INDICATIONS

Coumadin is used for treating and preventing harmful clots that may occur in the veins (venous thrombosis), in the lungs (pulmonary embolism), with a type of abnormal heartbeat (atrial fibrillation), or following a heart valve replacement. Coumadin is also used to reduce the risk of stroke and other problems in patients who have had a heart attack. Coumadin is an anticoagulant. It works by blocking the synthesis of certain clotting factors. Without these clotting factors, blood clots are unable to form.

INSTRUCTIONS

Use Coumadin as directed by your doctor.

• Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.
• Never take a double dose of this medication or take it together with other products that contain warfarin or coumarin.
• Your doctor may occasionally change your dose to make sure you get the best results.
• Take Coumadin at the same time every day. Coumadin can be taken with or without food.
• Avoid dieting to lose weight while taking Coumadin. Tell your doctor if your body weight changes for any reason.
• While taking Coumadin, your blood will need to be tested often. Visit your doctor regularly. 
• You may need to stop taking the medicine for a short time if you need antibiotics, surgery, dental work, a spinal tap, or spinal anesthesia (epidural).
• Continue to take Coumadin even if you feel well. Do not miss any doses, unless directed to do so by your doctor.
• If you miss a dose of Coumadin, contact your doctor right away.

Ask your health care provider any questions you may have about how to use Coumadin.

STORAGE

Store Coumadin at room temperature away from heat, moisture, and light. Do not store in the bathroom. Keep Coumadin out of the reach of children and away from pets.

MORE INFO:

Active Ingredient: Warfarin sodium.

SAFETY INFORMATION

Do NOT use Coumadin if:

• you are allergic to any ingredient in Coumadin
• you have bleeding tendencies, bleeding problems (eg, hemophilia), severe or uncontrolled high blood pressure, certain blood problems (eg, low white blood cell or platelet levels), or leukemia
• you have active serious bleeding, bleeding in the brain, certain blood vessel problems (eg, aneurysm, dissecting aorta), or inflammation or infection of the heart
• you have active ulcer or bleeding of the stomach or bowel, urinary tract, genitals, or respiratory tract
• you have recently had or will be having eye, brain, or spinal cord surgery; spinal puncture; spinal anesthesia; or any type of major surgery
• you are pregnant or may become pregnant
• you are unable to have routine blood clotting tests
• you are unable to follow your doctor's instructions properly and do not have someone to help you take your medicine
• you are taking mifepristone, streptokinase, or urokinase.

Contact your doctor or health care provider right away if any of these apply to you.

Some medical conditions may interact with Coumadin. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

• if you are planning to become pregnant or are breast-feeding
• if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
• if you have allergies to medicines or other substances
• if you have recently been injured, fallen, given birth, or had surgery
• if you have a history of stomach or bowel problems (eg, bleeding, ulcer, inflammation), heart problems (eg, heart failure, infection), blood clots, anemia or other blood problems (eg, protein C deficiency, high red blood cell levels), blood vessel problems, or high blood pressure
• if you have a history of liver, kidney, or thyroid problems; yellowing of the skin or eyes; mental or mood problems; high cholesterol; arthritis; diabetes; or cancer
• if you have poor nutrition, celiac disease, nutrient or fat absorption problems, or low levels of vitamin K or vitamin C in the blood, or if you drink alcohol
• if you have a fever, very poor health, diarrhea, fluid buildup, excessive fat in the stools (steatorrhea), a recent or current infection, or tuberculosis, or if you will be exposed to high temperatures for a prolonged period of time
• if you have a heart valve replacement, an intrauterine device (IUD), or a catheter.

Some medicines may interact with Coumadin. Tell your health care provider if you are taking any other medicines, especially any of the following:

• Heparin or other anticoagulants, nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, ibuprofen), salicylates (eg, aspirin), streptokinase, or urokinase because the risk of bleeding may be increased
• Mifepristone because excessive bleeding may occur
• Many prescription and nonprescription medicines (eg, used for infections, inflammation, aches and pains, high blood pressure, high cholesterol, seizures, mental or mood problems, diabetes, stomach or bowel problems, irregular heartbeat, birth control, hormone replacement, cancer, and others), multivitamin products, and herbal or dietary supplements (eg, herbal teas, coenzyme Q10, garlic, ginseng, ginkgo, St. John's wort) may interact with Coumadin, increasing the risk of serious side effects such as bleeding or blood clots.

This may not be a complete list of all interactions that may occur. Ask your health care provider if Coumadin may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

Important safety information:

• Tell your doctor or dentist that you take Coumadin before you receive any medical or dental care, emergency care, or surgery.
• Do NOT take more than the recommended dose or use for longer than prescribed without checking with your doctor. Contact your doctor right away if you may have taken too much of Coumadin.
• Do not drink alcohol while you are taking Coumadin; it may increase the risk of Coumadin's side effects.
• Do not change you activity level or weight without checking with your doctor; the risk of Coumadin's side effects may be increased.
• Do not change your eating habits without checking with your doctor. Eat a normal, balanced diet. Foods that have high levels of vitamin K (eg, green leafy vegetables, broccoli, liver, certain vegetable oils) may change the effect of Coumadin. Ask your doctor for a list of foods that may affect Coumadin. Tell your doctor if any foods on the list are a part of your diet.
• Do not eat cranberry products or drink cranberry juice while you are taking Coumadin. Tell your doctor if these products are already part of your diet.
• Elevated body temperature may increase the effect of Coumadin. Be careful to avoid becoming overheated, especially during hot weather.
• Coumadin decreases blood clotting. Use caution while doing activities such as brushing your teeth, flossing, or shaving. Avoid activities that may cause bruising or injury. Seek immediate medical attention if you fall or injure yourself. Tell your doctor if you have unusual bruising or bleeding. Tell your doctor if you have dark, tarry, or bloody stools.
• Do not take aspirin while you take Coumadin unless your doctor tells you to. If you already take aspirin for a heart or other condition, talk with your doctor about whether or not you should continue to take it with Coumadin.
• 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). This may increase your risk of developing a blood clot.
• If therapy with Coumadin is stopped, the blood thinning effects may last for 2 to 5 days after you stop taking it. Discuss any questions or concerns with your doctor. Do not suddenly stop taking Coumadin without checking with your doctor.
• Lab tests, including certain blood clotting tests (eg, PT, INR), may be performed while you use Coumadin. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.
• Use Coumadin with caution in Asian patients; they may be more sensitive to its effects, especially bleeding.
• Use Coumadin with caution in the elderly; they may be more sensitive to its effects, especially bleeding.
• Coumadin should be used with extreme caution in children; safety and effectiveness in children have not been confirmed. Children may need more frequent lab tests if they use Coumadin.
• If you may become pregnant, you must use an effective form of birth control while you take Coumadin. If you have questions about effective birth control, talk with your doctor.
• Pregnancy and breast-feeding: Do not use Coumadin if you are pregnant. It has been shown to cause harm to the fetus. Avoid becoming pregnant while you are taking it. If you think you may be pregnant, contact your doctor right away. It is not known if Coumadin is found in breast milk. If you are or will be breast-feeding while you use Coumadin, check with your doctor. Discuss any possible risks to your baby.

SIDE EFFECTS

All medicines may cause side effects, but many people have no, or minor, side effects.

No common side effects have been reported with Coumadin.

Seek medical attention right away if any of these severe side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); back, side, muscle, joint, or stomach pain; black, tarry, or bloody stools; blood in the urine (pink or brown urine); bloody or coffee ground-like vomit; chest pain; decreased urination; dizziness; fainting; fever; numbness or tingling; pain, unusual color, or temperature change in any area of the body; pale skin; purple, dark, or painful toes; shortness of breath; skin sores or ulcers; stroke symptoms (eg, confusion, slurred speech, vision problems, one-sided weakness); sudden severe pain in your legs, feet, or toes; trouble swallowing; unexplained swelling; unusual bruising or bleeding (eg, nosebleed, unusual bleeding from gums, increased bleeding from cuts, increased menstrual or vaginal bleeding, coughing up blood, bleeding at the injection site); unusual headache or weakness; unusual pain, swelling, or discomfort; wounds or sores that do not heal properly; yellowing of the skin or eyes.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider.