All about Warfarin (generic Coumadin)

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You may take two doses on the same day, but do not take two doses at the same time.

If you miss doses for two or more days, call your doctor for instructions.

If you do miss a dose, take it as soon as you can that same day.

If it is almost time for your next dose, take only that dose.

If you miss a dose, record the date of the missed dose and tell your prescriber or health care professional at your next visit.

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Coumadin can interact with a very wide variety of drugs, both prescription and over-the-counter.

Some medications can enhance the action of Coumadin and cause excessive blood thinning and life-threatening bleeding.

John's Wort, bromelains, coenzyme Q10, dan-shen, dong quai, garlic, and ginkgo biloba--are known to interact with Coumadin or otherwise affect coagulation.

A few examples of such medications include Aspirin, ibuprofen (Motrin), alcohol, Tylenol, cimetidine (Tagamet), oxandrolone (Oxandrin), certain vitamins, and antibiotics.

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These problems can change the effect of Coumadin (Warfarin).

If you have questions about effective birth control, talk with your doctor.

If you do not remember until the next day, skip the dose.

This medicine should not be used during pregnancy, especially during the first and third trimesters, as it may be harmful to the developing foetus.

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).

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Symptoms include: chest, muscle, abdomen, joint, or other pain; unexplained swelling; numbness and tingling; low blood pressure; paralysis; difficult breathing or swallowing; shortness of breath; dizziness; headache; unexplained shock; weakness The two most serious side effects are bleeding and necrosis (gangrene) of the skin.

Signs of overdose include bleeding gums, bruising, nosebleeds, heavy menstrual bleeding, and prolonged bleeding from cuts.

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The risk of hemorrhage usually depends on the dosage and length of treatment with Coumadin sodium.

The most serious risks associated with Coumadin treatment are hemorrhage (severe bleeding resulting in the loss of a large amount of blood) in any tissue or organ and, less frequently, the destruction of skin tissue cells (necrosis) or gangrene.

This belongs to the group of medicines known as anticoagulants.

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For this reason, salad and green vegetables (eg broccoli, particularly your consumption of green tea, avoid making sudden major changes to your diet, brussel sprouts, or spinach), which contain large amounts of vitamin K.

If you notice any of the following symptoms, contact your doctor immediately: Abdominal pain; high blood pressure; blood in the urine; muscle pain; foot ulcers; bluish mottling of the skin of the legs and hands; gangrene; abrupt and intense pain in the leg, foot, or toes; "purple toes syndrome" (see below); rash; or thigh or back pain.

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Warfarin may also be used for purposes other than those listed in this medication guide.

Treatment and prevention of blood clots lodged in the veins of the leg (deep vein thrombosis) Treatment and prevention of blood clots that have travelled to the lungs (pulmonary embolism) Preventing abnormal blood clots in conditions with increased risk, eg rheumatic heart disease, atrial fibrillation and after insertion of artificial (prosthetic) heart valves .

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ADULTS The administration and dosage of Coumadin must be individualized by your doctor according to your sensitivity to the drug.

Frequent blood tests are performed to measure blood clotting time (protime) during Coumadin treatment.

The duration of treatment will be determined by your physician.

A common starting dosage of Coumadin tablets for adults is 2 to 5 milligrams per day.

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Call 1-800-222-1222 to the American Association of Poison Control Centers, your local poison control center ( http://www.aapcc.org/findyour.htm ), or emergency room immediately.

Keep Warfarin (Coumadin) out of the reach of children and away from pets.

Symptoms of abnormal bleeding include: Blood in stools or urine, excessive menstrual bleeding, reddish or purplish spots on skin, excessive bruising, black stools, persistent bleeding from superficial injuries If you suspect an overdose, seek emergency medical treatment immediately.

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Throw away any unused medicine after the expiration date.

Keep out of the reach of children in a container that small children cannot open.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F).

Store at room temperature in tight, light resistant container.

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