ANTICOAGULANTS (Oral)

Brand & Generic Names

ANISINDIONE	Miradon
Anthrombin-K	Panwarfin
Carfin	Sofarin
Coumadin	WARFARIN SODIUM
DICUMAROL	Warfilone

Basic Information

• Habit forming? No
• Prescription needed? Yes
• Available as generic? Yes
• Drug class: Anticoagulant

Uses

Reduces blood clots. Used for abnormal clotting inside blood vessels.

Dosage & Usage Information

How to take:
Tablet--Swallow with liquid. If you can't swallow whole, crumble tablet and take with liquid or food.

When to take:
At the same time each day.

If you forget a dose:
Take as soon as you remember up to 12 hours late. If more than 12 hours, wait for next scheduled dose (don't double this dose). Inform your doctor of any missed doses.

What drug does:
Blocks action of vitamin K necessary for blood clotting.

Time lapse before drug works:
36 to 48 hours.

Don't take with:
Any other medicine without consulting your doctor or pharmacist.

Overdose

SYMPTOMS:
Bloody vomit, coughing blood, bloody or black stools, red urine.

WHAT TO DO:

• Dial 911 (emergency) or O (operator) for an ambulance or medical help. Then give first aid immediately.
• See EMERGENCY Information.

Possible Adverse Reactions or Side Effects

Life-threatening:

In case of overdose, see Overdose section.

Common:

Bloating, gas.

Infrequent:

• Black stools or bloody vomit, coughing up blood.
• Rash, hives, itch, blurred vision, sore throat, easy bruising, bleeding, cloudy or red urine, back pain, jaundice, fever, chills, fatigue, weakness, painful urination, decreased amount of urine, heavy menstruation, bleeding gums.
• Diarrhea, cramps, nausea, vomiting, swollen feet or legs, hair loss.

Rare:

• Bleeding into and under skin.
• Dizziness, headache, mouth sores.

Warnings & Precautions

Don't take if:

• You have been allergic to any oral anticoagulant.
• You have a bleeding disorder.
• You have an active peptic ulcer.
• You have ulcerative colitis.

Before you start, consult your doctor:

• If you take any other drugs, including nonprescription drugs.
• If you have high blood pressure.
• If you have heavy or prolonged menstrual periods.
• If you have diabetes.
• If you have a bladder catheter.
• If you have serious liver or kidney disease.
• If you will have surgery within 2 months, including dental surgery, requiring general or spinal anesthesia.

Over age 60:
Adverse reactions and side effects may be more frequent and severe than in younger persons.

Pregnancy:
Risk to unborn child outweighs drug benefits. Don't use.

Breast-feeding:
Drug filters into milk. May harm child. Avoid.

Infants & children:
Use only under doctor's supervision.

Prolonged use:
Talk to your doctor about the need for follow-up medical examinations or laboratory studies to check prothorombin time, stool and urine for blood.

Skin & sunlight:
No problems expected.

Driving, piloting or hazardous work:

• Avoid hazardous activities that could cause injury.
• Don't drive if you feel dizzy or have blurred vision.

Discontinuing:
Don't discontinue without consulting doctor. Dose may require gradual reduction if you have taken drug for a long time. Doses of other drugs may also require adjustment.

Others:

• Carry identification to state that you take anticoagulants.
• Advise any doctor or dentist whom you consult that you take this medicine.

Possible Interaction with Other Drugs

GENERIC NAME	COMBINED EFFECT
------------------------	-----------------------
Acetaminophen	Increased effect of anticoagulant.
Allopurinol	Increased effect of anticoagulant.
Aminoglutethmide	Decreased effect of anticoagulant.
Amiodarone	Increased effect of anticoagulant.
Androgens*	Increased effect of anticoagulant.
Antacids*	Decreased effect of
(large doses)	anticoagulant.
Antibiotics*	Increased effect of anticoagulant.
Antidiabetics*,	Increased effect of
oral	anticoagulant.
Antihistamines*	Unpredictable increased or
	decreased effect of anticoagulant.
Aspirin	Possible spontaneous bleeding.
Barbiturates*	Decreased effect of anticoagulant.
Benzodiazepines*	Unpredictable increased or
	decreased effect of anticoagulant.
Bismuth	Increased risk of bleeding.
Calcium supplements*	Decreased effect of anticoagulant.
Carbamazepine	Decreased effect of anticoagulant.
Cefixime	Increased effect of anticoagulant.
Chloramphenicol	Increased effect of anticoagulant.
Cholestyramine	Decreased effect of anticoagulant.
Clofibrate	Increased effect of anticoagulant.
Colestipol	Decreased effect of anticoagulant.
Contraceptives*	Decreased effect of anticoagulant.
Danazol	Increased effect of anticoagulant.
Dextrothyroxine	Increased effect of anticoagulant.
Diclofenac	Increased risk of bleeding.
Diflunisal	Increased effect of anticoagulant.
Dipyridamole	Increased risk of hemorrhage.
Disulfiram	Increased effect of anticoagulant.
Erythromycins*	Increased effect of anticoagulant.
Estramustine	Decreased effect of anticoagulant.
Estrogens	Decreased effect of anticoagulant.
Fenoprofen	Increased effect of anticoagulant.
Fluconazole	Increased effect of anticoagulant.
Fluoxetine	May cause confusion, agitation,
	convulsions and high blood
	pressure. Avoid combining.
Gemfibrozil	Increased effect of anticoagulant.
Glutethimide	Decreased effect of anticoagulant.
Griseofulvin	Decreased effect of anticoagulant.
Indomethacin	Increased effect of anticoagulant.
Itraconazole	Increased effect of anticoagulant.
Levamisole	Increased risk of bleeding.
Methimazole	Increased effect of anticoagulant.
Metronidazole	Increased effect of anticoagulant.
Mineral oil	Decreased absorption of
	anticoagulant.
Nalidixic acid	Increased effect of anticoagulant.
Nicardipine	Possible increased effect of
	anticoagulant.
Nimodipine	Possible increased effect of
	anticoagulant.
Nizatidine	Increased effect of anticoagulant.
Non-steroidal	Increased risk of bleeding.
Omeprazole	Increased effect of anticoagulant.
Paroxetine	Increased effect of anticoagulant.
Phenylbutazone	Increased effect of anticoagulant.
Phenytoin	Decreased levels of phenytoin.
Plicamycin	Increased effect of anticoagulant.
Propafenone	May require adjustment of
	anticoagulant dosage.
Primadone	Decreased effect of anticoagulant.
Rifampin	Decreased effect of anticoagulant.
Quinidine	Increased effect of anticoagulant.
Salicylates	Increased effect of anticoagulant.
Sulfadoxine and	Increased risk of toxicity.
Sulindac	Increased effect of anticoagulant.
Suprofen	Increased risk of bleeding.
Testolactone	Increased effect of anticoagulant.
Thyroid hormones*	Increased effect of anticoagulant.
Vitamin E	Increased risk of bleeding.
Vitamin K	Decreased effect of anticoagulant.
Note: Any medicine	Unpredictable absorption.

Possible Interaction with Other Substances

INTERACTS WITH	COMBINED EFFECT
---------------	---------------
Alcohol:	Can increase or decrease effect of
	anticoagulant. Use with caution.
Beverages:	None expected.
Cocaine:	None expected.
High in vitamin K	May decrease
such as fish, liver,	anticoagulant
spinach, cabbage,	effect.
Marijuana:	None expected.
Tobacco:	None expected.