Coumadin


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Coumadin

 [koo´mah-din]
trademark for preparations of warfarin sodium, an anticoagulant.

warfarin sodium

Apo-Warfarin (CA), Coumadin, Gen-Warfarin (CA), Jantoven, Marevan (UK), Novo-Warfarin (CA), Taro-Warfarin (CA)

Pharmacologic class: Coumarin derivative

Therapeutic class: Anticoagulant

Pregnancy risk category X

FDA Box Warning

• Drug may cause major or fatal bleeding. Bleeding is more likely during starting period and with higher dosage (resulting in higher International Normalized Ratio [INR]). Monitor INR regularly in all patients. Those at high risk for bleeding may benefit from more frequent INR monitoring, careful dosage adjustment, and shorter duration of therapy. Instruct patients about measures to minimize risk of bleeding and advise them to immediately report signs and symptoms of bleeding.

Action

Interferes with synthesis of vitamin K-dependent clotting factors (II, VII, IX, and X) and anticoagulant proteins C and S in liver

Availability

Injection: 5.4 mg/vial (2 mg/ml when reconstituted)

Tablets: 1 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg, 10 mg

Indications and dosages

Venous thrombosis; pulmonary embolism; atrial fibrillation; myocardial infarction (MI); thromboembolic complications of cardiac valve placement

Adults: Initially, 2.5 to 10 mg P.O. or I.V. daily for 2 to 4 days, then adjusted based on prothrombin time (PT) or International Normalized Ratio (INR). Usual maintenance dosage is 2 to 10 mg P.O. daily.

Dosage adjustment

• Elderly or debilitated patients

Off-label uses

• Acute coronary syndrome
• Intracoronary stent placement
• Prevention of catheter thrombosis

Contraindications

• Hypersensitivity to drug
• Uncontrolled bleeding
• Open wounds
• Severe hepatic disease
• Hemorrhagic or bleeding tendency
• Cerebrovascular hemorrhage
• Cerebral aneurysm or dissecting aorta
• Blood dyscrasias
• Pericarditis or pericardial effusion
• Bacterial endocarditis
• Malignant hypertension
• Recent brain, eye, or spinal cord injury or surgery
• Lumbar puncture and other procedures that may cause uncontrollable bleeding
• Major regional or lumbar block anesthesia
• Threatened abortion, eclampsia, preeclampsia
• Unsupervised senile, alcoholic, or psychotic patients
• Pregnancy, females of childbearing potential

Precautions

Use cautiously in:
• cancer, heparin-induced thrombocytopenia, moderate to severe renal impairment, moderate to severe hypertension, infectious GI disease, known or suspected deficiency in protein C-mediated anticoagulant response, polycythemia vera, vasculitis, severe diabetes mellitus
• indwelling catheter use
• history of poor compliance
• elderly or debilitated patients
• breastfeeding patients
• children younger than age 18 (safety and efficacy not established).

Administration

Be aware that warfarin is a high-alert drug.
• Know that I.V. form is reserved for patients who can't tolerate oral form. I.V. and oral dosages are identical.
• For I.V. use, reconstitute vial with 2.7 ml of sterile water for injection; administer over 1 to 2 minutes. After reconstitution, drug is stable for 4 hours at room temperature.
• Be aware that vitamin K reverses warfarin effects. If major bleeding occurs, fresh frozen plasma may be given.
• When converting to warfarin from heparin, give both drugs concomitantly for 4 to 5 days until therapeutic effect of warfarin occurs.

Adverse reactions

GI: nausea, vomiting, diarrhea, abdominal cramps, stomatitis, anorexia

GU: hematuria

Hematologic: eosinophilia, bleeding, hemorrhage, agranulocytosis, leukopenia

Hepatic: hepatitis

Skin: rash, dermatitis, urticaria, pruritus, alopecia, dermal necrosis

Other: fever, "purple toes" syndrome (bilateral painful, purple lesions on toes and sides of feet), hypersensitivity reaction

Interactions

Drug-drug.Abciximab, acetaminophen (chronic use), androgens, aspirin, capecitabine, cefamandole, cefoperazone, cefotetan, chloral hydrate, chloramphenicol, clopidogrel, disulfiram, eptifibatide, fluconazole, fluoroquinolones, itraconazole, metronidazole (including vaginal use), nonsteroidal anti-inflammatory drugs, plicamycin, quinidine, quinine, sulfonamides, thrombolytics, ticlopidine, tirofiban, valproic acid, zafirlukast: increased response to warfarin, greater risk of bleeding

Barbiturates, hormonal contraceptives containing estrogen: decreased anticoagulant effect

Drug-diagnostic tests.Alanine aminotransferase, aspartate aminotransferase, INR: increased values

Partial thromboplastin time, PT: prolonged

Drug-food.Vitamin K-rich foods (large amounts): antagonism of anticoagulant effect

Drug-herbs.Angelica: prolonged PT Anise, arnica, asafetida, bromelain, chamomile, clove, danshen, devil's claw, dong quai, fenugreek, feverfew, garlic, ginger, ginkgo, ginseng, horse chestnut, licorice, meadowsweet, motherwort, onion, papain, parsley, passionflower, quassia, red clover, Reishi mushroom, rue, sweet clover, turmeric, white willow, others: increased risk of bleeding

Coenzyme Q10, green tea, St. John's wort: decreased anticoagulant effect

Drug-behaviors.Alcohol use: enhanced warfarin activity

Patient monitoring

• Monitor PT, INR, and liver function tests.
• Watch for signs and symptoms of bleeding and hepatitis.

Patient teaching

Explain therapy to patient. Stress importance of adhering to schedule for laboratory tests.

Instruct patient to promptly report unusual bleeding or bruising.
• Caution patient to consult prescriber before taking over-the-counter preparations or herbs.
• Advise patient to inform all other health care providers (including dentist) that he is taking warfarin.
• Tell patient not to vary his intake of foods high in vitamin K (such as leafy green vegetables, fish, pork, green tea, and tomatoes), to avoid alterations in drug's anticoagulant effect.

Instruct females of childbearing age to report pregnancy immediately.
• Stress importance of avoiding contact sports and other activities that could cause injury and bleeding.
• Caution patient to avoid alcohol during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.

Coumadin

(ko͞o′mə-dĭn)
A trademark for the drug warfarin sodium.

Coumadin

(ko͞o′mə-dĭn)
A trademark for the sodium form of the anticoagulant warfarin.

Coumadin

a trademark for an anticoagulant (warfarin sodium).

warfarin

An anticoagulant that inhibits synthesis of liver-dependent coagulation factors (the prothrombin complex, factors II, VII, IX and X), which are formed by gamma-carboxylation of precursor proteins.
 
Indications
Prevention of uncomplicated distal DVT, prophylaxis and prevention of thromboembolism, post-acute myocardial infarction.

Monitoring
Warfarin therapy is monitored by serial evaluation of PT–2-3-fold > normal 12–16 seconds; its activity is increased by phenylbutazone, clofibrate (by outcompeting with warfarin for plasma-protein binding sites and decreased by barbiturates, which stimulate hepatic metabolism).

Coumadin®

Warfarin, see there.

Coumadin

A brand name for WARFARIN.

Patient discussion about Coumadin

Q. Have been taking Coumadin for 10 years and wonder how this will affect my overall health...?

A. It depends on the reason for which you take it. Usually, in the majority of the patients coumadin is given in order to prevent formation of clots in the blood. If these clots get stuck in an important organ, e.g. the brain, you can guess how bad it could be (in this example it would cause a stroke, a devastating condition). Therefore, it worth to take this medication (along with the inconveniencies and risk) to the rest of your life, because it'll make sure you'll stay alive to take it....

Generally, medications, especially potent ones like coumadin are proved to improve and prolong life of the patients before they are recommended.

Q. Looking to find some folks who are taking coumadin, yet are very active to the point of having many problems. Officiating basketball with bleeding in legs.

A. my grandfather takes coumadin and is sort of active... he tries to stay in shape. he asked his doctor about that and he said that there are 2 problems that can occur. first one is injuries that can be very dangerous. and the second is extreme blood pressure changes- that can raise the chances of brain hemorrhage- this can be lethal. so he instructed him to so "soft" sports. and not to over do it.

More discussions about Coumadin
References in periodicals archive ?
In our case, PE was suspected due to her previous history and as she had not been on coumadin for some time.
Half received 162 mg of aspirin, and the other were given 81 mg of aspirin plus Coumadin.
The patient also discontinued diltiazem and Coumadin because he was very confused and anxious because he did not understand the nature of his disease.
A From herbalist Jenny Boyes: Coumadin (Warfarin) works as an anticoagulant - it slows blood clotting and is used to treat high blood pressure by thinning the blood in the veins, thus easing pressure on the heart.
Four of the instruments have had a patient self-testing program for home monitoring of PT/ INR to optimize coumadin therapy.
Like Coumadin, it can be taken by mouth, but unlike Coumadin - which takes four days to work - Dabigatran acts within two hours
Richard Hays, a family practitioner who prescribes Coumadin for his patients diagnosed with atrial fibrillation.
The biggest thing for me was getting off the Coumadin.
His cardiologist discovered heart fibrillation and prescribed coumadin.
One contained an anti-coagulant similar to Coumadin, the other had an anti-anxiety drug like Xanax.
Vitamin K interferes with anti-coagulant drugs like coumadin, so check with your doctor if you're taking them.