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

Medmatics Announced Today the Release of CoaguTrak Fall '08, the ...  -  16 Sep 2008
..."We're dedicated to providing our customers with the most comprehensive and intuitive warfarin management software on the market," said Steve Larmon, MarketWatch

Mobidiag, Osmetech, RayBiotech, AnaSpec, MD Anderson Cancer Center ...  -  16 Sep 2008
In July, Osmetech received US Food and Drug Administration clearance to sell its eSensor XT-8 System and related eSensor Warfarin Sensitivity Test. bioArray News (subscription),

ESF study helps stop drugs slipping through safety net  -  16 Sep 2008
But without any blood clotting, patients would sooner or later bleed to death, so clearly warfarin must be given in the correct dose, finding the tight EurekAlert (press release),

Telemedicine supports patients on warfarin  -  Sep 15, 2008
Patients on oral anticoagulation therapy with warfarin need to regularly check their INR levels to avoid dangerous over or under-dosing with the drug. E-Health Europe,

Anticoagulant may be stopped cold turkey  -  Sep 14, 2008
Q: Our doctor took my husband off warfarin cold turkey after a number of years. Is this harmful? He's 89 years old and has had a couple of strokes in the Chicago Tribune,

US surgeon general issues "call to action" on DVT and PE  -  Sep 15, 2008
Nabel said the NHLBI is set to launch the first multicenter, randomized, clinical trial of genotype-guided dosing of warfarin therapy. TheHeart.Org,

TrimGen Expects FDA Clearance of Warfarin Genotyping Test Soon  -  Sep 11, 2008
By Turna Ray NEW YORK (GenomeWeb News) - TrimGen expects the US Food and Drug Administration to clear as an in vitro diagnostic its warfarin-dosing test “no GenomeWeb News (subscription),

Warfarin underused by patients at risk for stroke  -  Aug 28, 2008
Warfarin, also known by the trade name Coumadin, can reduce the risk of stroke by preventing the formation of blood clots, which often occur in patients Reuters

Warfarin safely continued during coronary angiography  -  Sep 10, 2008
The results of a new study suggest that patients receiving long-term warfarin therapy do not need to stop the drug prior to coronary angiography. Medicexchange,

New clinic glimpse of future  -  Sep 12, 2008
Though it can be highly effective in preventing potentially fatal blood clots, warfarin reacts differently in individuals. A dose that would help one London Free Press,

List of medications with potential safety problems  -  Sep 5, 2008
..._Stromectol and Warfarin, an anti-parasite drug and a blood thinner, drug interaction. _Revlimid, for multiple myeloma, severe skin blistering and bleeding. MLive.com,

Inverness Medical Launches Portable Blood Testing Monitor to Warn ...  -  Sep 5, 2008
The INRatio2 is used by healthcare professionals and their patients in the management of warfarin, a blood-thinning drug, to monitor the effectiveness of MarketWatch

Warfarin gene  -  Sep 3, 2008
To reduce the risk of clots, a physician may prescribe medication, called warfarin (Coumadin®). The drug works by blocking the action of proteins needed for WHOI,

Red liquid in storm drain not Warfarin  -  Sep 2, 2008
Responding to the alert from an unidentified source last week that “Aspen has dumped 100 litres of Warfarin (a drug to prevent blood clotting) into North The Herald Eastern Cape,

Public Comment Phase on Warfarin Genetic Test Reimbursement Ends ...  -  Sep 2, 2008
3, about whether Medicare should provide reimbursement for DNA tests for the common anticoagulant warfarin. Tomorrow marks the end of a public comment phase GenomeWeb News (subscription),

New Drug Protects Against Second Heart Attack or Stroke, Study ...  -  Sep 2, 2008
Most are prescribed aspirin, clopidogrel (also known as Plavix or Iscover) and/or warfarin. "Warfarin is clearly effective as an anticoagulant, Science Daily (press release)

Mania: Psychiatric Manifestations of the Antiphospholipid Syndrome  -  Sep 15, 2008
He was admitted to the intensive care unit, and anticoagulation therapy with warfarin and enoxaparin was begun. Further laboratory testing showed Psychosomatics (subscription)

Osmetech Files to Float Shares in US  -  Sep 12, 2008
In July, Osmetech received US Food and Drug Administration clearance to sell its eSensor XT-8 System and related eSensor Warfarin Sensitivity Test. GenomeWeb News (subscription),

Should Insurance Companies Pay for Genetic Testing?  -  Sep 2, 2008
Last year, the FDA announced that a genetic test might help doctors avoid a common catastrophe -- giving their patients an excessive dose of warfarin. Wired News

Atritech Files Pre-Market Approval Application for Its WATCHMAN(R ...  -  Aug 18, 2008
PROTECT AF evaluated the WATCHMAN(R) Left Atrial Appendage (LAA) Closure Technology versus the current standard of care, warfarin, in patients with MarketWatch

Offline -- only in print  -  Sep 12, 2008
...*You can quit warfarin cold turkey, but aspirin therapy might be a good idea. A Medical Edge column on Mind & Body. *A few months ago, General Motors Corp. Fort Wayne Journal Gazette,

High-Risk Patients Not Taking Blood Thinner Before Stroke  -  Aug 29, 2008
Furthermore, three-fourths of patients who were taking warfarin weren’t taking adequate doses of the drug to prevent a stroke. The rest were taking other, eMaxHealth.com,

Many women don't need blood thinners  -  Aug 26, 2008
In January, Gauvin went on the most commonly prescribed blood thinner, called warfarin. It's a drug also used in pest control. Canada.com,

This Month in Archives of Neurology  -  Sep 8, 2008
However, they point out that heparin bridging (intravenous heparin in the acute phase followed by warfarin) and enoxaparin bridging (full-dose enoxaparin Archives of Neurology

Salvo fired for drugs mix-up  -  Aug 30, 2008
The authority heard that Pettersen dispensed the wrong dosage of blood-thinning drug Warfarin to a client in March 2006. About a fortnight later, New Zealand Herald,

Gene Marker May Predict Doses Of Important Anticoagulant  -  Aug 25, 2008
A particular gene marker may help predict a patient’s safest and most effective dose of warfarin, the most widely prescribed anticoagulant in North America, eMaxHealth.com,

A personal map of your genome - a £30000 bargain  -  Aug 20, 2008
Variants that people inherit explain why some need very high doses of the blood-thinner warfarin that would be life-threatening to others. Times Online,

Medco Announces Research Collaboration with FDA Focused on ...  -  Aug 19, 2008
Medco has existing research collaborations with Mayo Clinic studying genetic consideration in the use of warfarin, and with LabCorp regarding breast cancer FOXBusiness

Drug trial explores link between genes and dosage  -  Aug 20, 2008
By Liaw Wy-Cin Researchers here have come up with a formula that calculates precisely how much of the blood-thinning drug warfarin patients need, Straits Times,

Deep Vein Thrombosis—Concepts and Controversy  -  Aug 25, 2008
Approximately 18% of specialists reported a preference for a 14-day regimen of warfarin with an International Normalized Ratio (INR) of 2 to 2.5. Ortho SuperSite,

Few high risk stroke patients taking blood thinner  -  Sep 2, 2008
Warfarin, a blood-thinner, reduces the risk of stroke by 70 per cent, and can also reduce the severity of a stroke. Only 40 per cent of patients who Calgary CTV,

Simple Rule May Allow Many Women To Stop Taking Blood Thinners  -  Aug 28, 2008
Once the initial blood clot is treated, warfarin is prescribed to reduce the risk of further clotting. “Many patients end up taking warfarin for the rest of eMaxHealth.com,

How Jan got advice so wrong  -  Aug 22, 2008
...before commencing new ‘alternative' treatments to avoid any potential interactions with their current medication (eg, Warfarin and St John’s Wort). Belfast Telegraph,

OSU Medical Center Study To Test New Blood-Thinning Drug  -  Aug 27, 2008
More than 14000 study participants will receive the experimental therapy or warfarin. Routine blood tests will be performed to monitor blood clot formation. Media Newswire (press release),

Extensive screening superior to limited screening in detecting ...  -  Sep 15, 2008
...include those without a family history of venous thrombosis, of more advanced age, and perhaps with persistently elevated D-dimers on warfarin therapy. HemOncToday,

Changing Trends in Anti-Coagulant Therapies. Are Heparins and Oral ...  -  Aug 22, 2008
Warfarin provides a convenient and affordable approach in the long-term outpatient management of thrombotic disorders. The optimized use of these drugs RedOrbit,

Aspen probing release of liquid into lake  -  Aug 26, 2008
Aspen responsible pharmacist Michael Aereboe was responding to an unidentified caller who said Aspen had dumped “100 litres of Warfarin�, a drug which The Herald Eastern Cape,

Medco, FDA Agree to Pharmacogenomics Collaboration  -  Aug 26, 2008
The collaboration will initially focus on blood-thinner warfarin and could later focus on areas such as oncology and virology. FDA news (subscription),

Diakron Gets Exclusive Rights To Merck Anticoagulant  -  Aug 22, 2008
The FDA estimates that 2 million patients start taking warfarin in the US every year to prevent blood clots, heart attacks and stroke. Pharmaceutical Online (press release),

Litany of Failures at Rest Home  -  Sep 1, 2008
A resident on Warfarin missed out on the medication for four days. Residents needing regular fluids received no help with managing cups at morning and RedOrbit,

What you need to know  -  Aug 28, 2008
...(Be careful about this with certain drugs, such as the blood thinner Coumadin, which also is known as warfarin. Ask your doctor. Louisville Courier-Journal,

Study looks at West Nile virus' long-term outcomes  -  Aug 24, 2008
But the ultimate goal is an alternative to that old standby warfarin, also called Coumadin, the nation's most troublesome lifesaver because of side effects GoErie.com,

Patients’ views sought  -  Aug 21, 2008
Formby Times SEFTON Primary Care Trust is surveying patients who use anticoagulation services, involving blood testing and prescription of Warfarin. icSeftonandWestLancs,

New Data is Presented on Investigational Oral Anticoagulant ...  -  Sep 2, 2008
The ARISTOTLE trial is investigating apixaban compared to warfarin in approximately 15000 patients with atrial fibrillation. MarketWatch

The Incidence of PICC Line-Associated Thrombosis With and Without ...  -  Sep 4, 2008
In a comparison of minidose warfarin and low molecular weight heparin (nadroparin) in cancer patients, 28.6% of the nadroparin group and 16.7% of the RedOrbit,

Best intentions  -  Sep 14, 2008
They put him on Warfarin, a drug that thins the blood and prevents clotting. They told him with a Gallic shrug that he would be on it for the rest of his Irish Independent,

Bristol-Myers Squibb and Pfizer Provide Update on Apixaban ...  -  Aug 26, 2008
The ARISTOTLE trial is investigating apixaban compared to warfarin in approximately 15000 patients with atrial fibrillation. MarketWatch

Study probes lower dose drugs for heart valve patients  -  Sep 11, 2008
..."The On-X valve could become the first mechanical heart valve approved for use with lower doses of anticoagulants such as Coumadin (warfarin) or even Indianapolis Star,

I was excited about Bradford away — damn my thin blood!  -  Sep 13, 2008
But it had to be cancelled at the last minute due to the spectacular warfarin-induced thinness of my blood. "It's not safe to operate", said the surgeon. Express & Echo,

Annual Report to shareholders  -  Sep 11, 2008
...blood coagulation in patients who bleed when receiving immune disease (PID) and fibrinogen for congenital deficiency. warfarin anticoagulant therapy. Sydney Morning Herald,

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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