Coumadin (Warfarin)

Coumadin treats or prevents blood clots that may occur in the veins and lungs. It is also used to reduce the risk of death, recurring heart attack, or blood clotting events (e.g., stroke) after a heart attack.

Use Coumadin as directed by your doctor.

• Take Coumadin by mouth with or without food.
• Do not eat grapefruit or drink grapefruit juice while you use Coumadin.
• It is very important to take Coumadin on a regular schedule as prescribed by your doctor. Take Coumadin at the same time each day.
• Continue to take Coumadin even if you feel well. Do not miss any doses, unless directed to do so by your doctor.

Coumadin is an anticoagulant. It works by blocking the formation of ceratin blood clotting factors.

If you miss a dose of Coumadin, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

If you miss a dose of Coumadin, contact your doctor right away. Take the missed dose as soon as possible if you remember on the same day. If you do not remember until the next day, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Do not use Coumadin if:

• you are allergic to any ingredient in Coumadin;
• you have bleeding tendencies, bleeding problems (eg, hemophilia), severe or uncontrolled high blood pressure, certain blood problems (eg, low white blood cell or platelet levels), or leukemia;
• you have active serious bleeding, bleeding in the brain, certain blood vessel problems (eg, aneurysm, dissecting aorta), or inflammation or infection of the heart;
• you have active ulcer or bleeding of the stomach or bowel, urinary tract, genitals, or respiratory tract;
• you have recently had or will be having eye, brain, or spinal cord surgery; spinal puncture; spinal anesthesia; or any type of major surgery;
• you are pregnant or may become pregnant;
• you are unable to have routine blood clotting tests;
• you are unable to follow your doctor's instructions properly and do not have someone to help you take your medicine;
• you are taking mifepristone, streptokinase, or urokinase.

• Tell your doctor or dentist that you take Coumadin before you receive any medical or dental care, emergency care, or surgery.
• Do not drink alcohol while you are taking Coumadin; it may increase the risk of Coumadin's side effects.
• Do not change you activity level or weight without checking with your doctor; the risk of Coumadin side effects may be increased.
• Do not eat cranberry products or drink cranberry juice while you are taking Coumadin. Tell your doctor if these products are already part of your diet.
• Elevated body temperature may increase the effect of Coumadin. Be careful to avoid becoming overheated, especially during hot weather.
• Coumadin decreases blood clotting. Use caution while doing activities such as brushing your teeth, flossing, or shaving. Avoid activities that may cause bruising or injury. Seek immediate medical attention if you fall or injure yourself. Tell your doctor if you have unusual bruising or bleeding. Tell your doctor if you have dark, tarry, or bloody stools.
• Do not take aspirin while you take Coumadin unless your doctor tells you to. If you already take aspirin for a heart or other condition, talk with your doctor about whether or not you should continue to take it with Coumadin.
• Tell your doctor if you will be traveling or if you will be confined to a bed or chair for a long period of time (eg, car or airplane ride). This may increase your risk of developing a blood clot.
• If therapy with Coumadin is stopped, the blood thinning effects may last for 2 to 5 days after you stop taking it. Discuss any questions or concerns with your doctor. Do not suddenly stop taking Coumadin without checking with your doctor.
• Lab tests, including certain blood clotting tests (eg, PT, INR), may be performed while you use Coumadin. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.
• Use Coumadin with caution in Asian patients; they may be more sensitive to its effects, especially bleeding.
• Use Coumadin with caution in the elderly; they may be more sensitive to its effects, especially bleeding.
• Coumadin should be used with extreme caution in children; safety and effectiveness in children have not been confirmed. Children may need more frequent lab tests if they use Coumadin.
• Pregnancy and breast-feeding: Do not use Coumadin if you are pregnant. It has been shown to cause harm to the fetus. Avoid becoming pregnant while you are taking it. If you think you may be pregnant, contact your doctor right away. It is not known if Coumadin is found in breast milk. If you are or will be breast-feeding while you use Coumadin, check with your doctor. Discuss any possible risks to your baby.

Seek medical attention right away if any of these severe side effects occur:

• severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); back, side, muscle, joint, or stomach pain; black, tarry, or bloody stools; blood in the urine (pink or brown urine); bloody or coffee ground-like vomit; chest pain; decreased urination; dizziness; fainting; fever; numbness or tingling; pain, unusual color, or temperature change in any area of the body; pale skin; purple, dark, or painful toes; shortness of breath; skin sores or ulcers; stroke symptoms (eg, confusion, slurred speech, vision problems, one-sided weakness); sudden severe pain in your legs, feet, or toes; trouble swallowing; unexplained swelling; unusual bruising or bleeding (eg, nosebleed, unusual bleeding from gums, increased bleeding from cuts, increased menstrual or vaginal bleeding, coughing up blood); unusual headache or weakness; unusual pain, swelling, or discomfort; wounds or sores that do not heal properly; yellowing of the skin or eyes.

Coumadin is to be used only by the patient for whom it is prescribed. Do not share it with other people.
If your symptoms do not improve or if they become worse, check with your doctor.