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Coumadin (warfarin) 

Indications  

Coumadin is a vitamin K antagonist used for: 

• Preventing and treating blood clots in veins (venous thrombosis), including pulmonary embolism (blood clot in the lungs) 
• Preventing and treating blood clots related to atrial fibrillation (an irregular heartbeat) or heart valve replacement surgery 
• Reducing the risk of death, heart attacks, and stroke after a heart attack 

Dosage and Administration 

• Take Coumadin exactly as prescribed by your healthcare provider. Your doctor will monitor your blood regularly to adjust your dose as needed. 
• Take Coumadin at the same time each day, with or without food. 
• Inform your doctor if you are planning any surgeries or dental procedures. 
• Do not double the dose to catch up. 
• Do not start or stop any other medication, including over-the-counter drugs or herbal supplements, without consulting your doctor. 
• Avoid alcohol intake while taking Coumadin, as it can increase the risk of bleeding. 
• Avoid activities that may increase the risk of injury or bleeding, such as contact sports or using sharp objects. 

Mechanism of Action 

Coumadin works by blocking the action of vitamin K, which is needed to make certain clotting factors in the blood. By reducing the activity of these clotting factors, Coumadin helps prevent blood clots from forming. 

Contraindications  

Do not use Coumadin if you have: 

• Pregnancy, except in women with mechanical heart valves 
• Bleeding disorders or recent surgeries with a high risk of bleeding 
• Hypersensitivity to Warfarin or any component of the medication 
• Malignant hypertension 

Side Effects  

Common Side Effects: 

• Bruising 
• Bleeding gums 
• Nosebleeds 
• Dizziness 
• Diarrhea 

Serious Side Effects: 

• Severe bleeding 
• Purple toes syndrome (rare) 
• Skin necrosis (tissue death) 

Precautions 

• Tissue Necrosis: Severe skin or tissue damage may occur, requiring medical attention. Discontinue Coumadin if necessary.
• Blood Clots: In some cases, blood clots or cholesterol microemboli may form, leading to serious complications. Stop taking Coumadin if such issues arise.
• Heparin-induced Thrombocytopenia (HIT): You may consider taking Coumadin after your platelet count has normalized if you have HIT.
• Pregnancy: Coumadin may cause fetal harm, but in some cases, the benefits may outweigh the risks for you if you have mechanical heart valves.

Storage Instructions 

• Protect Coumadin from light and moisture. 
• Store at controlled room temperature (59°-86°F, 15°-30°C). 
• Keep Coumadin in a tightly closed, light-resistant container. 

References 

https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/009218s107lbl.pdf