Coumadin

Common Name: warfarin sodium

How does Coumadin work?

Warfarin belongs to the class of medications called anticoagulants. It is sometimes referred to as a "blood thinner," although it does not actually thin the blood. Warfarin helps to prevent blood clots from forming or from getting bigger, but it does not dissolve blood clots. Warfarin is used for the treatment of blood clots in the veins, arteries, lungs, and heart. It is also used to prevent clots for people with conditions that put them at an increased risk of developing blood clots (e.g., some abnormal heart rhythms, leg circulation problems). Blood clots in the circulation are dangerous because they can cause medical problems such as heart attacks, stroke, and pulmonary embolism. Warfarin helps to reduce blood clotting within 24 hours of taking the medication. The full effect may take 72 to 96 hours to occur. Warfarin works by partially blocking the re-use of vitamin K in your liver. Vitamin K is needed to make clotting factors that help the blood to clot and prevent bleeding. Vitamin K is found naturally in foods such as leafy, green vegetables and certain vegetable oils. If you are taking warfarin, you may continue to eat these foods, but do not make any drastic changes to your diet. Your doctor may have suggested this medication for conditions other than the ones listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

How should I use Coumadin?

The dose of warfarin is individualized by your doctor according to blood clotting time as determined by laboratory tests performed at regular intervals. It is very important to keep your lab appointments, as there is a narrow margin between too much and too little of the medication. Too much medication may cause you to bleed more. Too little medication may let a harmful clot form. Different circumstances in your life (e.g., eating certain foods or using certain medications) can cause the medication to work more or less effectively. Ask your doctor or pharmacist for a list of these foods and medications. It is very important that you take warfarin exactly as prescribed by your doctor. If you miss a dose of warfarin, notify your health care provider right away. Take the dose as soon as possible on the same day, but do not take a double dose of warfarin the next day to make up for a missed dose. Do not start, stop, or change any medication except on the advice of your health care provider. It is important to manage your lifestyle and habits appropriately when taking warfarin: Do not make drastic changes in your diet, such as eating large amounts of green, leafy vegetables. Do not attempt to change your weight by dieting without first checking with your health care provider. Avoid drinking alcohol. Do not participate in any activity or sport that may result in serious injury. Avoid cutting yourself.

What form(s) does Coumadin come in?

Coumadin® is available in injectable and tablet form. Injection: Each vial contains warfarin 5.4 mg. Nonmedicinal ingredients: mannitol, sodium chloride, sodium hydroxide (pH adjustment from 8.1 to 8.3), sodium phosphate dibasic heptahydrate and sodium phosphate monobasic monohydrate, and water for injection. Tablets: 1 mg: Each pink, scored tablet with "COUMADIN" over "1" on one side and "DuPont" on the other, contains warfarin 1 mg. Nonmedicinal ingredients: D&C Red No. 6 Barium Lake, lactose anhydrous, magnesium stearate, and pregelatinized tapioca starch. 2 mg: Each lavender, scored tablet with "COUMADIN" over "2" on one side and "DuPont" on the other, contains warfarin 2 mg. Nonmedicinal ingredients: FD&C Blue No. 2 Aluminum Lake, FD&C Red No. 40 Aluminum Lake, lactose anhydrous, magnesium stearate, and pregelatinized tapioca starch. 2.5 mg: Each green, scored tablet with "COUMADIN" over "2.5" on one side and "DuPont" on the other, contains warfarin 2.5 mg. Nonmedicinal ingredients: D&C Yellow No. 10 Aluminum Lake, FD&C Blue No. 1 Aluminum Lake, lactose anhydrous, magnesium stearate, and pregelatinized tapioca starch. 3 mg: Each tan, scored tablet with "COUMADIN" over "3" on one side and "DuPont" on the other, contains warfarin 3 mg. Nonmedicinal ingredients: FD&C Blue No. 2 Aluminum Lake, FD&C Red No. 40 Aluminum Lake, FD&C Yellow No. 6 Aluminum Lake, lactose anhydrous, magnesium stearate, and pregelatinized tapioca starch. 4 mg: Each blue, scored tablet with "COUMADIN" over "4" on one side and "DuPont" on the other, contains warfarin 4 mg. Nonmedicinal ingredients: FD&C Blue No. 1 Aluminum Lake, lactose anhydrous, magnesium stearate, and pregelatinized tapioca starch. 5 mg: Each peach-coloured, scored tablet with "COUMADIN" over "5" on one side and "DuPont" on the other, contains warfarin 5 mg. Nonmedicinal ingredients: FD&C Yellow No. 6 Aluminum Lake, lactose anhydrous, magnesium stearate, and pregelatinized tapioca starch. 6 mg: Each teal, scored tablet with "COUMADIN" over "6" on one side and "DuPont" on the other, contains warfarin 6 mg. Nonmedicinal ingredients: FD&C Blue No. 1 Aluminum Lake, FD&C Yellow No. 6 Aluminum Lake, lactose anhydrous, magnesium stearate, and pregelatinized tapioca starch. 10 mg: Each white, scored tablet with "COUMADIN" over "10" on one side and "DuPont" on the other, contains warfarin 10 mg. Nonmedicinal ingredients: lactose anhydrous, magnesium stearate, and pregelatinized tapioca starch. There is no dye in this product.

What should I NOT take with Coumadin?

Anticoagulation (blood thinning) should not place in any situation where the risk of bleeding might be greater than the potential benefits of anticoagulation. This medication should not be used by anyone who: is pregnant (Warfarin may cause bleeding for the unborn child. Malformations have been reported for babies born to women who took warfarin during pregnancy. Women must take precautions not to become pregnant while using warfarin. Women who may become pregnant and who are considering taking this medication should carefully discuss the implications with their doctor. If a woman becomes pregnant while taking warfarin, the potential risks need to be discussed and the alternatives weighed.) has bleeding tendencies or blood disorders has bleeding tendencies associated with active ulceration or overt bleeding of the stomach, genitourinary, or respiratory tracts, or bleeding associated with many other medical conditions has a high risk of abortion, eclampsia, and preeclampsia (complications of pregnancy often associated with sudden onset of very high blood pressure) has senility, alcoholism, or psychosis, or other conditions where the person may not be able to cooperate with taking the medication and having the necessary lab tests on a regular basis has recently had or is planning to have surgery of the central nervous system or the eye or surgery associated with trauma resulting in large open surfaces is allergic to warfarin or any ingredient of the medication is undergoing certain types of anaesthesia has malignant hypertension Laboratory facilities must be available to those taking this medication in order to measure the effects of warfarin on blood thinning.

Are there any other precautions or warnings for Coumadin?

Bleeding: The most serious risk associated with warfarin is bleeding in any tissue or organ. The risk of bleeding is related to the level of intensity and the duration of treatment. It is extremely important to have regular blood tests (as prescribed by your doctor) to ensure that the correct level of blood thinning is occurring. Caution should be observed when warfarin is taken in any situation or in the presence of any predisposing condition where there exists an added risk of bleeding. NSAIDs: It is recommendedthat anyone taking nonsteroidal anti-inflammatory agents (NSAIDs) such as ASA or ibuprofen should be closely monitored to ensure that no change in anticoagulation dosage is required. NSAIDs can cause stomach ulcers and/or bleeding. Purple toes syndrome: Purple toes syndrome is a complication of warfarin treatment and consists of a dark, purplish or mottled colour of the toes, usually occurring 3 to 10 weeks (or later) after starting treatment with warfarin. Major features of this syndrome include: purple colour of bottom surfaces and sides of the toes that turns white under moderate pressure and fades with elevation of the legs pain and tenderness of the toes increasing and decreasing of the colour over time Inform your doctor at once if you notice these symptoms. Breast-feeding: Warfarin appears in the milk of nursing mothers in an inactive form. Infants nursed by mothers who use warfarin have no change in bleeding time. The effects of this medication for premature infants have not been evaluated. Pregnancy: Warfarin should not be used during pregnancy. Children: The safety and effectiveness of this medication for children below 18 years of age have not been established. However, the use of warfarin by children is necessary in certain situations.