Coumadin

Coumadin

What is Coumadin?

Coumadin is used to treat or prevent blood clots in veins or arteries, which can reduce the risk of stroke, heart attack, or other serious illnesses.

Coumadin may also be used for purposes not listed in this medication guide.

Warnings

You should not take Coumadin if you are prone to bleeding due to a medical condition, if you are having surgery, or if you need a lumbar puncture or epidural.Do not take Coumadin if you cannot take it on time every day.

Warfarin increases the risk of serious or fatal bleeding.especially if you have certain medical conditions, are 65 years of age or older, have had a stroke, or have had bleeding in the stomach or intestines.Seek emergency help if you have bleeding that won't stop.

Call your doctor immediately if you have other signs of bleeding, such as:Swelling, pain, very faint feeling or dizziness, unusual bruising, bleeding gums, nosebleeds, heavy menstruation or unusual vaginal bleeding, blood in the urine, bloody or tarry stools, coughing up blood, or vomit that looks like coffee grounds.

Many other medications can increase the risk of bleeding when used with Coumadin. Tell your doctor about any medicines you have recently taken.

Avoid making any changes to your diet without first speaking to your doctor. Some foods can make warfarin less effective.

Before you take this medicine

You should not take Coumadin if you are allergic to warfarin or if:

• you have very high blood pressure;

• you have recently had or are about to have surgery on your brain, spine or eye;

• you are undergoing a lumbar puncture or spinal anesthesia (epidural); or

• You cannot take warfarin on time every day.

You also should not take Coumadin if you are prone to bleeding due to a medical condition, such as:

• a blood cell disorder (e.g. low red blood cell count or low platelets);

• ulcers or bleeding in your stomach, intestines, lungs, or urinary tract;

• an aneurysm or bleeding in the brain; or

• an infection of the inner lining of the heart.

Do not take Coumadin if you are pregnant unless your doctor recommends it.Warfarin can cause birth defects, but preventing blood clots may outweigh the risks to the baby. If you are not pregnant, use effective birth control to prevent pregnancy while you are taking warfarin and for at least 1 month after your last dose.Tell your doctor immediately if you become pregnant.

Coumadin may cause you to bleed more easily, especially if you have ever had:

• high blood pressure or serious heart disease;

• kidney disease;

• cancer or low blood cell count;

• an accident or operation;

• bleeding in your stomach or intestines;

• a stroke; or

• if you are 65 or older.

To make sure this medicine is safe for you, tell your doctor if you have ever had:

• Diabetes;

• heart failure;

• liver disease, kidney disease (or if you are on dialysis);

• a hereditary clotting deficiency; or

• low blood platelets after taking heparin.

It is not known whether warfarin passes into breast milk. Watch for signs of bruising or bleeding in the baby if you take Coumadin while breastfeeding a baby.

How should I take Coumadin?

Take Coumadin exactly as your doctor has told you. Follow all instructions on your prescription label. Your doctor may occasionally change your dose. Do not take warfarin in larger or smaller amounts or for longer than your doctor prescribed.

Take this medicine at the same time every day with or without food. Never take a double dose.

Coumadin can make your bleeding easier.Seek emergency help if you have bleeding that won't stop.

You will need frequent “INR” or prothrombin time tests (to measure your blood clotting time and determine your warfarin dose). You must remain under the care of a doctor while taking Coumadin.

If you are given Coumadin in a hospital, call or see your doctor 3 to 7 days after you are discharged from the hospital. At this point, your INR needs to be tested. Don't miss any follow-up appointments.

Tell your doctor if you have diarrhea, fever, chills, or flu symptoms, or if your body weight changes.

You may need to stop taking Coumadin 5 to 7 days before surgery, dental work, or a medical procedure. Call your doctor for instructions.

Wear a medical warning label or ID card stating that you are taking warfarin. Any doctor who treats you should know that you are taking this medicine.

Store 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. Skip the missed dose if it is almost time for the next scheduled dose. Do not take extra medicine to make up for a missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help hotline at 1-800-222-1222.Overdose may result in excessive bleeding.

What to avoid

Avoid activities that could increase the risk of bleeding or injury. Be especially careful to avoid bleeding when shaving or brushing your teeth. Bleeding may occur more easily several days after stopping Coumadin.

Avoid making any changes to your diet without first speaking to your doctor. Foods high in vitamin K (liver, green leafy vegetables, or vegetable oils) may make warfarin less effective. If these foods are part of your diet, eat a consistent amount each week.

Grapefruit juice, cranberry juice, noni juice, and pomegranate juice can interact with warfarin and cause unwanted side effects. Avoid using these juice products while taking Coumadin.

Avoid alcohol.

Consult your doctor before taking medications for pain, arthritis, fever, or swelling. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), diclofenac, indomethacin, meloxicam and others.These medicines can affect blood clotting and can also increase your risk of stomach bleeding.

Side effects of Coumadin

If necessary, get emergency medical helpSigns of an allergic reaction to Coumadin: hives; difficult breathing; Swelling of your face, lips, tongue, or throat.

Coumadin increases the risk of bleeding, which can be serious or life-threatening.Call your doctor immediately if you notice any signs of bleeding, such as:

• sudden headache, feeling very weak or dizzy;

• swelling, pain, unusual bruising;

• Bleeding gums, nosebleeds;

• bleeding from wounds or needle injections that doesn't stop;

• heavy menstruation or abnormal vaginal bleeding;

• blood in the urine, bloody or tarry stools; or

• Coughing up blood or vomit that looks like coffee grounds.

Blood clots formed by Coumadin can block normal blood flow, which can lead to tissue death or amputation of the affected part of the body.Get medical help immediately if you have:

• pain, swelling, feeling hot or cold, skin changes or discoloration anywhere on your body; or

• Sudden and severe leg or foot pain, foot ulcer, purple toes or fingers.

Bleeding is the most common side effect of Coumadin.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You can report side effects to FDA at 1-800-FDA-1088.

What other drugs affect Coumadin?

Many medications (including some over-the-counter medicines and herbal products) can affect your INR and increase your risk of bleeding if you take them with Coumadin.Not all possible drug interactions are listed in this medication guide. It is very important that you ask your doctor and pharmacist before starting or stopping taking any other medicine, especially:

• other medicines to prevent blood clots;

• an antibiotic or antifungal;

• dietary supplements containing vitamin K; or

• herbal (botanical) products– Coenzyme Q10, cranberry, echinacea, garlic, ginkgo biloba, ginseng, goldenseal or St. John's wort.

This list is not exhaustive and many other medications can interact with warfarin. This includes prescription and over-the-counter medications, vitamins and herbal products. Give any doctor who treats you a list of all your medications.

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More information

Remember to keep this and all other medicines out of the reach of children, never share your medicines with others, and only use Coumadin for the prescribed indication.