Monograph Details
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Hematology
> Thromboembolic disorders
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COUMADIN |
| Manufacturer |
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Bristol-Myers Squibb |
| Legal Classification |
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Rx
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| Pharmacological Class |
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Coumarin anticoagulant. |
| Generic Name |
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Warfarin sodium 1mg, 2mg, 2½mg, 3mg, 4mg, 5mg, 6mg, 7½mg, 10mg (dye-free); scored tabs. |
| Also |
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• COUMADIN for INJECTION
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| Indications |
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Thromboembolic disorders. Thromboembolic complications from atrial fibrillation, cardiac valve replacement. Reduce risk of death, recurrent MIs, and thromboembolic events post-MI. |
| Children |
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<18yrs: see literature. |
| Adults |
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Individualize. IV: give as slow bolus dose over 1–2 minutes into a peripheral vein. ≥18yrs: Initially 2–5mg orally or IV daily. Usual maintenance: 2–10mg daily. Variations in CYP2C9 or VKORC1 enzymes, elderly, debilitated: use lower initial dose. Monitor PT; adjust dose and interval according to INR and/or PT (INR preferred). Converting from heparin: see literature. |
| Contraindications |
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Hazardous hemorrhagic conditions or treatments. Malignant hypertension. Blood dyscrasias. Unsupervised senile, alcoholic, uncooperative, or psychotic patients. CNS, ophthalmic, or traumatic surgery. Major regional, lumbar block anesthesia, spinal puncture. Inadequate lab facilities. Pregnancy (Cat.X). |
| Precautions |
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Monitor PT/INR. Hepatic or renal insufficiency. Infection. Trauma. Diabetes. Hypertension. CHF. Edema. Hyperlipidemia. Thyroid disorders. Collagen vascular disease. Protein C deficiency. Heparin-induced thrombocytopenia. Polycythemia vera. Cancer. Vasculitis. Indwelling catheter. Fever. Discontinue if tissue necrosis or systemic cholesterol microembolization occurs. Gangrene. Diarrhea. Disturbances of intestinal flora. Steatorrhea. Dental procedures. Elderly. Asian. Debilitated. Anticoagulation may persist 2–5 days after discontinuation. Write Rx using fractions rather than decimals. Nursing mothers. |
| Interactions |
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See literature. Potentiated by plasma protein bound drugs, analgesics, antiarrhythmics, antibiotics, β-blockers, diuretics, proton pump inhibitors, psychostimulants, thyroid drugs, uricosurics, vaccines, fibric acid derivatives, vitamin K deficiency, others. Antagonized by antacids, anxiolytics, antihistamines, antipsychotics, barbiturates, statins, hepatic enzyme inducers, oral contraceptives, diets high in vitamin K, others. Potentiates hypoglycemics, anticonvulsants, others. Caution with drugs that may cause hemorrhage (eg, NSAIDs, aspirin), herbal supplements (eg, ginkgo biloba, ginseng, St. John's wort), alcohol. Cholestatic hepatitis with concomitant ticlopidine. |
| Adverse Reactions |
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Tissue or organ hemorrhage, skin or tissue necrosis, hypersensitivity reactions, systemic cholesterol microembolization, purple toes syndrome, vasculitis, hepatic disorders, fever, dermatitis, urticaria, abdominal pain, asthenia, GI upset, headache, pruritus, alopecia, paresthesias. |
| How Supplied |
Tabs 1mg, 2mg, 2½mg, 3mg, 4mg, 5mg, 6mg—100, 1000
7½mg, 10mg—100
Inj (5mg vial)—6 |
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