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Drug Notebook

Generic Name: warfarin

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Warfarin Sodium, Coumadin, Jantoven
A coumarins and indandione - It is used to treat or prevent clots in the veins, arteries, lungs, or ... more
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FDA Alerts

Special Alerts:

[Posted 08/16/2007] FDA approved updated labeling to include pharmacogenomics information to the CLINICAL PHARMACOLOGY, PRECAUTIONS, and DOSAGE AND ADMINISTRATION sections of the prescribing information for the widely used blood-thinning drug, warfarin (Coumadin). This new information explains that people's genetic makeup may influence how they respond to the drug. Specifically, people with variations in two genes may need lower warfarin doses than people without these genetic variations. The two genes are called CYP2C9 and VKORC1. The CYP2C9 gene is involved in the breakdown (metabolism) of warfarin and the VKORC1 gene helps regulate the ability of warfarin to prevent blood from clotting.

The dosage and administration of warfarin must be individualized for each patient according to the particular patient's prothrombin time (PT) / International Normalized Ratio (INR) response to the drug. The specific dose recommendations are described in the warfarin product labeling, along with the new information regarding the impact of genetic information upon the initial dose and the response to warfarin. Ongoing warfarin therapy should be guided by continued INR monitoring. For more information visit the FDA website at: http://www.fda.gov/medwatch/safety/2007/safety07.htm#Warfarin and http://www.fda.gov/cder/drug/infopage/warfarin/default.htm.

[Posted 10/06/2006] FDA and Bristol-Myers Squibb notified pharmacists and physicians of revisions to the labeling for warfarin (Coumadin), to include a new patient Medication Guide as well as a reorganization and highlighting of the current safety information to better inform providers and patients.

The FDA regulation 21CFR 208 requires a Medication Guide to be provided with each prescription that is dispensed for products that FDA determines pose a serious and significant public health concern. Information about all currently approved Medication Guides is available at: http://www.fda.gov/cder/Offices/ODS/medication_guides.htm. For more information visit the FDA website at: http://www.fda.gov/medwatch/safety/2006/safety06.htm#Coumadin, http://www.fda.gov/medwatch/safety/2006/coumadin_medguide.pdf and http://www.fda.gov/medwatch/safety/2006/coumadin_PI_april2006.pdf.

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warfarin
(WAR far in)
What is this medicine?What is the price of this medication and similar alternatives?What side effects may I notice from receiving this medicine?How should I use this medicine?What if I miss a dose?What may interact with this medicine?Who should NOT use this medication?What should I watch for while using this medicine?What should I tell my health care provider before I take this medicine?Can I stop taking the medication if I feel better?I am on so many medications; do I have to take them all?Where can I get more information?

What is this medicine?
WARFARIN (WAR far in) is an anticoagulant. It is used to treat or prevent clots in the veins, arteries, lungs, or heart.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

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What is the price of this medication and similar alternatives?

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 09/2009. For the most current and up-to-date pricing information, please visit www.drugstore.com. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Coumadin 1MG Tablets B-M SQUIBB U.S. (PRIMARY CARE)30/$42.29 or 90/$101.01
Coumadin 10MG Tablets B-M SQUIBB U.S. (PRIMARY CARE)30/$58.73 or 90/$142.12
Coumadin 2MG Tablets B-M SQUIBB U.S. (PRIMARY CARE)30/$42.28 or 90/$105.71
Coumadin 2.5MG Tablets B-M SQUIBB U.S. (PRIMARY CARE)30/$44.63 or 90/$109.22
Coumadin 3MG Tablets B-M SQUIBB U.S. (PRIMARY CARE)30/$46.98 or 90/$111.58
Coumadin 4MG Tablets B-M SQUIBB U.S. (PRIMARY CARE)30/$45.8 or 90/$109.22
Coumadin 5MG Tablets B-M SQUIBB U.S. (PRIMARY CARE)30/$45.81 or 90/$115.1
Coumadin 6MG Tablets B-M SQUIBB U.S. (PRIMARY CARE)30/$58.73 or 90/$142.12
Coumadin 7.5MG Tablets B-M SQUIBB U.S. (PRIMARY CARE)30/$58.73 or 90/$146.82
Warfarin Sodium 1MG Tablets TARO30/$13.99 or 90/$30.99
Warfarin Sodium 10MG Tablets TARO30/$24.24 or 90/$63.74
Warfarin Sodium 2MG Tablets TARO30/$14.88 or 90/$32.97
Warfarin Sodium 2.5MG Tablets TARO30/$14.99 or 90/$33.97
Warfarin Sodium 3MG Tablets TARO30/$15.99 or 90/$40.97
Warfarin Sodium 4MG Tablets TARO30/$14.99 or 90/$33.98
Warfarin Sodium 5MG Tablets TARO30/$13.99 or 90/$34.99
Warfarin Sodium 7.5MG Tablets TARO30/$23.21 or 90/$61.05

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What side effects may I notice from receiving this medicine?
Side effects that you should report to your doctor or health care professional as soon as possible:
back or stomach pain
chest pain or fast or irregular heartbeat
difficulty breathing or talking, wheezing
dizziness
fever or chills
headaches
heavy menstrual bleeding or vaginal bleeding
nausea, vomiting
painful, blue, or purple toes
painful, prolonged erection
prolonged bleeding from cuts
signs and symptoms of bleeding such as bloody or black, tarry stools, red or dark-brown urine, spitting up blood or brown material that looks like coffee grounds, red spots on the skin, unusual bruising or bleeding from the eye, gums, or nose
skin rash, itching or skin damage
unusual swelling or sudden weight gain
unusually weak or tired
yellowing of skin or eyes

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):
diarrhea
unusual hair loss

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

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How should I use this medicine?
Take this medicine by mouth with a glass of water. Follow the directions on the prescription label. You can take this medicine with or without food. Take your medicine at regular intervals. Do not take it more often than directed. Do not stop taking except on the advice of your doctor or health care professional.

A special MedGuide will be given to you by the pharmacist with each prescription and refill. Be sure to read this information carefully each time.

Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.
NOTE: This medicine is only for you. Do not share this medicine with others.

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What if I miss a dose?
If you miss a dose, call your healthcare provider. Take the dose as soon as possible on the same day. If it is almost time for your next dose, take only that dose. Do not take double or extra doses to make up for a missed dose.

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What may interact with this medicine?
Do not take this medicine with any of the following medications:

  • agents that prevent or dissolve blood clots
  • aspirin or other salicylates
  • danshen
  • dextrothyroxine
  • mifepristone
  • St. John's Wort
  • red yeast rice

This medicine may also interact with the following medications:

  • acetaminophen
  • agents that lower cholesterol
  • alcohol
  • allopurinol
  • amiodarone
  • antibiotics or medicines for treating bacterial, fungal or viral infections
  • azathioprine
  • barbiturate medicines for inducing sleep or treating seizures
  • certain medicines for diabetes
  • certain medicines for heart rhythm problems
  • certain medicines for high blood pressure
  • chloral hydrate
  • cisapride
  • disulfiram
  • female hormones, including contraceptive or birth control pills
  • general anesthetics
  • herbal or dietary products like cranberry, garlic, ginkgo, ginseng, green tea, or kava kava
  • influenza virus vaccine
  • male hormones
  • medicines for mental depression or psychosis
  • medicines for some types of cancer
  • medicines for stomach problems
  • methylphenidate
  • NSAIDs, medicines for pain and inflammation, like ibuprofen or naproxen
  • propoxyphene
  • quinidine, quinine
  • raloxifene
  • seizure or epilepsy medicine like carbamazepine, phenytoin, and valproic acid
  • steroids like cortisone and prednisone
  • tamoxifen
  • thyroid medicine
  • tramadol
  • vitamin c, vitamin e, and vitamin K
  • zafirlukast
  • zileuton

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

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Who should NOT use this medication?

  • Pregnancy.
  • Bleeding, hemorrhagic blood dyscrasias (e.g., hemophilia, polycythemia vera, purpura, leukemia) or a history of hemorrhagic diathesis or tendencies.
  • Recent or contemplated eye, brain, or spinal cord surgery or prostatectomy.
  • Open ulcerative, traumatic, or surgical wounds.
  • Active ulceration of the GI, respiratory, or GU tracts.
  • Cerebrovascular hemorrhage.
  • Aneurysms (cerebral, dissecting aorta).
  • Pericarditis and pericardial effusions.
  • Bacterial endocarditis.
  • Eclampsia, preeclampsia, or threatened abortion.
  • Spinal puncture or other diagnostic or therapeutic procedures with potential for uncontrolled bleeding.
  • Major regional or lumbar block anesthesia.
  • Severe, uncontrolled, or malignant hypertension.
  • Unsupervised patients with senility, alcoholism, or psychosis.
  • Known hypersensitivity to warfarin or any ingredient in the formulation.

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What should I watch for while using this medicine?
Visit your doctor or health care professional for regular checks on your progress. You will need to have your blood checked regularly to make sure you are getting the right dose of this medicine. When you first start taking this medicine, these tests are done often. Once the correct dose is determined and you take your medicine properly, these tests can be done less often.

While you are taking this medicine, carry an identification card with your name, the name and dose of medicine(s) being used, and the name and phone number of your doctor or health care professional or person to contact in an emergency.

You should discuss your diet with your doctor or health care professional. Many foods contain high amounts of vitamin K, which can interfere with the effect of this medicine. Your doctor or health care professional may want you to limit your intake of foods that contain vitamin K. Foods that have moderate to high amounts of vitamin K include brussel sprouts, kale, green tea, asparagus, avocado, broccoli, cabbage, cauliflower, collard greens, liver, soybean oil, soybeans, certain beans, mustard greens, peas (black eyed peas, split peas, chick peas), turnip greens, parsley, green onions, spinach, and lettuce.

This medicine can cause birth defects or bleeding in an unborn child. Women of childbearing age should use effective birth control while taking this medicine. If a woman becomes pregnant while taking this medicine, she should discuss the potential risks and her options with her health care professional.

Avoid sports and activities that might cause injury while you are using this medicine. Severe falls or injuries can cause unseen bleeding. Be careful when using sharp tools or knives. Consider using an electric razor. Take special care brushing or flossing your teeth. Report any injuries, bruising, or red spots on the skin to your doctor or health care professional.

If you have an illness that causes vomiting, diarrhea, or fever for more than a few days, contact your doctor. Also check with your doctor if you are unable to eat for several days. These problems can change the effect of this medicine.

Even after you stop taking this medicine, it takes several days before your body recovers its normal ability to clot blood. Ask your doctor or health care professional how long you need to be careful. If you are going to have surgery or dental work, tell your doctor or health care professional that you have been taking this medicine.

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What should I tell my health care provider before I take this medicine?
They need to know if you have any of these conditions:

  • alcoholism
  • anemia
  • blood disease, bleeding disorders, hemorrhage, hemophilia or aneurysm
  • bowel disease, diverticulitis, or ulcers
  • cancer
  • diabetes
  • heart disease
  • heart valve infection
  • high blood pressure
  • history of bleeding in the gastrointestinal tract
  • history of stroke or other brain injury or disease
  • kidney or liver disease
  • older than 65 years
  • protein or vitamin deficiency
  • psychosis or dementia
  • recent surgery or injury
  • an unusual or allergic reaction to warfarin, other medicines, foods, dyes, or preservatives
  • pregnant or trying to get pregnant
  • breast-feeding

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Can I stop taking the medication if I feel better?
As a general rule, you should always take your medications exactly as prescribed and do not change the dosage or stop taking the medication without first discussing it with your healthcare provider.

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I am on so many medications; do I have to take them all?
This is called polypharmacy—many different medications being used at the same time by one person. Sometimes, being on multiple medications is acceptable and appropriate but at other times it may be problematic. If you are receiving your medications from multiple physicians you need to ensure that they all know what medications you are taking. The best way to do this is to make a list of all the medications you are currently using, including all nutritional supplements, homeopathic remedies, vitamins and over-the-counter drugs (if possible, also include all the diseases you have been diagnosed with). Give a copy to every doctor who takes care of you so they have it on file, this way they can avoid duplicating medications and perhaps even try to consolidate some. After every doctor's visit remember to update the list accordingly. Also, as much as you possibly can, try to use the same pharmacy to fill all your prescriptions, this way any potential drug interactions can be caught and averted.

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Where can I get more information?
More Information

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