Warfarin

pronounced as(war' far in)

URL of this page: http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682277.html
What side effects can this medication cause? What storage conditions are needed for this medicine? In case of
emergency/overdose What other information should I know? Brand names
Why is this medication prescribed? How should this medicine be used? Other uses for this medicine What special
precautions should I follow? What special dietary instructions should I follow? What should I do if I forget a dose?

Important Warning:
Warfarin may cause severe bleeding that can be life-threatening and even cause death. Tell your doctor if you have or
have ever had a blood or bleeding disorder; bleeding problems, especially in your stomach or your esophagus (tube
from the throat to the stomach), intestines, urinary tract or bladder, or lungs; high blood pressure; heart attack; angina
(chest pain or pressure); heart disease; pericarditis (swelling of the lining (sac) around the heart); endocarditis (infection
of one or more heart valves); a stroke or ministroke; aneurysm (weakening or tearing of an artery or vein); anemia (low
number of red blood cells in the blood); cancer; chronic diarrhea; or kidney, or liver disease. Also tell your doctor if you
fall often or have had a recent serious injury or surgery. Bleeding is more likely during warfarin treatment for people
over 65 years of age, and it is also more likely during the first few weeks of warfarin treatment. Bleeding is also more
likely to occur for people who take high doses of warfarin, or take this medication for a long time. The risk for bleeding
while taking warfarin is also higher for people participating in an activity or sport that may result in serious injury. Tell
your doctor and pharmacist if you are taking or plan to take any prescription or nonprescription medications, vitamins,
nutritional supplements, and herbal or botanical products (See SPECIAL PRECAUTIONS), as some of these products may
increase the risk for bleeding while you are taking warfarin. If you experience any of the following symptoms, call your
doctor immediately: pain, swelling, or discomfort, bleeding from a cut that does not stop in the usual amount of time,
nosebleeds or bleeding from your gums, coughing up or vomiting blood or material that looks like coffee grounds,
unusual bleeding or bruising, increased menstrual flow or vaginal bleeding, pink, red, or dark brown urine, red or tarry
black bowel movements, headache, dizziness, or weakness.

Some people may respond differently to warfarin based on their heredity or genetic make-up. Your doctor may order a
blood test to help find the dose of warfarin that is best for you. Keep all appointments with your doctor and the
laboratory. Your doctor will order certain tests to check your body's response to warfarin.

Warfarin prevents blood from clotting so it may take longer than usual for you to stop bleeding if you are cut or injured.
Avoid activities or sports that have a high risk of causing injury. Call your doctor if bleeding is unusual or if you fall and
get hurt, especially if you hit your head.

If your doctor tells you to stop taking warfarin, the effects of this medication may last for 2 to 5 days after you stop
taking it.

Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you
begin treatment with warfarin and each time you refill your prescription. Read the information carefully and ask your
doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website
(http://www.fda.gov/downloads/Drugs/DrugSafety/ucm088578.pdf) or the manufacturer's website to obtain the
Medication Guide.

Talk to your doctor about the risk(s) of taking warfarin.

Why is this medication prescribed?

1
Warfarin is used to prevent blood clots from forming or growing larger in your blood and blood vessels. It is prescribed
for people with certain types of irregular heartbeat, people with prosthetic (replacement or mechanical) heart valves,
and people who have suffered a heart attack. Warfarin is also used to treat or prevent venous thrombosis (swelling and
blood clot in a vein) and pulmonary embolism (a blood clot in the lung). Warfarin is in a class of medications called
anticoagulants ('blood thinners'). It works by decreasing the clotting ability of the blood.

How should this medicine be used?

Warfarin comes as a tablet to take by mouth. It is usually taken once a day with or without food. Take warfarin at
around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or
pharmacist to explain any part you do not understand. Take warfarin exactly as directed. Do not take more or less of it
or take it more often than prescribed by your doctor. Call your doctor immediately if you take more than your
prescribed dose of warfarin.

Your doctor will probably start you on a low dose of warfarin and gradually increase or decrease your dose based on the
results of your blood tests. Make sure you understand any new dosing instructions from your doctor.

Continue to take warfarin even if you feel well. Do not stop taking warfarin without talking to your doctor.

Other uses for this medicine

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before taking warfarin,

 tell your doctor and pharmacist if you are allergic to warfarin or any other medications.
 do not take two or more medications that contain warfarin at the same time. Be sure to check with your doctor
or pharmacist if you are uncertain if a medication contains warfarin or warfarin sodium.
 tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional
supplements you are taking or plan to take, especially antibiotics; aspirin or aspirin-containing products and
other nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn);
heparin; medications for cancer, cholesterol, colds and allergies, depression, diabetes, digestive problems
(including ulcers and heartburn), gout, heart disease, mental illness, pain,seizures, thyroid problems, and
tuberculosis; oral contraceptives (birth control pills); streptokinase; ticlopidine; or urokinase. Many other
medications may also interact with warfarin, so be sure to tell your doctor about all the medications you are
taking, even those that do not appear on this list. Do not take any new medications or stop taking any
medication without talking to your doctor.
 tell your doctor and pharmacist what herbal or botanical products you are taking, especially bromelains,
coenzyme Q10 (Ubidecarenone), cranberry products, danshen, dong quai, garlic, Ginkgo biloba, ginseng, and
St. John's wort. There are many other herbal or botanical products which might affect your body's response to
warfarin. Do not start or stop taking any herbal products without talking to your doctor.
 tell your doctor if you have or have ever had a thyroid condition or diabetes. Also tell your doctor if you have
an infection, a gastrointestinal illness such as diarrhea, or sprue (an allergic reaction to protein found in grains
that causes diarrhea), or an indwelling catheter (a flexible plastic tube that is placed into the bladder to allow
the urine to drain out).
 Tell your doctor if you are pregnant, think you might be pregnant, or plan to become pregnant while taking
warfarin. You should not take warfarin if you are pregnant. Talk to your doctor about the use of effective birth
control while taking warfarin. If you become pregnant while taking warfarin, call your doctor immediately.
Warfarin may harm the fetus.
2
  tell your doctor if you are breast-feeding.
 if you are having surgery, including dental surgery, or any type of medical or dental procedure, tell the doctor
or dentist that you are taking warfarin. Your doctor may tell you to stop taking warfarin before the surgery or
procedure or change your dosage of warfarin before the surgery or procedure. Follow your doctor's directions
carefully and keep all appointments with the laboratory if your doctor orders blood tests to find the best dose
of warfarin for you.
 tell your doctor if you drink or have ever drunk large amounts of alcohol. Your doctor will probably tell you not
to take warfarin. Avoid drinking alcohol while you are taking this medication.
 If you are going to receive an immunization, such as a flu shot, or any other injection into a muscle, tell the
health care professional that you are taking warfarin.

What special dietary instructions should I follow?

Eat a normal, healthy diet with the same amount of foods that contain vitamin K; ask your doctor or pharmacist for a list
of foods that contain vitamin K. Be sure to talk to your doctor before you make any changes in your diet or try to gain or
lose weight. Do not eat large amounts of leafy, green vegetables or certain vegetable oils, such as soybean or canola,
that contain large amounts of vitamin K. Avoid juice or products that contain cranberries. Ask your doctor about eating
licorice while taking warfarin.

Tell your doctor if you drink nutritional supplements or receive supplements by a feeding tube.

What should I do if I forget a dose?

Take the missed dose as soon as you remember it, if it is the same day that you were to take the dose. Do not take a
double dose the next day to make up for a missed one. Talk to your doctor if you miss a dose of warfarin.

What side effects can this medication cause?

Warfarin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go
away:

 gas
 change in the way things taste
 tiredness
 pale skin
 loss of hair
 feeling cold or having chills

If you experience any of the following symptoms, or those listed in the IMPORTANT WARNING
section, call your doctor immediately:

 hives
 rash
 itching
 difficulty breathing or swallowing
 swelling of the face, throat, tongue, lips, or eyes
 hoarseness
 chest pain or pressure
 swelling of the hands, feet, ankles, or lower legs
 fever

3
  infection
 nausea
 vomiting
 diarrhea
 loss of appetite
 pain in the upper right part of the stomach
 yellowing of the skin or eyes
 flu-like symptoms
 joint or muscle pain
 difficultly in moving any part of your body
 feelings of numbness, tingling, pricking, burning, or creeping on the skin
 painful erection of the penis that lasts for hours

You should know that warfarin may cause necrosis or gangrene (death of skin or other body tissues). Call your doctor
immediately if you notice a purplish or darkened color to your skin, skin changes, ulcers, or an unusual problem in any
area of your skin or body, or if you have a severe pain that occurs suddenly, or color or temperature change in any area
of your body. Call your doctor immediately if your toes become painful or become purple or dark in color. You may need
medical care right away to prevent amputation (removal) of your affected body part.

Warfarin may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

What storage conditions are needed for this medicine?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room
temperature and away from excess heat, moisture (not in the bathroom), and light. Throw away any medication that is
outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not
breathing, call local emergency services at 911.

Symptoms of overdose may include:

 bloody or red, or tarry bowel movements

 spitting or coughing up blood
 heavy bleeding with your menstrual period
 pink, red, or dark brown urine
 coughing up or vomiting material that looks like coffee grounds
 small, flat, round red spots under the skin
 unusual bruising or bleeding
 continued oozing or bleeding from minor cuts

What other information should I know?

Carry an identification card or wear a bracelet stating that you take warfarin. Ask your pharmacist or doctor how to
obtain this card or bracelet. List your name, medical problems, medications and dosages, and doctor's name and
telephone number on the card.

Tell all your healthcare providers that you take warfarin.

4
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your
prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines
you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this
list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry
with you in case of emergencies.

Brand names
 Coumadin®

Last Reviewed - 09/01/2008

American Society of Health-System Pharmacists, Inc. Disclaimer

AHFS® Consumer Medication Information. © Copyright, 2010. The American Society of Health-System Pharmacists, Inc.,
7272 Wisconsin Avenue, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized
by ASHP.

Question
Warfarin diet: What foods should I avoid?

Can you tell me what I should eat while I am taking warfarin (Coumadin)? What
foods should I avoid?

Answer
from Sheldon G. Sheps, M.D.

Warfarin is a blood-thinning medication that helps treat and prevent blood clots. There is no specific warfarin
(Coumadin) diet. However, certain foods and beverages can make it so warfarin doesn't effectively prevent blood clots.
It's important to pay attention to what you eat while taking warfarin.

One nutrient that can lessen warfarin's effectiveness is vitamin K. It's important to be consistent in how much vitamin K
you get daily. The average daily allowance of vitamin K for adult men is 120 micrograms (mcg). For adult women, it's 90
mcg. While eating small amounts of foods that are rich in vitamin K shouldn't cause a problem, avoid eating or drinking
large amounts of:

 Kale
 Spinach
 Brussels sprouts
 Parsley
 Collard greens
 Mustard greens
 Chard
 Green tea

5
Certain drinks can increase the effect of warfarin, leading to bleeding problems. Avoid or drink only small amounts of
these drinks when taking warfarin:

 Cranberry juice
 Alcohol

Talk to your doctor before making any major changes in your diet and before starting any over-the-counter medications,
vitamins or herbal supplements. If you are unable to eat for several days or have ongoing stomach upset, diarrhea or
fever, consult your doctor. These signs and symptoms may mean you need a different dose of warfarin.

Blood thinners: Can I still get blood clots?

Warfarin side effects: Watch for dangerous interactions
Warfarin: Any harm in long-term use?
Blood thinners: Can I still get blood clots?

Related Links
Related Guides
Children
Parent

1. May 13, 2010

© 1998-2010 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these
materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.com,"
"EmbodyHealth," "Enhance your life," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for
Medical Education and Research.

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

.What is warfarin?
Warfarin is an anticoagulant (blood thinner). Warfarin reduces the formation of blood clots by blocking the formation of
certain clotting factors.

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

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

Important information about warfarin

Warfarin can harm an unborn baby or cause birth defects. Do not use warfarin if you are pregnant or may become
pregnant. Never take a double dose of this medication or take it together with other products that contain warfarin or
coumarin. 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, stomach bleeding, bleeding in the brain, recent or upcoming surgery, or if you need
a spinal tap or spinal anesthesia (epidural).

6
Warfarin may cause you to bleed more easily, especially if you have: a history of bleeding problems, high blood pressure
or severe heart disease, kidney disease, cancer, surgery or a medical emergency, a disease affecting the blood vessels in
your brain, a history of stomach or intestinal bleeding, if you are 65 or older, or if you are severely ill or debilitated.

Many drugs (including some over-the-counter medicines and herbal products) can cause serious medical problems or
death if you take them with warfarin. It is very important to tell your doctor about all medicines you have recently used.
Ask your doctor before taking any medicine for pain, arthritis, fever, or swelling. These medicines may affect blood
clotting and may also increase your risk of stomach bleeding. Any doctor, dentist, surgeon, or other medical care
provider who treats you should know that you are taking warfarin. Avoid making any changes in your diet without first
talking to your doctor.

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;
 if you have recently had or will soon have any type of surgery (especially brain, spine, or eye surgery); 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 may cause you to bleed more easily, especially if you have:

 a history of bleeding problems;

 high blood pressure or severe heart disease;
 kidney disease;
 cancer;
 surgery or a medical emergency;
 a disease affecting the blood vessels in your brain;
 a history of stomach or intestinal bleeding;
 if you are 65 or older; or
 if you are severely ill or debilitated.

FDA pregnancy category X. Warfarin can cause birth defects or fatal bleeding in an unborn baby. Do not take warfarin if
you are pregnant or may become pregnant. Use effective birth control and tell your doctor right away if you become
pregnant while taking warfarin.

If you have any of these other conditions, you may need a dose adjustment or special tests:

 liver disease;
 celiac sprue (an intestinal disorder);
 diabetes;
 congestive heart failure;
 overactive thyroid;

7
  a connective tissue disorder such as Marfan Syndrome, Sjogren syndrome, scleroderma, rheumatoid arthritis,
or lupus; or
 if you have ever had low blood platelets after receiving heparin.

Warfarin may pass into breast milk and cause bleeding problems in the nursing baby. Do not use warfarin without telling
your doctor if you are breast-feeding a baby.

How should I take warfarin?

Take warfarin exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than
recommended. Follow the directions on your prescription label. Never take a double dose of this medication or take it
together with other products that contain warfarin or coumarin.

Your doctor may occasionally change your dose to make sure you get the best results.

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

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

Call your doctor if you have any illness with diarrhea, fever, chills, body aches, or flu symptoms.

While taking warfarin, your blood will need to be tested often. Visit your doctor regularly.

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 warfarin. 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 warfarin 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, 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 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, celecoxib (Celebrex), ibuprofen (Advil, Motrin), diclofenac (Cataflam, Voltaren), indomethacin (Indocin),
naproxen (Aleve, Naprosyn), piroxicam (Feldene), and others. These medicines may affect blood clotting and may also
increase your risk of stomach bleeding.

Do not eat large amounts of foods high in vitamin K (such as liver, leafy green vegetables or vegetable oils). Vitamin K
can make warfarin less effective. Avoid making any changes in your diet without first talking to your doctor.

8
Avoid eating cranberries, drinking cranberry juice, or taking cranberry herbal products. Avoid herbal teas that contain
tonka beans, sweet clover, or sweet woodruff.

Drinking alcohol can increase certain side effects of warfarin.

Warfarin side effects

Get emergency medical help if you have any of these signs of an allergic reaction to warfarin: hives; difficulty breathing;
swelling of your face, lips, tongue, or throat. Stop using warfarin and call your doctor at once if you have a serious side
effect such as:

 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;
 unusual bleeding (nose, mouth, vagina, or rectum), bleeding from wounds or needle injections, any bleeding
that will not stop;
 easy bruising, purple or red pinpoint spots under your skin;
 blood in your urine, black or bloody stools, coughing up blood or vomit that looks like coffee grounds;
 pale skin, feeling light-headed or short of breath, rapid heart rate, trouble concentrating;
 dark urine, jaundice (yellowing of the skin or eyes);
 pain in your stomach, back, or sides;
 urinating less than usual or not at all;
 numbness or muscle weakness; or
 any illness with diarrhea, fever, chills, body aches, or flu symptoms.

Less serious warfarin 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.

What other drugs will affect warfarin?

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

Warfarin can interact with certain herbal (botanical) products, which can increase your risk of bleeding. Do not use any
of the following products without first asking your doctor:

 bromelains;
 coenzyme Q10;
 cranberry;
 danshen;
 dong quai;
 garlic;
 ginkgo biloba;
 ginseng; or
 St. John's wort.
9
This list is not complete and there are many other drugs that can interact with warfarin. Tell your doctor about all
medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new
medication without telling your doctor. Keep a list of all your medicines and show it to any healthcare provider who
treats you.

More Warfarin resources

 Warfarin Side Effects (in More Detail)
 Warfarin Dosage
 Warfarin Use in Pregnancy & Breastfeeding
 Drug Images
 Warfarin Drug Interactions
 Warfarin Support Group
 18 Reviews for Warfarin - Add your own review/rating

 Warfarin Prescribing Information (FDA)

 Warfarin MedFacts Consumer Leaflet (Wolters Kluwer)
 warfarin Advanced Consumer (Micromedex) - Includes Dosage Information
 Coumadin Monograph (AHFS DI)
 Coumadin Prescribing Information (FDA)
 Jantoven Prescribing Information (FDA)

Compare Warfarin with other medications

 Antiphospholipid Syndrome
 Chronic Central Venous Catheterization
 Deep Vein Thrombosis Prophylaxis after Hip Replacement Surgery
 Deep Vein Thrombosis Prophylaxis after Knee Replacement Surgery
 Deep Vein Thrombosis, First Event
 Deep Vein Thrombosis, Recurrent Event
 Heart Attack
 Heart Failure
 Prevention of Thromboembolism in Atrial Fibrillation
 Prosthetic Heart Valves
 Prosthetic Heart Valves, Mechanical Valves
 Prosthetic Heart Valves, Tissue Valves
 Protein S Deficiency
 Pulmonary Embolism, First Event
 Pulmonary Embolism, Recurrent Event
 Thromboembolic Stroke Prophylaxis

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 warfarin 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
10
 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 1996-2010 Cerner Multum, Inc. Version: 12.01. Revision Date: 05/26/2010 9:09:13 AM.

Source: http://www.medicinenet.com/script/main/art.asp?articlekey=727

warfarin, Coumadin
GENERIC NAME: warfarin
BRAND NAME: Coumadin

DRUG CLASS AND MECHANISM: Coumadin is an oral anticoagulant that inhibits the synthesis of clotting factors, thus
preventing blood clot formation. Blood clots can occur in the veins of the lower extremities, usually after periods of
immobility. These clots can break off and become lodged in the blood vessels of the lung (pulmonary embolism), causing
shortness of breath, chest pain, and even life-threatening shock. Blood clots can also occur in the atria of the heart
during atrial fibrillation, and around artificial heart valves. One of these clots can also break off and obstruct a blood
vessel in the brain, causing an embolic stroke with paralysis. Coumadin is important in preventing the formation of
blood clots. It is also important to prevent extension of clots already formed, and to minimize the risk of blood clot
embolization to other vital organs such as the lungs and brain.

PRESCRIPTION: yes

GENERIC AVAILABLE: yes

PREPARATIONS: tablets (1mg, 2mg, 2.5mg, 5mg, 7.5mg, 10mg)

STORAGE: Store at room temperature in tight, light resistant container.

PRESCRIBED FOR: Coumadin is used in treating patients with blood clots in the lower extremities to prevent extension
of the clot, and to reduce the risk of pulmonary embolism. Patients with pulmonary embolism are treated with
Coumadin to prevent further blood clot emboli. Coumadin is also used in patients with atrial fibrillation and artificial
heart valves to reduce the risk of strokes. It is also helpful in preventing blood clot formation in certain orthopedic
surgeries such as knee or hip replacements. Coumadin is also used in preventing blood clot closure of coronary artery
stents.

11
DOSING: Coumadin may be taken with or without food. Since Coumadin is metabolized by the liver and excreted by the
kidneys, dosages need to be lowered in patients with liver and kidney dysfunction. Frequent blood tests are performed
to measure blood clotting time (protime) during Coumadin treatment. Protime results help doctors adjust medication
dose to avoid excessive blood thinning and risk of bleeding.

DRUG INTERACTIONS: Many drugs, both prescription and nonprescription (OTC), can affect the anticoagulant action of
Coumadin. Some medications can enhance the action of Coumadin and cause excessive blood thinning and life-
threatening bleeding. A few examples of such medications include Aspirin, acetaminophen (Tylenol and others), alcohol,
ibuprofen (Motrin), cimetidine (Tagamet), oxandrolone (Oxandrin), certain vitamins, and antibiotics. Patients on
Coumadin should regularly consult their doctor before instituting any medications on their own. It is also advisable for
patients on Coumadin to carry identifications to alert other health professionals.

PREGNANCY: Coumadin should be avoided by pregnant women or women who may become pregnant. Birth defects
and fetal bleeding have been reported.

SIDE EFFECTS: The two most serious side effects are bleeding and necrosis (gangrene) of the skin. Bleeding can occur in
any organ or tissue. Bleeding around the brain can cause severe headache and paralysis. Bleeding in the joints can cause
joint pain and swelling. Bleeding in the stomach or intestines can cause weakness, fainting spells, black tarry stools,
vomiting of blood, or coffee ground material. Bleeding in the kidneys can cause back pain and blood in urine. Other side
effects include purple, painful toes, rash, hair loss, bloating, diarrhea, and jaundice (yellowing of eyes and skin). Signs of
overdose include bleeding gums, bruising, nosebleeds, heavy menstrual bleeding, and prolonged bleeding from cuts.

Reference: FDA Prescribing Information

Last Editorial Review: 8/24/1999

12