Download Coumadin - Pinky S. Tiwari, MD, PA

Pinky S. Tiwari, M.D., P.A.
Diplomate, American Board of Neurology
Diplomate, American Board of Electrodiagnostic Medicine
St. Luke’s Medical Tower
6624 Fannin, Suite 2190
Houston, TX 77030
Telephone: (713) 790 – 1775
www.texasneuro.com
Fax: (713) 790 – 1605
COUMADIN
WARFARIN - ORAL
Pronunciation: (WARF-uh-rin)
BRAND NAME(S):
Coumadin
USAGE:
Warfarin is used to prevent and treat harmful blood clots. This medication helps to keep blood flowing smoothly in your
body by decreasing the amount of clotting proteins in the blood. Warfarin is sometimes commonly referred to as a "blood
thinner," but its more correct term is "anticoagulant." Conditions which increase your risk of developing blood clots include
a certain type of irregular heart rhythm (atrial fibrillation), heart valve replacement, or a recent heart attack. Preventing
harmful blood clots helps to reduce the risk of a stroke or heart attack.
HOW TO USE
Take this medication by mouth usually once a day, or as directed by your doctor. It is very important to take it exactly as
prescribed. Do not increase the dose, take it more frequently, or stop using it unless directed by your doctor.
Use this medication regularly in order to get the most benefit from it. Remember to use it at the same time each day.
The dosage is based on your medical condition and response to therapy. Laboratory tests (prothrombin time-PT and
international normalized ratio-INR) will be performed periodically to monitor your response to therapy and your dose may
be adjusted based on the results.
SIDE EFFECTS:
Nausea, vomiting, loss of appetite, stomach/abdominal bloating or cramps may occur. If any of these effects persist or
worsen, notify your doctor or pharmacist promptly.
Remember that your doctor has prescribed this medication because the benefit to you is greater than the risk of side
effects. Many people using this medication do not have serious side effects.
This medication can cause bleeding if its effect on your blood clotting proteins is too much (unusually high PT and INR
results). Even if your doctor stops your medication, this risk can persist for up to a week. Tell your doctor immediately if
any of these signs of serious bleeding occur: unusual pain/swelling/discomfort, prolonged bleeding from cuts or gums,
persistent nosebleeds, unusually heavy or prolonged menstrual flow, unusual or easy bruising, dark urine, black stools,
severe headache, unusual dizziness.
Tell your doctor immediately if any of these highly unlikely but very serious side effects occur: persistent nausea or
vomiting, stomach/abdominal pain, yellowing of eyes/skin.
This drug may infrequently cause serious (possibly fatal) complications from the dislodging of solid patches of cholesterol
from blood vessel walls which can block the blood supply to parts of your body. If left untreated, this can lead to severe
tissue damage (gangrene). Seek immediate medical attention if any of these unlikely but serious side effects occur:
painful red rash, dark discoloration of any body part (e.g., purple toe syndrome), sudden intense pain (e.g., back or
muscle pain), foot ulcers, unusual change in the amount of urine, vision changes, confusion, slurred speech, one-sided
weakness.
A very serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a
serious allergic reaction may include: rash, itching, swelling, severe dizziness, trouble breathing.
If you notice other effects not listed above, contact your doctor or pharmacist.
PRECAUTIONS:
Before taking warfarin, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies.
This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor
or pharmacist if you have: blood disorders (e.g., hemophilia), bleeding conditions (e.g., active ulcers), uncontrolled severe
high blood pressure (malignant hypertension), recent or planned surgery, received certain procedures (e.g., spinal cord
injections, major anesthesia).
Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, kidney
disease, alcohol abuse, tissue damage (e.g., gangrene, necrosis), trauma, high blood pressure, severe diabetes,
congestive heart failure, cancer, collagen vascular disease (e.g., lupus, polyarteritis), radiation therapy, underactive or
overactive thyroid, poor nutrition, intestinal absorption problems, low blood levels of vitamin K, swelling of the arms/legs
(edema), high cholesterol/fat blood levels, catheters in your body (e.g., urinary or intravenous type), side effects with
heparin treatment (heparin-induced thrombocytopenia), family members who did not respond to warfarin treatment,
conditions that make it difficult to follow a warfarin treatment plan (e.g., dementia, psychosis).
Avoid alcohol while taking this drug because it may increase the risk of stomach bleeding.
Avoid getting injections into the muscles (intramuscular-IM). If they must be given, limit injections to the arms.
The FDA has stated that generic warfarin products are interchangeable. However, consult your doctor and pharmacist
before switching warfarin products.
If you have an illness or infection that causes vomiting, diarrhea or fever for more than a few days, contact your doctor
immediately because these conditions can affect how well this drug works.
This medication can cause heavy bleeding. Be extra careful to avoid injuries (e.g., avoid contact sports). Use an electric
razor when shaving and a soft toothbrush when brushing your teeth.
It is important that all your doctors and dentists know you take warfarin.
Caution is advised when using this drug in the elderly because they may be more sensitive to its effects.
This medication must not be used during pregnancy because of possible fetal harm and birth defects. Discuss reliable
forms of birth control with your doctor. If you become pregnant or think you may be pregnant, inform your doctor
immediately. You will be switched over to another anticoagulant (e.g., heparin-type) during pregnancy. Consult your
doctor for more information.
This medication does not pass into breast milk. While there have been no reports of harm to nursing infants, consult your
doctor before breast-feeding.
DRUG INTERACTIONS:
This drug should not be used with the following medications because very serious interactions may occur: imatinib,
mifepristone.
If you are currently using any of these medications, tell your doctor or pharmacist before starting warfarin.
Many drugs and herbal products interact with warfarin. Before using this medication, tell your doctor or pharmacist of all
prescription and nonprescription/herbal products you may use, especially of: acetaminophen (repeated use or large
doses), allopurinol, aminoglutethimide, amiodarone, anabolic steroids (e.g., danazol, stanozolol), certain injectable
cephalosporin antibiotics (e.g., cefamandole, cefotetan), macrolide antibiotics (e.g., erythromycin, clarithromycin), certain
oral and injectable penicillin-type antibiotics (e.g., dicloxacillin, piperacillin), quinolone antibiotics (e.g., ciprofloxacin,
levofloxacin), certain other antibiotics (e.g., chloramphenicol, metronidazole), azole antifungals (e.g., voriconazole, vaginal
miconazole), barbiturates (e.g., phenobarbital), birth control pills, certain drugs to treat cancer (e.g., capecitabine,
fluorouracil), carbamazepine, drugs to lower cholesterol or triglycerides (e.g., cholestyramine, fenofibrate, gemfibrozil,
lovastatin, simvastatin), cimetidine, corticosteroids (e.g., prednisone), disulfiram, glucagon, griseofulvin, herbal/dietary
products (e.g., bromelains, co-enzyme Q, danshen, dong quai, garlic, ginkgo biloba, ginseng, St. John's wort),
nonsteroidal anti-inflammatory drugs (NSAIDs such as celecoxib, ibuprofen, topical methylsalicylate), omeprazole,
propafenone, propoxyphene, quinidine, quinine, rifamycins (e.g., rifampin, rifabutin), certain sedatives (e.g., chloral
hydrate, ethchlorvynol, glutethimide), sulfa drugs, sulfinpyrazone, SSRI antidepressants (e.g., fluoxetine, fluvoxamine),
tamoxifen, drugs to treat thyroid disease (e.g., levothyroxine, propylthiouracil), vitamin E, vitamin K, zafirlukast.
Check all prescription and nonprescription medicine labels carefully since many contain pain relievers/fever reducers
(NSAIDs such as ibuprofen, naproxen, or aspirin) which can increase the risk of bleeding/anti-platelet effect when used
with warfarin. Low-dose aspirin, as prescribed by your doctor for specific medical reasons such as heart attack or stroke
prevention or to prevent clotting of artificial heart valves (usually these dosages are 81-325 mg per day), should be
continued. Consult your doctor or pharmacist for more details.
Related drugs (anti-platelet drugs such as clopidogrel, dipyridamole, ticlopidine) prescribed for specific medical reasons
should be continued, unless otherwise directed by your doctor. Consult your doctor or pharmacist for more details
including the possible serious side effects associated with ticlopidine (e.g., immune system problem, liver disease when
used with warfarin).
While taking warfarin, it is important to eat a normal, balanced diet. The amount of vitamin K in your body affects the way
that warfarin works. It is best to avoid sudden changes in your diet, especially unusual increases or decreases in the
amount of foods high in vitamin K (e.g., liver, broccoli, cauliflower, cabbage, Brussels sprouts, kale, spinach and other
green leafy vegetables, green tea, and certain vitamin supplements). It is best to avoid strictly vegetarian diets that consist
of foods high in vitamin K.
This product can affect the results of certain lab tests. Make sure laboratory personnel and your doctors know you use this
drug.
OVERDOSE:
If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call
the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly.
Symptoms of overdose may include unusual or prolonged bleeding, dark urine or black stools.
NOTES:
Do not share this medication with others.
Laboratory and/or medical tests (e.g., blood tests such as PT/INR, complete blood count) should be performed
periodically to monitor your progress or check for side effects. It is important to keep all lab and medical appointments.
Consult your doctor or pharmacist for more details.
MISSED DOSE:
If you miss a dose, use it as soon as you remember if it is on the same day. If it is near the time of the next dose, skip the
missed dose and resume your usual dosing schedule. Do not double the dose to catch up because this could increase
your risk for bleeding. Keep a record of missed doses to give to your doctor or pharmacist. Call your doctor or pharmacist
if you miss 2 or more doses in a row.
STORAGE:
Store at room temperature between 59-86 degrees F (15-30 degrees C) away from light and moisture. Do not store in the
bathroom. Keep all medicines away from children and pets.
MEDICAL ALERT: Your condition can cause complications in a medical emergency. For enrollment information call
MedicAlert at 1-800-854-1166 (USA), or 1-800-668-1507 (Canada).