Warfarin

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pronounced as(war' far in)
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?
What side effects can this medication cause? What should I know about storage and disposal of
this medication? In case of emergency/overdose What other information should I know? Brand
names

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 month 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.
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.

Keep all appointments with your doctor and the laboratory. Your doctor will order a blood test
(PT [prothrombin test] reported as INR [international normalized ratio] value) regularly to check
your body's response to warfarin.
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?

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

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

What special precautions should I follow?

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Before taking warfarin,

tell your doctor and pharmacist if you are allergic to warfarin, any other medications, or
any of the ingredients in warfarin tablets. Ask your pharmacist or check the Medication
Guide for a list of the ingredients.

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 acyclovir
(Zovirax); allopurinol (Zyloprim); alprazolam (Xanax); antibiotics such as ciprofloxacin
(Cipro), clarithromycin (Biaxin, in Prevpac), erythromycin (E.E.S., Eryc, Ery-Tab),
nafcillin, norfloxacin (Noroxin), sulfinpyrazone, telithromycin (Ketek), and tigecycline
(Tygacil); anticoagulants such as argatroban (Acova), dabigatran (Pradaxa), bivalirudin
(Angiomax), desirudin (Iprivask), heparin, and lepirudin (Refludan); antifungals such as
fluconazole (Diflucan), itraconazole (Onmel, Sporanox), ketoconazole (Nizoral),
miconazole (Monistat), posaconazole (Noxafil), terbinafine (Lamisil), voriconazole
(Vfend); antiplatelet medications such as cilostazol (Pletal), clopidogrel (Plavix),
dipyridamole (Persantine, in Aggrenox), prasugrel (Effient), and ticlopidine (Ticlid);
aprepitant (Emend); aspirin or aspirin-containing products and other nonsteroidal antiinflammatory drugs such as celecoxib (Celebrex), diclofenac (Flector, Voltaren, in
Arthrotec), diflunisal, fenoprofen (Nalfon), ibuprofen (Advil, Motrin), indomethacin
(Indocin), ketoprofen, ketorolac, mefenamic acid (Ponstel), naproxen (Aleve, Naprosyn),
oxaprozin (Daypro), piroxicam (Feldene), and sulindac (Clinoril); bicalutamide;
bosentan; certain antiarrhythmic medications such as amiodarone (Cordarone, Nexterone,
Pacerone), mexiletine, and propafenone (Rythmol); certain calcium channel blocking
medications such as amlodipine (Norvasc, in Azor, Caduet, Exforge, Lotrel, Twynsta),
diltiazem (Cardizem, Cartia XT, Dilacor XR, Tiazac) and verapamil (Calan, Isoptin,
Verelan, in Tarka); certain medications for asthma such as montelukast (Singulair),
zafirlukast (Accolate), and zileuton (Zyflo); certain medications used to treat cancer such
as capecitabine (Xeloda), imatinib (Gleevec), and nilotinib (Tasigna); certain medications
for cholesterol such as atorvastatin (Lipitor, in Caduet) and fluvastatin (Lescol); certain
medications for digestive disorders such as cimetidine (Tagamet), famotidine (Pepcid),
and ranitidine (Zantac); certain medications for human immunodeficiency virus (HIV)
infection such as amprenavir, atazanavir (Reyataz), efavirenz (Sustiva), etravirine
(Intelence), fosamprenavir (Lexiva), indinavir (Crixivan), lopinavir/ritonavir, nelfinavir

(Viracept), ritonavir (Norvir), saquinavir (Invirase), and tipranavir (Aptivus); certain

medications for narcolepsy such as armodafinil (Nuvigil) and modafinil (Provigil);
certain medications for seizures such as carbamazepine (Carbatrol, Equetro, Tegretol),
phenobarbital, phenytoin (Dilantin, Phenytek), and rufinamide (Banzel); certain
medications to treat tuberculosis such as isoniazid (in Rifamate, Rifater) and rifampin
(Rifadin, in Rifamate, Rifater); certain selective serotonin reuptake inhibitors (SSRIs) or
selective serotonin and norepinephrine reuptake inhibitors (SNRIs) such as citalopram
(Celexa), desvenlafaxine (Pristiq), duloxetine (Cymbalta), escitalopram (Lexapro),
fluoxetine (Prozac, Sarafem, in Symbyax), fluvoxamine (Luvox), milnacipran (Savella),
paroxetine (Paxil, Pexeva), sertraline (Zoloft), venlafaxine (Effexor) corticosteroids such
as prednisone; cyclosporine (Neoral, Sandimmune); disulfiram (Antabuse); methoxsalen
(Oxsoralen, Uvadex); metronidazole (Flagyl); nefazodone (Serzone), oral contraceptives
(birth control pills); oxandrolone (Oxandrin); pioglitazone (Actos, in Actoplus Met,
Duetact, Oseni); propranolol (Inderal) or vilazodone (Viibryd). 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 coenzyme Q10 (Ubidecarenone), Echinacea, garlic, Ginkgo biloba, ginseng,
goldenseal, 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 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. Pregnant women should not take warfarin unless they
have a mechanical heart valve. 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.

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.

ask your doctor about the safe use of alcoholic beverages while you are taking warfarin.

tell your doctor if you use tobacco products. Cigarette smoking may decrease the
effectiveness of this medication.

What special dietary instructions should I follow?

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Eat a normal, healthy diet. Some foods and beverages, particularly those that contain vitamin K,
can affect how warfarin works for you. Ask your doctor or pharmacist for a list of foods that
contain vitamin K. Eat consistent amounts of vitamin K-containing food on a week-to-week
basis. Do not eat large amounts of leafy, green vegetables or certain vegetable oils that contain
large amounts of vitamin K. Be sure to talk to your doctor before you make any changes in your
diet. Talk to your doctor about eating grapefruit and drinking grapefruit juice while taking this
medication.

What should I do if I forget a dose?

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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. Call your doctor if
you miss a dose of warfarin.

What side effects can this medication cause?

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

gas

abdominal pain

bloating

change in the way things taste

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

infection

nausea

vomiting

diarrhea

extreme tiredness

lack of energy

loss of appetite

pain in the upper right part of the stomach

yellowing of the skin or eyes

flu-like symptoms

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 should I know about storage and disposal of this

medication?
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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
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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 the following:

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?

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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.
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 (overthe-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
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Coumadin

Jantoven