Warfarin

This page contains recent news articles, when available, and an overview of Warfarin but does not offer medical advice. You should contact your physician with regard to any health issues or concerns.


Overview:

Warfarin
(when available)

Pharmacology and use:
Warfarin, a coumarin anticoagulant, is a racemic mixture of two active isomers. It is used in the prevention and treatment of thromboembolic disease including venous thrombosis, thromboembolism, and pulmonary embolism as well as for the prevention of ischemic stroke in patients with atrial fibrillation (AF). For the treatment of retinal vascular occlusion, pulmonary embolism, cardiomyopathy, atrial fibrillation and flutter, cerebral embolism;, transient cerebral ischaemia, arterial embolism and thrombosis.

Mechanism Of Action:
Warfarin inhibits vitamin K reductase, resulting in depletion of the reduced form of vitamin K (vitamin KH2). As vitamin K is a cofactor for the carboxylation of glutamate residues on the N-terminal regions of vitamin K-dependent proteins, this limits the gamma-carboxylation and subsequent activation of the vitamin K-dependent coagulant proteins. The synthesis of vitamin K-dependent coagulation factors II, VII, IX, and X and anticoagulant proteins C and S is inhibited. Depression of three of the four vitamin K-dependent coagulation factors (factors II, VII, and X) results in decresed prothrombin levels and a decrease in the amount of thrombin generated and bound to fibrin. This reduces the thrombogenicity of clots.

News Articles on Warfarin

Donor Express rounding up blood donors  -  21 Apr 2009
Donors taking blood thinners such as Coumadin, Heparin, Lovenox and Warfarin are now eligible to donate blood seven days after their last dose of medication Cookeville Herald Citizen

Forest Laboratories, Inc. and Cypress Bioscience, Inc. Announce ...  -  21 Apr 2009
Patients should be cautioned regarding the risk of bleeding associated with concomitant use of Savella and NSAIDs, aspirin, warfarin or other drugs that PR Newswire (press release)

Myocardial Infarction In Pregnancy  -  21 Apr 2009
Warfarin is a pregnancy category D drug that crosses the placental barrier and is contraindicated in pregnancy. 8 Heparin is in category C and is the ADVANCE for Physician Assistants

Brain bleeding 'caused by aspirin'  -  21 Apr 2009
...that prevent platelet aggregation (clumping of platelets within blood vessels), such as aspirin or anticoagulant drugs, including warfarin or heparin. Nursing Times

Report: 271 Million Pounds of Pharmaceuticals Released Into US ...  -  21 Apr 2009
Warfarin, which also is a common rat poison and pesticide, is so effective at inhibiting growth of aquatic plants and animals it's actually deliberately FOXNews

Warfarin project in Cardiff, Vale and Wrexham  -  ‎Apr 20, 2009‎
PATIENTS prescribed blood-thinning drug warfarin are being targeted by local health boards as part of the 1000 Lives campaign. WalesOnline

ACC: Dual Antiplatelet Therapy Best When Warfarin Not Possible  -  ‎Mar 31, 2009‎
Explain to interested patients that warfarin may be contraindicated when risk of bleeding is high because of inability to comply with monitoring to make MedPage Today

High-stakes huddle  -  ‎Apr 19, 2009‎
And getting the right dose is critical — patients who take more warfarin than they can tolerate are at risk of life-threatening bleeding, while those who Pioneer Press

Warfarin No Help Against Thromboses in Cancer Patients  -  ‎Apr 16, 2009‎
...“These findings only add to the assertion that the time has come to move on from warfarin for thromboprophylaxis in patients with cancer. Oncology Nursing News

Cardiology Confab Roundup: Drugs, Stents & More  -  ‎Mar 30, 2009‎
The Watchman could be an alternative to the blood-thinner warfarin, which can pose safety risks to patients because it’sa challenge to get the dose right. Wall Street Journal Blogs

Gene-Based Strategy May Improve Dosing of Warfarin  -  ‎Apr 13, 2009‎
Researchers are on their way to proving that a genetically based dosing system for warfarin—one of the most widely prescribed drugs in the world—could Oncology Nursing News

Estimation of the Warfarin Dose With Clinical and Pharmacogenetic Data  -  ‎Apr 8, 2009‎
Study Question: Does an algorithm for estimating appropriate warfarin dose based on clinical and genetic data perform better in terms of estimating warfarin Cardiosource

Down to earth approach to heart study  -  ‎Apr 20, 2009‎
Dr Roger Patel cautioned: “It will take 5-10 years to develop and it would finesse treatment for a minority of patients on the blood thinning drug Warfarin. Bournemouth Daily Echo

Prophylaxis agents lower DVT rates, but increase bleeding rates  -  ‎Apr 15, 2009‎
To evaluate an approach combining mechanical prophylaxis and warfarin, Maloney and his colleagues studied 807 patients who underwent prophylaxis after total Ortho SuperSite

Health & Science: Scientists research using targeted drugs  -  ‎Apr 16, 2009‎
Recent research from The International Warfarin Pharmacogenetics Consortium, published in the Feb. 19 issue of the New England Journal of Medicine with The Heights (subscription)

Study: Atritech device outperforms warfarin in stroke prevention  -  ‎Mar 30, 2009‎
Watchman -- an implantable device from Atritech -- was more effective than the blood thinner warfarin in reducing the risk of stroke and cardiac death. SmartBrief

Astra's "son of Exanta" shows mid-stage promise  -  ‎Mar 29, 2009‎
Researchers said on Sunday that AZD0837 appeared as effective as warfarin -- an old drug that is notoriously difficult to use -- and had a similar or lower Reuters

Clopidogrel plus aspirin decreases stroke risk in patients with AF ...  -  ‎Apr 14, 2009‎
Among patients with atrial fibrillation (AF) who are deemed unsuitable for warfarin treatment or who are unwilling to take it, clopidogrel plus aspirin is Modern Medicine

Drug mix safer for AF patients  -  ‎Apr 9, 2009‎
A combination of clopidogrel and aspirin could be a safer alternative for AF patients who are unable to tolerate warfarin, Canadian research suggests. Healthcare Republic

Blood test delay led to death of gran  -  ‎Apr 18, 2009‎
Maureen Bevins, 71, needed regular blood checks after being put on anti-clotting drug Warfarin following a heart operation. An inquest at Preston Coroner's Lancashire Evening Post

Genes help find the right warfarin dose  -  ‎Apr 1, 2009‎
Researchers in Sweden and the UK have found all the genes that determine the correct dosage of the blood-thinning drug warfarin, which could lead to safer Pharmaceutical Technology Europe

Prosthetic Mitral Valve with Partial Thrombosis  -  ‎Apr 15, 2009‎
Since then she had been taking a maintenance dose of warfarin. The physical examination was notable for bibasilar crackles and a muffled S1 heart sound. New England Journal of Medicine (subscription)

Letter: My dilemma, guns and health  -  ‎Apr 17, 2009‎
I'm up to five different heart medications and need something better than Plan D. When I was taking Atenolol and Warfarin, I drove up to Thunder Bay for a River Falls Journal

Designer drugs  -  ‎Apr 10, 2009‎
Consider the rat-poison-turned-blood-thinner warfarin, also known as Coumadin. Too much and a patient can bleed to death, too little and he can throw a clot Indianapolis Business Journal

For Prevention of Stroke, Surveyed Cardiologists and PCPs Expect ...  -  ‎Apr 2, 2009‎
Despite the proven effectiveness and widespread use of vitamin K antagonists such as warfarin (Bristol-Myers Squibb's Coumadin) for stroke prevention and PR Newswire (press release)

Should you customize your drugs to your DNA?  -  ‎Apr 9, 2009‎
A genetic test recently approved by the FDA should help doctors determine the optimal dose of warfarin (sold as Coumadin), a blood thinner used by 1 million msnbc.com

New genetics tests locally  -  ‎Apr 13, 2009‎
One, the Warfarin Mutation Panel, looks at sensitivity to Coumadin (warfarin), a blood thinner. People with increased sensitivity need different doses, Knoxville News Sentinel

Experimental Heart Device Shows Promise, Risk  -  ‎Apr 2, 2009‎
The study found that the Watchman device was as good at preventing stroke as blood-thinning drugs Coumadin or warfarin. However, the procedure to implant OneMedPlace

Deep Venous Thrombosis (DVT)  -  ‎Apr 2, 2009‎
Question: I recently had a clot in my leg and have been put on Warfarin tablets to thin my blood. I have been told I will only have to take the tablets for Rundtownnews.co.uk

Clopidogrel plus asprin cuts risk of stroke by 28%  -  ‎Apr 2, 2009‎
By Nigel Praities Combined therapy with clopidogrel and aspirin can substantially reduce the risk of stroke in patients not suitable for warfarin therapy, Pulse

It's a first: Treat me, treat my dog? Warfarin name explained  -  ‎Apr 16, 2009‎
Dear Dr. Gott: You recently discussed warfarin, the brand name of which is Coumadin. It was discovered by serendipity by Dr. Karl Paul Link at the Tulsa World

Atritech raises $30m in financing  -  ‎Apr 1, 2009‎
The Protect AF clinical trial evaluates the Watchman device versus the current standard of care, warfarin, in patients with atrial fibrillation. Pharmaceutical Business Review

The body has mechanisms for handling bruises  -  ‎Mar 29, 2009‎
They include fish oil and/or Vitamin E, and certain prescription medications, in particular, blood thinners known as Warfarin. News Chief

Combination therapy benefits people with quivering heart  -  ‎Apr 1, 2009‎
Oral blood thinners, such as warfarin and aspirin, are the only proven therapies for atrial fibrillation. Research has shown that warfarin is more effective Insciences Organisation

Reducing harm from high-risk medicines  -  ‎Mar 30, 2009‎
Patient Safety First encourages them to tackle warfarin as a priority. While it is associated with the highest medicines-related harm, reducing harm from Nursing Times

EPA may relax pharma waste rule  -  ‎Mar 30, 2009‎
Currently, hospitals that generate pharmaceutical wastes on RCRA’s P- and U-lists (eg, warfarin, physostigmine, and chemotherapy drugs) are classified as Solid Waste & Recycling

Risky yet promising stroke-blocking device announced  -  ‎Mar 30, 2009‎
It has also been highlighted that many patients are looking for an alternative to drugs currently on offer such as warfarin and Coumadin, which also have a Barchester Healthcare

Plavix + Aspirin = New Treatment for Atrial Fibrillation  -  ‎Apr 6, 2009‎
There may be a new treatment option for atrial fibrillation patients who either cannot take the current most-often-prescribed treatment of warfarin HealthNews

Stroke-blocking device shows promise  -  ‎Apr 4, 2009‎
The current standard treatment is the drug warfarin, but it requires frequent blood tests to get the dose right. A new study presented at a cardiology Times and Transcript

Travel Health: Jet Lag, Cosmic Radiation and In-Flight Emergencies  -  ‎Apr 16, 2009‎
People taking warfarin (coumadin) or who have epilepsy should also not take melatonin. Other treatment methods have been recommended, such as going to bed New York Times

Boehringer Ingelheim Plans to Launch US Registry to Assess the ...  -  ‎Mar 31, 2009‎
..."The Extent of Warfarin Use and its Effectiveness within Atrial Fibrillation Patients from a US Nationally Representative Sample." (8) Tapson V, Hayers T, FOXBusiness

Cholesterol drug lowers blood clot risk, study says  -  ‎Mar 30, 2009‎
What's more, there was also no bleeding risk with Crestor, which is an issue with other anti-clotting medicines, such as heparin and warfarin. CTV.ca

Family quiz doctors over death  -  ‎Apr 14, 2009‎
She said: "That night the staff could not find a doctor to decide whether he should have had his Warfarin or other anti-coagulant drugs. Tivyside Advertiser

The drug–drug interaction between proton pump inhibitors and ...  -  ‎Mar 30, 2009‎
For example, patients taking clopidogrel and warfarin therapy who require a proton pump inhibitor may need to avoid pantoprazole, since warfarin is CMAJ

Co-location must end now – IMO CEO  -  ‎Apr 17, 2009‎
Further cuts in GP payments would only result in job losses in practice staff and the transfer of many pro bono services – such as Warfarin monitoring Irish Medical Times

Clopidogrel benefit greater in smokers: New CLARITY-TIMI 28 analysis  -  ‎Apr 9, 2009‎
...in time, platelet aggregation with clopidogrel will likely be checked routinely, in the same way as prothrombin time is checked in those on warfarin, TheHeart.Org

Aspirin Linked to Brain Microbleed  -  ‎Apr 13, 2009‎
These were overwhelmingly warfarin (Coumadin) and other vitamin K antagonists rather than heparin. Although not significant, anticoagulants displayed a MedPage Today

Lower your risk of heart disease with omega-3 fatty acids.  -  ‎Apr 15, 2009‎
...about mercury levels in fish, and patients taking anticoagulants such as Coumadin (warfarin) need to consult first about their anticoagulation levels. Examiner.com

Fruitful Knowledge  -  ‎Apr 13, 2009‎
...more popular supplements on the market today and can be taken by almost anyone who is not taking blood-thinning medications such as warfarin (Coumadin). Massage Today

Facing a Scourge of Killer Clots  -  ‎Mar 31, 2009‎
...such as putting certain patients on blood-thinning medications -- including anticlotting drugs heparin or warfarin -- and using special compression Wall Street Journal

Brand Names/Synonyms:
Warfarin is also known by the following brand names and/or synonyms200 Coumarin; Arab Rat Death; Arab Rat Deth; Athrombin; Athrombin-K; Athrombine-K; Brumolin; Caswell No. 903; Co-Rax; Compound 42; Coumadin; Coumafen; Coumafene; Coumaphen; Coumaphene; Coumarins; Coumefene; D-Con; Dethmor; Dethnel; Dicusat E; Eastern States Duocide; Fasco Fascrat Powder; Frass-Ratron; HSDB 1786; Jantoven; Killgerm Sewarin P; Kumader; Kumadu; Kumatox; Kypfarin; Latka 42; Liqua-Tox; Maag Rattentod Cum; Mar-Frin; Marevan; Martin's Mar-Frin; Maveran; Mouse Pak; Panwarfin; Place-Pax; Prothromadin; RAX; Rat & Mice Bait; Rat &Amp; Mice Bait; Rat-Gard; Rat-Kill; Rat-Mix; Rat-Ola; Rat-Trol; Ratorex; Ratox; Ratoxin; Ratron; Ratron G; Ratten-Koederrohr; Rattenstreupulver Neu Schacht; Rattentraenke; Rattunal; Rcr Grey Squirrel Killer Concentrate; Rcra Waste Number P001; Ro-Deth; Rodafarin; Rodafarin C; Rodex; Rodex Blox; Rosex; Rough & Ready Mouse Mix; Rough &Amp; Ready Mouse Mix; Sakarat; Sewarin; Sofarin; Solfarin; Sorexa Plus; Temus W; Tintorane; Tox-Hid; Twin Light Rat Away; Vampirinip Ii; Vampirinip Iii; W.A.R.F. 42; Waran; Warf 42; Warf Cmpd. 42; Warf Compound 42; Warfarat; Warfarin; Warfarin Plus; Warfarin Q; Warfarin Sodium; Warfarine; Warficide; Warfilone; Zoocoumarin

Drug Category:
Warfarin is categorized under the following by the FDA: Rodenticides; Anticoagulants; Coumarin and Indandione Derivatives; ATC:B01AA03

Dosage Forms:
POWDER FOR SOLUTION; TABLET

Absorption:
Not Available

Interactions:
-->Interactions for Warfarin:

Drugs may interact with COUMADIN through pharmacodynamic or pharmacokinetic mechanisms. Pharmacodynamic mechanisms for drug interactions with COUMADIN are synergism (impaired hemostasis, reduced clotting factor synthesis), competitive antagonism (vitamin K), and altered physiologic control loop for vitamin K metabolism (hereditary resistance). Pharmacokinetic mechanisms for drug interactions with COUMADIN are mainly enzyme induction, enzyme inhibition, and reduced plasma protein binding. It is important to note that some drugs may interact by more than one mechanism.

The following factors, alone or in combination, may be responsible for INCREASED PT/INR response

ENDOGENOUS FACTORS

blood dyscrasias —

diarrhea

hyperthyroidism

see CONTRAINDICATIONS

elevated temperature

poor nutritional state

cancer

hepatic disorders

steatorrhea

collagen vascular disease

infectious hepatitis

vitamin K deficiency

congestive heart failure

jaundice

 

EXOGENOUS FACTORS

Potential drug interactions with COUMADIN are listed below by drug class and by specific drugs.

Classes of Drugs

5-lipoxygenase Inhibitor

Antiparasitic/Antimicrobials

HMG-CoA Reductase

Adrenergic Stimulants, Central

Antiplatelet Drugs/Effects

Inhibitors

Alcohol Abuse Reduction

Antithyroid Drugs

Leukotriene Receptor Antagonist

Preparations

Beta-Adrenergic Blockers

Monoamine Oxidase Inhibitors

Analgesics

Cholelitholytic Agents

Narcotics,prolonged

Anesthetics, Inhalation

Diabetes Agents, Oral

Nonsteroidal Anti-Inflammatory

Antiandrogen

Diuretics

Agents

Antiarrhythmics

Fungal Medications, Intravaginal,

Psychostimulants

Antibiotics

Systemic

Pyrazolones

Aminoglycosides (oral)

Gastric Acidity and Peptic

Salicylates

Cephalosporins, parenteral

Ulcer Agents

Selective Serotonin

Macrolides

Gastrointestinal

Reuptake Inhibitors

Miscellaneous

Prokinetic Agents

Steroids, Adrenocortical

Penicillins, intravenous,

Ulcerative Colitis Agents

Steroids, Anabolic (17-Alkyl

high dose

Gout Treatment Agents

Testosterone Derivatives)

Quinolones (fluoroquinolones)

Hemorrheologic Agents

Thrombolytics

Sulfonamides, long acting

Hepatotoxic Drugs

Thyroid Drugs

Tetracyclines

Hyperglycemic Agents

Tuberculosis Agents

Anticoagulants

Hypertensive Emergency Agents

Uricosuric Agents

Anticonvulsants

Hypnotics

Vaccines

Antidepressants

Hypolipidemics

Vitamins

Antimalarial Agents

Bile Acid-Binding Resins

 

Antineoplastics

Fibric Acid Derivatives

 

Specific Drugs Reported

acetaminophen

fluconazole

penicillin G,intravenous

alcohol

fluorouracil

pentoxifylline

allopurinol

fluoxetine

phenylbutazone

aminosalicylic acid

flutamide

phenytoin

amiodarone HCl

fluvastatin

piperacillin

aspirin

fluvoxamine

piroxicam

atorvastatin

gemfibrozil

pravastatin

azithromycin

glucagon

prednisone

capecitabine

halothane

propafenone

cefamandole

heparin

propoxyphene

cefazolin

ibuprofen

propranolol

cefoperazone

ifosfamide

propylthiouracil

cefotetan

indomethacin

quinidine

cefoxitin

influenza virus vaccine

quinine

ceftriaxone

itraconazole

ranitidine

celecoxib

ketoprofen

rofecoxib

cerivastatin

ketorolac

sertraline

chenodiol

levamisole

simvastatin

chloramphenicol

levofloxacin

stanozolol

chloral hydrate

levothyroxine

streptokinase

chlorpropamide

liothyronine

sulfamethizole

cholestyramine

lovastatin

sulfamethoxazole

cimetidine

mefenamic acid

sulfinpyrazone

ciprofloxacin

methimazole

sulfisoxazole

cisapride

methyldopa

sulindac

clarithromycin

methylphenidate

tamoxifen

clofibrate

methylsalicylate ointment

tetracycline

COUMADIN overdose

(topical)

thyroid

cyclophosphamide

metronidazole

ticarcillin

danazol

miconazole

ticlopidine

dextran

(intravaginal,systemic)

tissue plasminogen

dextrothyroxine

moricizine hydrochloride

activator (t-PA)

diazoxide

nalidixic acid

tolbutamide

diclofenac

naproxen

tramadol

dicumarol

neomycin

trimethoprim/sulfamethoxazole

diflunisal

norfloxacin

urokinase

disulfiram

ofloxacin

valproate

doxycycline

olsalazine

vitamin E

erythromycin

omeprazole

zafirlukast

ethacrynic acid

oxaprozin

zileuton

fenofibrate

oxymetholone

 

fenoprofen

paroxetine

 

also: other medications affecting blood elements which may modify hemostasis dietary deficiencies prolonged hot weather unreliable PT/INR determinations

increased and decreased PT/INR responses have been reported.

The following factors, alone or in combination, may be responsible for DECREASED PT/INR response

ENDOGENOUS FACTORS

edema

hypothyroidism

hereditary coumarin resistance

nephrotic syndrome

hyperlipemia

 

EXOGENOUS FACTORS

Potential drug interactions with COUMADIN (Warfarin Sodium) are listed below by drug class and by specific drugs.

Classes of Drugs

Adrenal Cortical Steroid Inhibitors

Antithyroid Drugs

HMG-CoA Reductase Inhibitors

Antacids

Barbiturates

Immunosuppressives

Antianxiety Agents

Diuretics

Oral Contraceptives,

Antiarrhythmics

Enteral Nutritional Supplements

Estrogen Containing

Antibiotics

Fungal Medications, Systemic

Selective Estrogen Receptor

Anticonvulsants

Gastric Acidity and

Modulators

Antidepressants

Peptic Ulcer Agents

Steroids, Adrenocortical

Antihistamines

Hypnotics

Tuberculosis Agents

Antineoplastics

Hypolipidemics

Vitamins

Antipsychotic Medications

Bile Acid-Binding Resins

 

Specific Drugs Reported

alcohol

COUMADIN underdosage

phenytoin

aminoglutethimide

cyclophosphamide

pravastatin

amobarbital

dicloxacillin

prednisone

atorvastatin

ethchlorvynol

primidone

azathioprine

glutethimide

propylthiouracil

butabarbital

griseofulvin

raloxifene

butalbital

haloperidol

ranitidine

carbamazepine

meprobamate

rifampin

chloral hydrate

6-mercaptopurine

secobarbital

chlordiazepoxide

methimazole

spironolactone

chlorthalidone

moricizine hydrochloride

sucralfate

cholestyramine

nafcillin

trazodone

clozapine

paraldehyde

vitamin C (high dose)

corticotropin

pentobarbital

vitamin K

cortisone

phenobarbital

 

also: diet high in vitamin K unreliable PT/INR determinations

Increased and decreased PT/INR responses have been reported.

Because a patient may be exposed to a combination of the above factors, the net effect of COUMADIN on PT/INR response may be unpredictable. More frequent PT/INR monitoring is therefore advisable. Medications of unknown interaction with coumarins are best regarded with caution. When these medications are started or stopped, more frequent PT/INR monitoring is advisable.

It has been reported that concomitant administration of warfarin and ticlopidine may be associated with cholestatic hepatitis.

Botanical (Herbal) Medicines

Caution should be exercised when botanical medicines (botanicals) are taken concomitantly with COUMADIN. Few adequate, well-controlled studies exist evaluating the potential for metabolic and/or pharmacologic interactions between botanicals and COUMADIN. Due to a lack of manufacturing standardization with botanical medicinal preparations, the amount of active ingredients may vary. This could further confound the ability to assess potential interactions and effects on anticoagulation. It is good practice to monitor the patient’s response with additional PT/INR determinations when initiating or discontinuing botanicals.

Specific botanicals reported to affect COUMADIN therapy include the following:

• Bromelains, danshen, dong quai (Angelica sinensis), garlic, Ginkgo biloba, and ginseng are associated most often with an INCREASE in the effects of COUMADIN.

• Coenzyme Q10 (ubidecarenone) and St. John’s wort are associated most often with a DECREASE in the effects of COUMADIN.

Some botanicals may cause bleeding events when taken alone (e.g., garlic and Ginkgo biloba) and may have anti-coagulant, antiplatelet, and/or fibrinolytic properties. These effects would be expected to be additive to the anticoagulant effects of COUMADIN. Conversely, other botanicals may have coagulant properties when taken alone or may decrease the effects of COUMADIN.

Some botanicals that may affect coagulation are listed below for reference; however, this list should not be considered all-inclusive. Many botanicals have several common names and scientific names. The most widely recognized common botanical names are listed.

Botanticals that contain coumarins with potential anticoagulant effects:

Alfalfa

Celery

Parsley

Angelica (Dong Quai)

Chamomile

Passion Flower

Aniseed

(German and Roman)

Prickly Ash (Northern)

Arnica

Dandelion3

Quassia

Asa Foetida

Fenugreek

Red Clover

Bogbean1

Horse Chestnut

Sweet Clover

Boldo

Horseradish

Sweet Woodruff

Buchu

Licorice3

Tonka Beans

Capsicum2

Meadowsweet1

Wild Carrot

Cassia3

Nettle

Wild Lettuce

Miscellaneous botanticals with anticoagulant properties:

Bladder Wrack (Fucus)

Pau d’arco

 

Botanicals that contain salicylate and/or have antiplatelet properties:

Agrimony4

Dandelion3

Meadowsweet1

Aloe Gel

Feverfew

Onion5

Aspen

Garlic5

Policosanol

Black Cohosh

German Sarsaparilla

Poplar

Black Haw

Ginger

Senega

Bogbean1

Ginkgo Biloba

Tamarind

Cassia3

Ginseng (Panax)5

Willow

Clove

Licorice3

Wintergreen

Botanticals with fibrinolytic properties:

Bromelains

Garlic5

Inositol Nicotinate

Capsicum2

Ginseng (Panax)5

Onion5

Botanticals with coagulant properties:

Agrimony4 Mistletoe

Yarrow

Goldenseal

 

1 Contains coumarins and salicylate.

2 Contains coumarins and has fibrinolytic properties.

3 Contains coumarins and has antiplatelet properties.

4 Contains salicylate and has coagulant properties.

5 Has antiplatelet and fibrinolytic properties.

Effect on Other Drugs

Coumarins may also affect the action of other drugs. Hypoglycemic agents (chlorpropamide and tolbutamide) and anticonvulsants (phenytoin and phenobarbital) may accumulate in the body as a result of interference with either their metabolism or excretion.

Special Risk Patients

COUMADIN (Warfarin Sodium) is a narrow therapeutic range (index) drug, and caution should be observed when warfarin sodium is administered to certain patients such as the elderly or debilitated or when administered in any situation or physical condition where added risk of hemorrhage is present.

Intramuscular (I.M.) injections of concomitant medications should be confined to the upper extremities which permits easy access for manual compression, inspections for bleeding and use of pressure bandages.

Caution should be observed when COUMADIN (or warfarin) is administered concomitantly with nonsteroidal antiinflammatory drugs (NSAIDs), including aspirin, to be certain that no change in anticoagulation dosage is required. In addition to specific drug interactions that might affect PT/INR, NSAIDs, including aspirin, can inhibit platelet aggregation, and can cause gastrointestinal bleeding, peptic ulceration and/or perforation.

Acquired or inherited warfarin resistance should be suspected if large daily doses of COUMADIN are required to maintain a patient’s PT/INR within a normal therapeutic range.

SIDE EFFECTS

Potential adverse reactions to COUMADIN may include:

• Fatal or nonfatal hemorrhage from any tissue or organ. This is a consequence of the anticoagulant effect. The signs, symptoms, and severity will vary according to the location and degree or extent of the bleeding. Hemorrhagic complications may present as paralysis; paresthesia; headache, chest, abdomen, joint, muscle or other pain; dizziness; shortness of breath, difficult breathing or swallowing; unexplained swelling; weakness; hypotension; or unexplained shock. Therefore, the possibility of hemorrhage should be considered in evaluating the condition of any anticoagulated patient with complaints which do not indicate an obvious diagnosis. Bleeding during anticoagulant therapy does not always correlate with PT/INR.

• Bleeding which occurs when the PT/INR is within the therapeutic range warrants diagnostic investigation since it may unmask a previously unsuspected lesion, e.g., tumor, ulcer, etc.

• Necrosis of skin and other tissues.

• Adverse reactions reported infrequently include: hypersensitivity/allergic reactions, systemic cholesterol microembolization, purple toes syndrome, hepatitis, cholestatic hepatic injury, jaundice, elevated liver enzymes, vasculitis, edema, fever, rash, dermatitis, including bullous eruptions, urticaria, abdominal pain including cramping, flatulence/bloating, fatigue, lethargy, malaise, asthenia, nausea, vomiting, diarrhea, pain, headache, dizziness, taste perversion, pruritus, alopecia, cold intolerance, and paresthesia including feeling cold and chills.

Rare events of tracheal or tracheobronchial calcification have been reported in association with long-term warfarin therapy. The clinical significance of this event is unknown.

Priapism has been associated with anticoagulant administration, however, a causal relationship has not been established.

 




Chemical IUPAC Name:
2-hydroxy-3-(3-oxo-1-phenyl-butyl)-chromen-4-one

:
 
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