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Coumadin (Generic Warfarin)

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WARNING

Warfarin has the potential to induce fatal or seriously life-threatening haemorrhage. Inform your doctor if you have or have ever had a blood or bleeding disorder, bleeding issues, particularly in the lungs, urinary tract, bladder, or intestines, high blood pressure, heart attack, or angina (chest discomfort or pressure); heart disease, pericarditis (inflammation of the sac surrounding the heart), endocarditis (infection of one or more heart valves), a stroke or ministroke, aneurysm (weakening or tearing of an artery or vein), anaemia (low red blood cell count), cancer, chronic diarrhoea, kidney, or liver disease are just a few of the conditions that can affect the body. Those over the age of 65 are more likely to experience bleeding with warfarin therapy, and bleeding is also more likely to occur in the first month of therapy. Those who use warfarin at high doses or for an extended period of time have a higher risk of bleeding. Those who engage in activities or sports that have a high risk of serious injury are also more likely to experience bleeding while taking warfarin. Inform your doctor and pharmacist if you’re currently taking or intend to start taking any prescription or over-the-counter drugs, vitamins, dietary supplements, herbal products, or botanicals (see SPECIAL PRECAUTIONS), as some of these things may make bleeding more likely while you’re taking warfarin. Call your doctor right away if you experience any of the following symptoms: pain, swelling, or discomfort; bleeding from a cut that does not stop in the usual amount of time; nosebleeds; bleeding from your gums; coughing up or vomiting blood or material that resembles coffee grounds; unusual bleeding or bruising; increased menstrual flow; vaginal bleeding; pink, red, or dark brown urine; red or tarry black bowel movements; headache; dizziness; or weakness.

Warfarin may affect certain people differently depending on their genetic makeup or ancestry. For you to receive the best dose of warfarin, your doctor may prescribe a blood test.

If you cut yourself or get hurt, it could take longer than usual for the bleeding to cease because warfarin slows blood from clotting. Avoid engaging in sports or activities that carry a significant risk of harm. If you experience unusual bleeding or if you fall and suffer an injury, particularly if you hit your head, call your doctor.

Keep all of your appointments with your physician and the lab. To monitor your body’s reaction to warfarin, your doctor will routinely conduct a blood test (PT [prothrombin test] reported as INR [international normalised ratio] value).

The effects of warfarin may linger for 2 to 5 days after you stop taking it if your doctor instructs you to stop.

The manufacturer’s patient information sheet (Medication Guide) will be sent to you by your doctor or pharmacist when you start taking warfarin and at each time your prescription is renewed. If you have any questions, carefully read the material and contact your doctor or pharmacist. The Medication Guide is also available on the manufacturer’s website or the Food and Drug Administration (FDA) website.

The risks of taking warfarin should be discussed with your doctor.

Why is this medication prescribed?

Warfarin is used to stop blood clots in your blood and blood vessels from forming or expanding. Those who have specific forms of irregular heartbeats, prosthetic (replacement or mechanical) heart valves, or who have had a heart attack are administered it. Warfarin is also used to treat or prevent pulmonary embolism and venous thrombosis (swelling and blood clot in a vein) (a blood clot in the lung). Warfarin belongs to a group of drugs known as anticoagulants, also known as “blood thinners.” It functions by lessening the blood’s capacity to clot.

How should this medicine be used?

Warfarin is available as an oral tablet. Typically, it is taken once day, with or without food. Take warfarin every day at roughly the same time. Ask your doctor or pharmacist to explain any instructions on your prescription label that you are unsure about following. Administer warfarin as prescribed. Never take it in larger or less amounts or more frequently than directed by your doctor. If you take more warfarin than is recommended, call your doctor right away.

According to the outcomes of your blood tests, your doctor will likely put you on a low dose of warfarin and gradually raise or decrease it. Be sure you comprehend any modifications to your doctor’s dose recommendations.

Even if you feel better, keep taking warfarin. Without first consulting your doctor, do not discontinue taking warfarin.

Other uses for this medicine

Ask your doctor or pharmacist for more details if you believe this drug should be used for something else.

What special precautions should I follow?

Before taking warfarin,

  • If you have an allergy to warfarin, any other drugs, or any of the substances in warfarin tablets, let your doctor and pharmacist know right once. For a list of the ingredients, consult the Medication Guide or speak with your pharmacist.
  • Never take two or more warfarin-containing drugs at the same time. If you’re unsure whether a drug contains warfarin or warfarin sodium, be sure to ask your doctor or pharmacist.
  • Inform your doctor and pharmacist of all prescription and over-the-counter drugs, vitamins, and dietary supplements you are currently taking or intend to take, including acyclovir (Zovirax), allopurinol (Zyloprim), and valacyclovir (Valtrex); antibiotics like ciprofloxacin (Cipro), clarithromycin (Biaxin, in Prevpac), erythromycin (E.E.S., Eryc, Ery-Tab), nafcillin, norfloxacin (Noroxin), sulfinpyrazone, telithromycin (Ketek), and tigecycline (Tygacil); alprazolam (Xanax); heparin, bivalirudin, desirudin, bivalirudin (Angiomax), posaconazole (Noxafil), miconazole (Monistat), terbinafine (Lamisil), and voriconazole (Vfend) are examples of anticoagulants. Antifungals include fluconazole (Diflucan), itraconazole (Onmel, Sporanox), ketoconazole (Nizoral); antiplatelet drugs such ticlopidine (Ticlid), cilostazol (Pletal), clopidogrel (Plavix), dipyridamole (Persantine, in Aggrenox), and prasugrel (Effient); aspirin or aspirin-containing medicines, as well as other nonsteroidal anti-inflammatory medications such celecoxib (Celebrex), diclofenac (Flector, Voltaren, in Arthrotec), diflunisal, fenoprofen (Nalfon), ibuprofen (Advil, Motrin), indomethacin (Indocin), ketoprofen, ketorolac, mefenamic acids (Ponstel), bosentan, bicalutamide, certain antiarrhythmic drugs such amiodarone (Cordarone, Nexterone, Pacerone), mexiletine, and propafenone (Rythmol), as well as calcium channel blockers like amlodipine (Norvasc, in Azor, Caduet, Exforge, Lotrel, and Twynsta), diltiazem (Cardizem, Cartia XT, Dilacor XR, Tiazac); several asthma drugs, including zileuton (Zyflo), zafirlukast (Accolate), and montelukast (Singulair); some cancer-treatment drugs, including capecitabine (Xeloda), imatinib (Gleevec), and nilotinib (Tasigna); a few drugs for lowering cholesterol, like atorvastatin (Lipitor, in Caduet) and fluvastatin (Lescol); a few drugs for gastrointestinal issues, like cimetidine (Tagamet), famotidine (Pepcid), and ranitidine (Zantac); amprenavir, atazanavir (Reyataz), efavirenz (Sustiva), etravirine (Intelence), fosamprenavir (Lexiva), indinavir (Crixivan), lopinavir/ritonavir, nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Invirase), and tipranavir (Aptivus); a few drugs to treat seizures, including rufinamide (Banzel), phenobarbital, phenytoin (Dilantin, Phenytek), and carbamazepine (Carbatrol, Equetro, Tegretol); a few drugs to treat tuberculosis, including isoniazid (in Rifamate, Rifater) and rifampin (Rifadin, in Rifamate, Rifater); a few selective serotonin reuptake inhibitors (SSRIs) or selective serotonin and norepinephrine reuptake inhibitors (SNRIs), including citalopram (Celexa), desvenlafaxine (Pristiq), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, in Symbyax), fluvoxamine  (Luvox), oral contraceptives (birth control pills), disulfiram (Antabuse), methoxsalen (Oxsoralen, Uvadex), metronidazole (Flagyl), nefazodone (Serzone), oxandrolone (Oxandrin), pioglitazone (Actos, in Actoplus Met, Duetact, Oseni), propranolol (Inderal), or vil (Viibryd). Warfarin may interact with a wide range of other drugs, so be sure to let your doctor know about everything you’re taking even anything not on this list. Without consulting your doctor, never start a new drug or stop one you are already taking.
  • In particular, mention coenzyme Q10 (Ubidecarenone), Echinacea, garlic, Ginkgo biloba, ginseng, goldenseal, and St. John’s wort to your physician and pharmacist. There are numerous additional herbal or botanical products that could impact how your body reacts to warfarin. Never begin using or discontinue using any herbal products without first consulting your doctor.
  • If you have diabetes now or formerly had it, let your doctor know. Moreover, let your physician know if you have an infection, a digestive disorder like diarrhoea or sprue (an allergic reaction to a protein in grains that causes diarrhoea), an indwelling catheter, or any other conditions (a flexible plastic tube that is placed into the bladder to allow the urine to drain out).
  • If you take warfarin and are pregnant, suspect you could be pregnant, or intend to get pregnant, let your doctor know right away. Warfarin shouldn’t be used by pregnant women unless they have a mechanical heart valve. Consult your physician about using reliable birth control while taking warfarin. Warfarin can cause pregnancy, so call your doctor right once if it does. The foetus could suffer from warfarin.
  • Inform your doctor if you are nursing a baby.
  • Inform the doctor or dentist that you are taking warfarin if you are undergoing surgery, including dental surgery, or any other kind of medical or dental operation. Your doctor might advise you to cease taking warfarin prior to the operation or surgery or adjust your warfarin dosage. If your doctor requests blood tests to determine the appropriate warfarin dose for you, carefully follow his or her instructions and maintain all appointments with the laboratory.
  • Inquire with your doctor about whether drinking alcohol is safe while taking warfarin.
  • If you use tobacco products, let your doctor know. Smoking cigarettes may make this medication less effective.

What special dietary instructions should I follow?

Consume a typical, nutritious diet. Warfarin’s effectiveness for you can be impacted by certain meals and drinks, especially those that contain vitamin K. Get a list of foods containing vitamin K from your physician or pharmacist. Weekly, consume a steady amount of foods that contain vitamin K. Eat just little amounts of leafy green vegetables and some vegetable oils that are high in vitamin K. Before changing your diet in any way, be sure to consult your doctor. When taking this medication, discuss with your doctor if you should consume grapefruit or grapefruit juice.

What should I do if I forget a dose?

If it is the same day that you were supposed to take the medication, take the missed dose as soon as you remember it. To make up for a missed dose, do not take a double dose the following day. If you forget to take your warfarin medication, call your doctor.

What side effects can this medication cause?

Warfarin could have negative effects. If any of these symptoms are severe or do not go away, let your doctor know right once:

  • Gas
  • Abdomen ache
  • Bloating
  • Alteration in the flavour of items
  • Missing hair
  • Experiencing goosebumps or feeling cold

Call your doctor right away if you have any of the following symptoms or any of those detailed in the IMPORTANT CAUTION section:

  • Hives
  • Rash
  • Itching
  • Breathing or swallowing challenges
  • Face, throat, tongue, lips, or eye swelling
  • Hoarseness
  • Chest pressure or discomfort
  • Hands, foot, ankles, or lower legs swelling
  • Fever
  • Infection
  • Nausea
  • Vomiting
  • Diarrhea
  • Extreme fatigue
  • Not enough energy
  • Reduced appetite
  • Upper right stomach region discomfort
  • Skin or eyes turning yellow
  • Flu-like signs

You should be aware that warfarin can result in gangrene or necrosis (death of skin or other body tissues). Call your doctor right away if you notice a purplish or darkened colour to your skin, skin changes, ulcers, or an unusual problem in any area of your skin or body. You should also call your doctor right away if you experience sudden, severe pain or a change in colour or temperature in any part of your body. If your toes start to hurt or turn purple or dark in colour, call your doctor right away. To avoid having your damaged body part amputated (removed), you might need medical attention straight away.

Other adverse reactions to warfarin may occur. If you have any strange side effects while taking this medicine, call your doctor right away.

What should I know about storage and disposal of this medication?

Keep this medication tightly closed in the original container and out of the reach of children. Keep it at room temperature and away from sources of extreme heat, moisture, and light (such as the restroom).

Unused prescriptions must be disposed of carefully to prevent pets, kids, and other people from ingesting them. You should not, however, dispose of this medication in the toilet. Instead, utilising a medicine take-back programme is the easiest approach to get rid of your medication. To find out about take-back programmes in your area, speak with your pharmacist or the garbage/recycling department in your city. If you do not have access to a take-back programme, see the FDA’s Safe Disposal of Medications website at http://goo.gl/c4Rm4p for additional information.

Although many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and are simple for young children to open, it is crucial to keep all medications out of sight and out of reach of children. Always lock safety caps and promptly stash medication up and away from young children where it is out of their sight and reach to prevent poisoning. http://www.upandaway.org

In case of emergency/overdose

Call the poison control hotline at 1-800-222-1222 in the event of an overdose. Moreover, information can be found online at https://www.poisonhelp.org/help. Call 911 right once if the person has collapsed, experienced a seizure, is having difficulty breathing, or cannot be roused.

Overdose signs could include the following:

  • Viscous, bloody, or coloured stools
  • Blood being coughed up or spit up
  • Heavy bleeding throughout your menstruation
  • Red, dark brown, or pink urine
  • Vomiting or coughing up what seems to be coffee grounds
  • Red dots under the skin that are tiny, flat, and spherical.
  • Significant bruising or bleeding
  • Persistent bleeding or seeping from small wounds

What other information should I know?

Keep a card with your identification or wear a bracelet that says you take warfarin. To receive this wristband or card, inquire with your pharmacist or physician. On the card, include your name, address, phone number, and information about your doctor, drugs, dosages, and medical conditions.

Inform all of your medical professionals that you take warfarin.

No one else should take your medication. Any queries you may have regarding medication refills should be directed to your pharmacist.

You should keep a written record of every medication you take, including any over-the-counter (OTC) items, prescription drugs, and dietary supplements like vitamins and minerals. This list should be brought with you whenever you see a doctor or are admitted to the hospital. You should always have this information with you in case of emergencies.

Brand names

  • Coumadin®
  • Jantoven®
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