Coumadin

Coumadin is a prescription medication used to lower the chances of blood clots forming in your body due to various causes. Coumadin belongs to a group of drugs called anticoagulants or "blood thinners". It helps prevent blood clots from forming by decreasing the formation of substances in the blood known as clotting factors. Careful monitoring of side effects is required using regular blood tests.

This medication comes in tablet form. It is also available in an injectable form to be infused into a vein by a healthcare provider at a hospital or other medical facility. Coumadin is usually taken once daily, with or without food. The dosage will vary depending on the results of your PT/INR test (blood test).

Common side effects of Coumadin are nausea, vomiting, and an altered sense of taste. Seek medical attention if you experience bruising or bleeding.

Coumadin is a prescription medication used to lower the chances of blood clots forming in your body due to various causes.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Take Coumadin exactly as your doctor prescribes it. Follow the directions on your prescription label carefully.

Your doctor will adjust your dose from time to time depending on your response to Coumadin based upon your PT/INR.

Bleeding Risk

• Coumadin sodium can cause major or fatal bleeding. Bleeding is more likely to occur during the starting period and with a higher dose (resulting in a higher INR).
• Risk factors for bleeding include high intensity of anticoagulation (INR greater than 4), age 65 or older, highly variable INRs, history of gastrointestinal bleeding, hypertension, cereberovascular disease, serious heart disease, anemia, malignancy, trauma, renal insufficiency, concomitant drugs, and long duration of warfarin therapy.
• Regular monitoring of INR should be performed on all treated patients. Those at high risk of bleeding may benefit from more frequent INR monitoring, careful dose adjustment to desired INR, and a shorter duration of therapy.
• Patients should be instructed about prevention measures to minimize the risk of bleeding and to report immediately to physicians the signs and symptoms of bleeding.

Coumadin can cause serious side effects. Call your healthcare provider right away if you get any of the following signs or symptoms of bleeding problems:

• pain, swelling, or discomfort
• headaches, dizziness, or weakness
• unusual bruising (bruises that develop without known cause or grow in size)
• nosebleeds
• bleeding gums
• bleeding from cuts takes a long time to stop
• menstrual bleeding or vaginal bleeding that is heavier than normal
• pink or brown urine
• red or black stools
• coughing up blood
• vomiting blood or material that looks like coffee grounds

Serious side effects of Coumadin also include:

• death of skin tissue (skin necrosis or gangrene). This can happen soon after starting Coumadin. It happens because blood clots form and block blood flow to an area of your body. Call your healthcare provider right away if you have pain, color, or temperature change to any area of your body. You may need medical care right away to prevent death or loss (amputation) of your affected body part.
• “purple toes syndrome.” Call your healthcare provider right away if you have pain in your toes and they look purple in color or dark in color.

Other side effects with Coumadin include:

• allergic reactions
• liver problems
• low blood pressure
• swelling
• low red blood cells
• paleness
• fever

Do not take Coumadin if:

• your chance of having bleeding problems is higher than the possible benefit of treatment. Your healthcare provider will decide if Coumadin is right for you. Talk to your healthcare provider about all of your health conditions.
• you are pregnant or plan to become pregnant. Coumadin can cause death or birth defects to an unborn baby. Use effective birth control if you can get pregnant.
• you are allergic to Coumadin or to anything else in Coumadin.

What to Avoid:

• Do not start, stop, or change any medicine without talking with your healthcare provider.
• Do not make changes in your diet, such as eating large amounts of green, leafy vegetables.
• Do not change your weight by dieting, without first checking with your healthcare provider.
• Avoid drinking alcohol.
• Do not do any activity or sport that may cause a serious injury.

Coumadin can cause serious side effects. See "Drug Precautions" section.

Common, less serious side effects include:

• nausea
• vomiting
• diarrhea
• changes in taste
• stomach pain
• gas
• bloating
• hair loss
• rash
• chills

This is not a complete list of Coumadin side effects. Ask your doctor or pharmacist for more information.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088

Many medicines, including prescription and non-prescription medicines, vitamins and herbal supplements can interact with Coumadin and affect the dose you need, or increase Coumadin side effects.

Some of the medications known to interact with Coumadin are:

• aspirin
• ibuprofen (Motrin, Advil)
• naproxen (Aleve)
• acetaminophen (Tylenol)
• some antibiotics
• heparin
• cold medicines
• allergy medicines
• birth control pills
• amiodarone

There are many more medicines that interact with Coumadin. Before taking a new medicine, check with your doctor or pharmacist to be certain it won't interact with Coumadin.

• Do not take other medicines that contain warfarin. Warfarin is the active ingredient in Coumadin.

Tell your doctor if you are pregnant or planning to become pregnant. Coumadin should not be taken during pregnancy. Coumadin can cause death or birth defects to an unborn baby.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Coumadin falls into 2 categories: D for women with mechanical heart valves, and X for all other pregnant women. It has been shown that use of Coumadin in pregnant women caused some babies to be born with problems. However, because women with mechanical heart valves are at a high risk of thromboembolism (blood clot in blood vessel), the benefits of taking Coumadin may outweigh the risks.

Talk to your doctor about the risks of taking Coumadin during pregnancy.

Studies have shown that Coumadin is not excreted in human milk. Caution should be exercised if you are breastfeeding and also taking Coumadin.

While on warfarin, do not start, stop, or change any medicine without talking with your healthcare provider.

In addition, do not make changes in your diet, such as eating large amounts of green, leafy vegetables.

While on warfarin, do not change your weight by dieting, without first checking with your healthcare provider.

Call your healthcare provider right away if you notice signs or symptoms of bleeding problems.