood cell disorder, blood in your urine or stools, an infection of the lining of your heart, ulcer or stomach bleeding, coughing up blood, recent head injury or bleeding in the brain, recent or upcoming surgery, or if you need a spinal tap or spinal anesthesia (epidural). Do not take warfarin if you cannot be reliable in taking it every day.

Do not use warfarin if you are pregnant, unless your doctor tells you to. Warfarin can cause birth defects, but the benefits of preventing blood clots in certain women may outweigh any risks to the baby.

Warfarin increases your risk of bleeding, which can be severe or life-threatening. Avoid activities that may increase your risk of bleeding or injury.

Call your doctor or seek emergency medical attention if you have bleeding that will not stop. You may also have bleeding on the inside of your body, such as in your stomach or intestines. Call your doctor at once if you have black or bloody stools, or if you cough up blood or vomit that looks like coffee grounds. These could be signs of bleeding in your digestive tract.

Many drugs (including some over-the-counter medicines and herbal products) can cause serious medical problems if you take them with warfarin. It is very important to tell your doctor about all medicines you have recently used.

While using warfarin, you will need frequent blood tests.

What should I discuss with my healthcare provider before taking warfarin?

You should not take warfarin if you are allergic to it, or if you have:

  • hemophilia or any bleeding disorder that is inherited or caused by disease;

  • a blood cell disorder such as anemia (lack of red blood cells) or a low level of platelets in your blood;

  • blood in your urine or stools, or if you have been coughing up blood;

  • an infection of the lining of your heart (also called bacterial endocarditis);

  • stomach or intestinal bleeding or ulcer;

  • recent head injury, aneurysm, or bleeding in the brain; or

  • if you undergo a spinal tap or receive spinal anesthesia (epidural).

You should not take warfarin if you cannot be reliable in taking it because of alcoholism, psychiatric problems, dementia, or similar conditions.

Warfarin can make you bleed more easily, especially if you have:

  • a history of bleeding problems;

  • high blood pressure or severe heart disease;

  • kidney or liver disease;

  • cancer;

  • a disease affecting the blood vessels in your brain;

  • a history of stomach or intestinal bleeding;

  • a surgery or medical emergency;

  • if you receive any type of injection (shot);

  • if you are 65 or older; or

  • if you are severely ill or debilitated.

To make sure warfarin is safe for you, tell your doctor if you have:

  • celiac sprue (an intestinal disorder);

  • diabetes;

  • congestive heart failure;

  • overactive thyroid;

  • recent or upcoming surgery on your brain, spine, or eye;

  • a connective tissue disorder such as Marfan Syndrome, Sjogren syndrome, scleroderma, rheumatoid arthritis, or lupus;

  • a hereditary clotting deficiency (warfarin may make your symptoms worse at first);

  • if you use a catheter; or

  • if you have ever had low blood platelets after receiving heparin.

Do not use warfarin if you are pregnant, unless your doctor tells you to. Warfarin can cause birth defects. However, the benefits of preventing blood clots in certain women may outweigh any risks to the baby. Tell your doctor right away if you become pregnant during treatment. Use effective birth control while you are using this medication.

It is not known whether warfarin passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take warfarin?

Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take warfarin in larger or smaller amounts or for longer than your doctor tells you to. Never take a double dose of this medication.

Take warfarin at the same time every day. Warfarin can be taken with or without food.

Tell your doctor if you have any illness with diarrhea, fever, chills, body aches, or flu symptoms. Tell your doctor if your body weight changes for any reason.

While using warfarin, you will need frequent "INR" or prothrombin time tests (to measure how long it takes your blood to clot). You may not notice any change in your symptoms, but your blood work will help your doctor determine how long to treat you with warfarin. You must remain under the care of a doctor while using warfarin. Do not miss any follow-up appointments.

Wear a medical alert tag or carry an ID card stating that you take warfarin. Any doctor, dentist, surgeon, or other medical care provider who treats you should know that you are taking this medication. You may need to stop taking the medicine for a short time if you need antibiotics, surgery, dental work, a spinal tap, or spinal anesthesia (epidural).

Store at room temperature away from heat, moisture, and light.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose can cause excessive bleeding.

What should I avoid while taking warfarin?

Ask your doctor before taking any medicine for pain, arthritis, fever, or swelling. This includes acetaminophen (Tylenol), aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), diclofenac, indomethacin, meloxicam, and others. These medicines may affect blood clotting and may also increase your risk of stomach bleeding.

Avoid making any changes in your diet without first talking to your doctor. Foods that are high in vitamin K (liver, leafy green vegetables, or vegetable oils) can make warfarin less effective. If these foods are part of your diet, eat a consistent amount on a weekly basis.

Grapefruit or cranberry juice may interact with warfarin and lead to unwanted side effects. Avoid the use of grapefruit or cranberry products while taking warfarin.

Warfarin side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Warfarin may cause you to bleed more easily, which can be severe or life-threatening. Call your doctor or seek emergency medical attention if you have any unusual bleeding, or bleeding that will not stop. You may also have bleeding on the inside of your body, such as in your stomach or intestines. Call your doctor at once if you have black or bloody stools, or if you cough up blood or vomit that looks like coffee grounds. These could be signs of bleeding in your digestive tract.

Call your doctor at once if you have:

  • pain, swelling, hot or cold feeling, skin changes, or discoloration anywhere on your body;

  • sudden and severe leg or foot pain, foot ulcer, purple toes or fingers;

  • sudden headache, dizziness, or weakness;

  • easy bruising, purple or red pinpoint spots under your skin, bleeding from wounds or needle injections;;

  • pale skin, feeling light-headed or short of breath, rapid heart rate, trouble concentrating;

  • dark urine, jaundice (yellowing of the skin or eyes);

  • little or no urinating;

  • numbness or muscle weakness; or

  • pain in your stomach, back, or sides.

Common side effects may include:

  • nausea, vomiting, mild stomach pain;

  • bloating, gas; or

  • altered sense of taste.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

What other drugs will affect warfarin?

Many drugs (including some over-the-counter medicines and herbal products) can affect your INR and may increase the risk of bleeding if you take them with warfarin. Not all possible drug interactions are listed in this medication guide. It is very important to ask your doctor before you start or stop using any other medicine, especially:

  • other medications to prevent blood clots;

  • an antibiotic, antifungal medication, sulfa drug, or medicine to treat tuberculosis;

  • supplements that contain vitamin K;

  • an antidepressant--citalopram, duloxetine, fluoxetine, fluvoxamine, paroxetine, sertraline, venlafaxine, vilazodone, and others; seizure medication--carbamazepine, phenobarbital, phenytoin; herbal (botanical) products--coenzyme Q10, cranberry, echinacea, garlic, ginkgo biloba, ginseng, goldenseal, or St. John's wort.

This list is not complete and many other drugs can interact with warfarin. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start or stop using a new medicine without your doctor's advice. Give a list of all your medicines to any healthcare provider who treats you.

Where can I get more information?

  • Your pharmacist can provide more information about warfarin.
  • 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.
  • Disclaimer: 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.

Copyright 1996-2012 Cerner Multum, Inc. Version: 17.02. Revision Date: 2013-09-13, 3:40:25 PM.

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