COUMADIN (WARFARIN)

 What is warfarin?

• Warfarin is the generic name for Coumadin.  It may also be called Jantoven.  These are three names for the same medication.
   
• It is a blood thinner that helps prevent your body from forming a clot.  Some people may be using warfarin to help treat a current blood clot.
   
• Blood thinners, such as warfarin, are called anticoagulants.

Why am I taking warfarin?

• People who take this medication may have (or had) a:
  
  
  • Clot in the leg (deep vein thrombosis),
  • Clot in the lung (pulmonary embolism),
  • Clot in the brain (ischemic stroke),
  • Heart attack (myocardial infarction),
  • Heart valve replacement,
  • Irregular heart beat (atrial fibrillation).
    
    
•  Warfarin helps reduce the chance that your body will form a clot.  Blood clots can cause serious medical problems.

 What does warfarin (Coumadin) do?

• Warfarin blocks the formation of Vitamin K dependent clotting factors by working in the liver.
   
• This is called “thinning” your blood because it decreases the chance of a blood clot forming in your body.
   
• Warfarin does not break up existing blood clots.  Instead, it allows your body time to absorb a current clot and prevent you from forming new clots. 

How do I know my medication is working?

• Your physician will monitor your blood with a test called an INR.  The INR or International Normalized Ratio is a worldwide standard measure for reporting clotting time.  It tells how long it takes your blood to clot.
  
  
•  Generally, your doctor will take a small amount of blood at an office visit. 

• At first, your INR will need to be monitored every few days.  Gradually, as the medication is adjusted best to your body and diet, INR testing can be extended to once a month. 

How do I know what my INR goal is?

• The doctor will determine the INR goal for you based on the reason you are taking warfarin
   
• The test results will help the doctor decide the dose of warfarin (Coumadin) that you should take.
   
• It is important to have your INR checked when scheduled
   
• It is important to try and go to the same office or lab each time
   
• If you are planning a trip, talk with your doctor about using another laboratory while travelling.

What do warfarin tablets look like?

• Warfarin comes as a tablet. It is made by several different drug manufacturers and is available in many different shapes.
   
• It is important to double check with your pharmacist the brand and color of your tablet each time you receive a new prescription from the physician.

• Each tablet has the strength imprinted on one side and is scored, which makes it easy to adjust your dose as recommended by your physician.

 How should I take my warfarin (Coumadin)?

• Take the dose as instructed no more than once a day, usually at 6pm (easier to remember if taken at dinner with your meal)
   
• The medication can be taken before or after food. Pick one or the other.
  
  
• If you forget to take your dose and remember within 8 hours, take the dose.  If it is past 8 hours, skip the missed dose. 

DO NOT TAKE A DOUBLE DOSE

• If you forget two or more days in a row call your doctor, the dose may need to be changed
  
  
•  When you take the dose, check off the day on your home calendar.
   
• Contact your pharmacy to refill your prescription at least 1 week before your prescription runs out to avoid missing a dose.
   
• Continue to take warfarin as long as your doctor prescribes it. 

Where should I keep my warfarin (Coumadin):

• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.
   
• Ask your pharmacist, doctor, or healthcare provider about the best way to dispose of any leftover medicine after you have finished your treatment.  You will also need to throw away old medicine after the expiration date has passed.
  
  
•  Keep all medicine away from children and never share your medicine with anyone.
   
• Bathroom cabinets are usually not suitable for storing medications because of the humidity.

 Can I Exercise?

• Check with your doctor before starting any exercise or sports program 

What should I know about the foods I eat?

Be sure to talk with your doctor if you are planning any major diet changes such as a weight reducing diet or if you plan to add any nutritional supplements (multivitamins) 

• Vitamin K is needed for normal blood clotting. It is found in many foods (spinach, turnip greens, other leafy vegetables, broccoli, brussels sprouts, kale, parsley, natto (Japanese dish) liver or green tea. It is important to eat a CONSISTENT amount daily while taking warfarin.

• Avoid having more than one serving of foods with high amounts of Vitamin K.
  
  
•  Vegetables low in Vitamin K are corn. squash, potatoes, onions, carrots, cucumbers, celery, peppers, pumpkin and tomatoes
   
• Avoid grapefruit and cranberry products
  
  
•  Avoid heavy drinking of beverages containing alcohol (heavy drinking = more than two ounces of liquor, 10oz of wine or 24 ounces of beer per day) Heavy drinking increases the INR.
   
• Tell your doctor if you are planning to:
  • Eat more or less vegetables
  • Change to or from a vegetarian style of eating
  • Follow a special meal plan to lose or gain weight

• Herbal supplements that may increase your risk of bleeding include (garlic, ginger, ginko biloba, ginseng, feverfew, tumeric, St. John’s Wort, chondrotin sulphate and green tea.
  
  
•  It is important to discuss the risks versus benefits of taking any new supplement with your pharmacist or physician while you are taking warfarin.  

What if I become pregnant while taking warfarin?

• Tell your doctor right away, if you become pregnant as warfarin can potentially harm an unborn baby.
   
• It is important to avoid pregnancy while taking warfarin.  It is recommended to use two methods of birth control while taking warfarin.

• If you are a woman who is taking warfarin and you are planning to become pregnant, talk with your doctor about the risk and alternative treatment options.           

Who else should I tell that I am taking warfarin?

• Tell all doctors and dentists before treatment that you are taking warfarin 

Travel

• Check with your doctor before travelling. You may need to have a blood test and the dose adjusted before you leave.
   
• Carry your medications with you at all times: Do not put medication in checked baggage or leave them in the car. 

Illness and Emergencies

• Keep your doctors phone number close by in the event of an emergency
   
• Illness can change the way warfarin works. Call your doctor if you have any symptoms of illness, such as vomiting, diarrhea, infection or fever

• Avoid situations where you may get hurt at home or work.  Minor injuries must be monitored for bleeding.
  
  
•  Falls that cause bruising and cuts are more serious when you are on anticoagulants

 ***If you do cut yourself and the cut is small, apply constant pressure over the cut until the bleeding stops.  This may take up to 20 minutes.  If the bleeding does not stop, continue to hold pressure and go to the emergency room.  If the cut it large, apply pressure and get help immediately either by calling 911 or by going to the nearest emergency room. ***

 Precautions when taking warfarin(Coumadin)

• Many medications and vitamins can have an effect on the action of warfarin.  These may include:
  
  •  Prescription medications
    
  •  Non-prescription medications such as acetaminophen, aspirin, ibuprofen, non steroidal anti inflammatory drugs (NSAIDS), cold and cough medicines or other medications for pain or discomfort
     
  • Vitamin preparation containing Vitamin K (phytonadione) or large amounts of vitamins C or E
     
• Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using this medicine several days before having surgery or medical tests.
   
• You may bleed more easily while you are using this medicine. Stay away from rough sports
   
• Brush and floss your teeth gently.
   
• Be careful when using sharp objects, including razors and fingernail clippers. 

Call your doctor if you notice any of these side effects:

• Bleeding from your gums or nose, or ears
• Coughing up blood (bright red or coffee ground)
• Cuts that won’t stop bleeding after applying pressure for 20 minutes
• Bruises that appear without reason or become swollen or larger after time
• Unusual hemorrhoidal bleeding
• Reddish or rusty colored urine
• Menstrual bleeding, longer and heavier than normal
• Red or black bowel movements
• Vomiting of blood or material that looks like coffee grounds
• Yellowing of your skin or the whites of your eyes
• Feeling tired or looking pale(symptoms of anemia)
• Sudden changes in speech or vision
• Numbness or tingling in one side of face or arm

Call your healthcare provider if you have questions, problems, lifestyle changes or symptoms related to the use of warfarin (Coumadin).

***Alert the healthcare provider or pharmacist if there is any change in warfarin tablet color, shape or markings.***

Carry an ID card or wear a medical alert bracelet to let any emergency caregivers know that you are using warfarin.

Always refer to your healthcare provider for specific instructions

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