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Active substance(s): ACENOCOUMAROL

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Sinthrome® 1mg Tablets
Your medicine is known by the above name, but will be referred to as
Sinthrome throughout this:
Patient Information Leaflet
Read all of this leaflet carefully before you start taking this
medicine because it contains important information for you
• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you only. Do not pass it on to
others. It may harm them, even if their signs of illness are the same
as yours.
• If you get any side effects talk to your doctor or pharmacist. This
includes any possible side effects not listed in this leaflet. (See
section 4)
What is in this leaflet
1) What Sinthrome is and what it is used for
2) What you need to know before you take Sinthrome
3) How to take Sinthrome
4) Possible side effects
5) How to store Sinthrome
6) Contents of the pack and other information

1) What Sinthrome is and what it is used for
Sinthrome belongs to a group of medicines called anticoagulants (blood
thinning medicines).
Sinthrome is used to treat and prevent blood clots blocking the blood
vessels e.g. deep vein thrombosis (DVT).
Sinthrome does not dissolve blood clots that have already formed but it
may stop the clots from becoming larger and causing more serious

2) What you need to know before you take Sinthrome
Follow all the doctor’s instructions carefully. They may differ from the
general information contained in this leaflet.
Do not take Sinthrome:
• if you are allergic (hypersensitive) to acenocoumarol, any other
medicines that you have taken to thin your blood or to any of the
ingredients in Sinthrome (see Section 6, Contents of the pack and
other information)
• if you are pregnant, planning to become pregnant or breast-feeding
(see Pregnancy, breast- feeding and fertility).
• if you are an alcoholic
• if you have any mental illness for example, schizophrenia or dementia
• if you have recently had, or are about to have an operation on your
spine, brain, eyes or any major surgery
• if you have had a stroke caused by bleeding into your brain
• if you suffer from very high blood pressure
• if you have a stomach ulcer or any intestinal bleeding
• if you pass blood in your water or cough up blood
• if you suffer from any bleeding disorders, bleeding problems or
unexplained bruising
• if you have pericarditis or endocarditis – inflammation or infection
around the heart which causes pain in the chest
• if you have severe liver or kidney disease
• if you regularly drink cranberry juice or take cranberry extracts.
If any of the above applies to you, or if you are not sure, speak to your
doctor or pharmacist before you take Sinthrome.
Warnings and precaution
Before you take Sinthrome tell your doctor or pharmacist:
• if you have cancer
• if you have an infection or inflammation (swelling)
• if you have a disorder affecting the absorption of food from the
stomach and/or intestine
• if you have heart failure (which causes swelling and shortness of
• if you have liver or kidney problems
• if you have an overactive thyroid
• if you are elderly
• if you suffer from a blood disorder such as protein C or protein S
deficiency – this would cause you to bleed for longer than normal after
a cut or injury.
You should NOT receive any injections into your muscles whilst you are
taking Sinthrome.
If you need any injections into your spine or as part of a scan or X-ray test
or if you need minor surgery, including dental surgery, make sure you
discuss your treatment with your doctor first.
If you are involved in an accident while on Sinthrome you are likely to
bleed more than normal. The doctor or hospital staff must be informed that
you are taking Sinthrome immediately. Always carry your personal
anticoagulation card (an identification card from your pharmacist stating
that you are using this medicine).
If any of the above applies to you, or if you are not sure, speak to your
doctor or pharmacist before you take Sinthrome.

Other medicines and Sinthrome
Tell your doctor or pharmacist if you are taking or have recently taken any
other medicines, including medicines obtained without prescription (overthe-counter). This applies especially to the following medicines as they
may interfere with Sinthrome:
Medicines that increase the activity of Sinthrome such as:
• heparin - to thin the blood in the treatment of deep vein thrombosis,
blood clots or after surgery
• antibiotics (e.g. clindamycin)
• salicylic acid and related substances (e.g. acetyl salicylic acid,
aminosalicylic acid, diflunisal) (medicine used against pain)
• clopidogrel, ticlopidine, phenylbutazone or other pyrazolone derivatives
(sulfinpyrazone), other non-steroidal anti-inflammatory agents
(medicines affecting the function of platelets (particles in the blood
involved in blood clotting)).
When Sinthrome is prescribed in combination with these drugs, more
frequent monitoring (including blood tests) will be needed.
Other medicines that may increase the activity of Sinthrome such as:
• allopurinol or sulfinpyrazone - for the treatment of gout and to lower
uric acid levels
• clofibrate and related substances -medicines used against high
• anabolic steroids - used as replacement therapy
• androgens such as testosterone and mesterolone - used as
replacement therapy
• corticosteroids such as prednisolone and methylprednisolone steroids used to treat inflammatory bowel disease, arthritis and certain
skin conditions
• anti-arrhythmic agents such as amiodarone and quinidine - medicines
for an irregular heartbeat
• antibiotics
fluoroquinolones)-medicines used against infections
• disulfiram - for alcohol dependence
• etacrynic acid or thiazide diuretics (“water tablets”) such as
bendroflumethiazide or metolazone - for water retention or high blood
• glucagon - used to treat low blood sugar levels
• selective serotonin re-uptake inhibitors such as fluoxetine and
paroxetine - used to treat anxiety and depression
• paracetamol – a medicine used for pain
• sulfonamides such as co-trimoxazole - used to treat infections
• sulphonylureas
such as
tolbutamide, chlorpropamide and
glibenclamide - oral medicines for diabetes
• thyroid hormones such as levothyroxine - used to treat an underactive
• statins and other lipid lowering drugs such as fenofibrate, simvastatin
or colestyramine - used to lower blood cholesterol levels
• imidazole derivatives (e.g. metronidazole, and even when
administered locally, miconazole) - a medicine used against infection
• tramadol - a strong pain killer
• tamoxifen - for breast cancer and fertility
• azathioprine - for organ transplantation, chronic inflammatory and
autoimmune diseases
• proton pump inhibitors (e.g. omeprazole)
• plasminogen activators (e.g. urokinase) streptokinase and alteplase,
thrombin inhibitors (e.g. argatroben) - medicines used to breakdown
blood clots during heart stroke
• antineoplastics such as mercaptopurine and 5-fluorouracil - for breast,
gastrointestinal and skin cancer
• H2-agonists such as cimetidine or ranitidine - used to treat stomach or
intestinal ulcers
• prokinetic agents (e.g. cisapride) - medicines used against HIV
• antacids (e.g. magnesium hydroxide) and viloxazine - medicine used
against stomach acidity.
Medicines that may decrease the effect of Sinthrome such as:
• aminoglutethimide - used to treat cancer or Cushing’s syndrome
• protease inhibitors such as ritonavir or indinavir - used to treat HIV
• barbiturates such as sodium amytal or phenobarbital and
carbamazepine - for epilepsy or to help you sleep
• corticosteroids
prednisolone) – medicines used to treat inflammation
• oral contraceptives such as femodene, logynon and cilest - for birth
• rifampicin - medicine used against infection
• St John’s Wort - for depression
• cholestyramine - medicine used against high cholesterol levels
• griseofulvin - used to treat fungal infections.
Effects of Sinthrome on other medicines
• Sinthrome may increase the risk of toxicity by hydantoin derivatives
such as phenytoin -medicines used to treat epilepsy.
Sinthrome with food and drink
Be careful when drinking alcohol as it may affect how Sinthrome thins your
blood. Check with your doctor first.

You should avoid drinking cranberry juice or taking other cranberry
products, such as capsules or concentrates as this could mean you do not
receive the correct amount of acenocoumarol.
If you are 65 years or older you may be more sensitive to the effects of
Sinthrome and so need more frequent check-ups. You may also need
lower doses.
Children and adolescents
Experience with Sinthrome in children and adolescents is limited and so
these patients need more frequent check-ups. (see Section 3)
Pregnancy, breast-feeding and fertility
Do NOT take Sinthrome if you are pregnant. Sinthrome, like other
anticoagulants can cause serious harm to your baby. Tell your doctor if
you are pregnant or trying to become pregnant. Your doctor will discuss
with you the potential risk of taking Sinthrome during pregnancy.
The decision to breast-feed while taking Sinthrome should be carefully
considered with your doctor. You and your child may require blood tests if
you are breast-feeding while you are taking Sinthrome. However, as a
precaution, your doctor should prescribe vitamin K to your child to prevent
their blood from being thinned.
If you are of child bearing age, a pregnancy test may be done by your
doctor to rule out pregnancy before you are given Sinthrome. You may
also be asked to use birth control while taking Sinthrome.
Ask your doctor or pharmacist for advice before taking any medicine.
Driving and using machines
Sinthrome has no influence on the ability to drive or use machines.
Sinthrome contains lactose
If you have been told by your doctor that you have an intolerance to some
sugars, contact your doctor or pharmacist before taking this medicinal

3) How to take Sinthrome
Always take Sinthrome exactly as your doctor has told you to. You should
check with your doctor or pharmacist if you are not sure.
Sinthrome should be taken as a single dose at the same time every day.
Swallow your tablets whole with a drink of water.
Your doctor will arrange regular blood tests during treatment with
Sinthrome to check on how fast your blood is clotting. This will help the
doctor decide on your dose.
The dose of Sinthrome will vary from patient to patient and from day to
day. The following can be used as a guide:
Adults and elderly:
The usual starting dose is between 2 mg/day to 4 mg/day without
administration of a loading dose. Treatment can be started with a loading
dose regimen, usually 6 mg on the first day followed by 4 mg on the
second day.
Elderly patients, patients with liver disease or severe heart failure or
malnourished patients may need lower doses.
Sinthrome is not recommended for children.
Tell your doctor or dentist or pharmacist at every visit that you are using
What to do if you take more Sinthrome than you should
If you accidentally take too many tablets, or someone else takes any of
your medicine, you should tell your doctor immediately or contact the
nearest accident and emergency department. You may require blood tests
to monitor your condition and treatment may be required. Show any leftover medicines or the empty packet to the doctor.
If you forget to take Sinthrome
Do not worry. If you forget to take a dose, take it as soon as possible,
unless it is almost time to take the next dose. Do NOT take a double dose.
Then go on as before.
If you have any questions about stopping Sinthrome, talk to your doctor.

4) Possible side effects
Like all medicines, Sinthrome can cause side effects, although not
everyone gets them.
Tell your doctor straight away if you have any of the following side effects:
Common (may affect up to 1 in 10 people):
• unusual bleeding such as:
bleeding from the gums
unexplained bruising or nosebleeds
heavy periods
heavy bleeding from cuts or wounds
• signs of bleeding inside the body such as:
stomach or abdominal pain
blood in the urine


bloody or black tarry stools
coughing or vomiting blood
severe headache
joint pain or stiffness
blurred sight.

Rare (may affect up to 1 in 1000):
• allergic reaction in the form of skin rash, or itching
• skin rashes
A painful skin rash. On rare occasions Sinthrome can cause
serious skin conditions, including one called calciphylaxis that
can start with a painful skin rash but can lead to serious
complications. This adverse reaction occurs more frequently in
patients with chronic disease kidney disease.
• itching
• unexplained fever
• loss of appetite
• feeling or being sick
• unusual hair loss.
Very rare (may affect up to 1 in 10,000):
• bruising with blistering of the skin with or without scars, usually in
areas of:
or sometimes in the toes
• bruising or bleeding under the skin (possible sign of vasculitis)
• jaundice (possible signs of liver injury).
Reporting of side effects
If you get any side effects, talk to your doctor or pharmacist. This includes
any possible side effects not listed in this leaflet. You can also report side
effects directly via the Yellow Card Scheme at: or search for MHRA Yellow Card in the
Google Play or Apple App Store. By reporting side effects you can help
provide more information on the safety of this medicine.

5) How to store Sinthrome
Keep all medicines out of the sight and reach of children.
Do not take Sinthrome after the expiry date printed on the carton, label or
blister strip after EXP. The expiry date refers to the last day of the month.
If your doctor decides to stop your treatment, return any unused medicine
to the pharmacist. Only keep it if your doctor tells you to.
If the tablets become discoloured or show any other signs of deterioration,
you should seek the advice of your pharmacist who will tell you what to do.
Medicines should not be disposed of via wastewater or household waste.
Ask your pharmacist on how to dispose of medicines no longer required.
These measures will help protect the environment.

6) Contents of the pack and other information
What Sinthrome contains:
Each Sinthrome tablet contains 1mg of the active ingredient
acenocoumarol. This is the new name for nicoumalone. The ingredient
itself has not changed.
The other ingredients are lactose, hypromellose, magnesium stearate,
maize starch, talc and colloidal silicon dioxide.
What Sinthrome looks like and contents of the pack
Sinthrome tablets are white, round, flat, with “CG” imprinted on one side
and “AA” on the other. They come in cartons of 100 tablets.
PL 10383/1836

Sinthrome® 1mg Tablets


Who makes and repackages your medicine?
Your medicine is manufactured by Merus Labs Netherlands B.V.,
Herengracht 483, 1017 BT Amsterdam, The Netherlands. Procured from
within the EU and repackaged by Product Licence Holder: Primecrown Ltd,
4/5 Northolt Trading Estate, Belvue Road, Northolt, Middlesex, UB5 5QS.
Leaflet date: 12.12.2017
Sinthrome is a registered trademark of Novartis AG, Basel, Switzerland.

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