Coumadin (Warfarin)

Coumadin Information:

Coumadin (generic name: Warfarin) belongs to a group of medications called anticoagulants. Anticoagulant medications basically reduce the clotting tendency of the blood. Warfarin is the most popularly prescribed anticoagulant in the world and has been used since the 1950’s. Warfarin is very commonly referred to as a blood thinner, however this is incorrect as Warfarin will not affect the thickness of the blood. Rather, Warfarin works in the liver to reduce the quantity of key proteins that allow blood to clot. Warfarin is used to prevent thrombus (abnormal formation of clots) and embolism (migration of these clots to potentially dangerous areas). Thus, Warfarin is used in conditions where clot formation and migration may occur and be potentially dangerous. This includes atrial fibrillation, patients with artificial heart valves, deep vein thrombosis (DVT), and pulmonary embolism.

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Coumadin Side Effects:

The most common and not serious side effects of Warfarin include nausea and/or vomiting, stomach upset, loss of appetite. Warfarin may have some potentially serious side effects related to bleeding. The patient may be over benefiting from the effects of Warfarin, and this may lead to potentially dangerous bleeding. This risk of bleeding may be increased when Warfarin is combined with antiplatelet drugs (ex. Coumadin, Aspirin), other NSAID drugs (ex. Advil, Naproxen), and prednisone. Other side effects (related to bleeding) should be discussed immediately with your primary care physician, include persistent nosebleeds, unexplained bruising, unexplained fatigue (may be a sign of anemia), coughing up blood, black/tarry stools, persistent bleeding from cuts or from the gums, pink/dark urine, vomit that is bloody, or has a coffee ground appearance, and unusually heavy or prolonged menstrual flow.

Monitor for any signs of bleeding (see side effects above) and discuss immediately with your primary care physician if they occur. Before taking any prescription, over the counter, or herbal medicine, discuss with your family care physician and/or pharmacist the potential for an interaction. Discuss actively with your primary care physician, the need for frequent INR monitoring. This will ensure that Warfarin is working correctly and that you are less likely to experience any side effects. Avoid abrupt changes in your diet while taking Warfarin. This may lead to potential changes in Vitamin K and hence reduced effectiveness of Warfarin. Warfarin may be taken with or without food and should be taken at the same time each day.

Coumadin Directions:

Patients taking Warfarin will always be sent for testing of the efficacy of Warfarin. This test, the INR (International Normalized Ratio), must always be undertaken to ensure that Warfarin is working correctly and to prevent any side effects of Warfarin. Quite simply, the INR is used to test the effectiveness of anticoagulant medications. A normal patient will have an INR between 0.6 to 1.5. When taking Warfarin, a patient will require that their blood clots more slowly, and so an INR of 2-3 is usually required (for patients at higher risk of clot formations, an INR of 3.5 or greater may be required). If the INR goes beyond 4, this can potentially lead to dangerous bleeding complications. It will take at least 1 week of daily Warfarin dosing to get a stable INR reading, the physician may need to increase/decrease the dosage following 1 week of treatment.

Coumadin Precautions:

Warfarin is a drug with a narrow therapeutic index. This simply means that it will work effectively at a very small range. There exists numerous drugs that affect this narrow range and cause an interaction with Warfarin. The patient is strongly advised to discuss with his/her primary care physician and/or pharmacist before starting on any new medication(including herbal medicine) while taking Warfarin. A very brief list of potential drug interactions includes: fenofibrate, erythromycin, fluconazole, simvastatin, phenytoin, levofloxacin, ketorolac, prednisone, phenobarbital, and St. John’s wort. There also exists a food interaction with foods that contain Vitamin K. Examples include green leafy vegetables, such as spinach. The patients is advised to avoid such foods as they will reduce the effectiveness of Warfarin.

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