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ISMP © 2013 Warfarin Report these signs to your doctor immediately! Too little , too much ! Too little warfarin can lead to a blood clot , too much can lead to bleeding Some foods high in vitamin K Signs of bleeding Unusually heavy/long menstrual flow Unusual pain, swelling, discomfort Coughing up blood Avoid (may also be a sign of a clot) Vomit that is bloody or looks like coffee Cranberries/cranberry juice Unusual or easy bruising grounds Pink or brown urine Severe dizziness, weakness, headache, Keep your intake of foods high in Prolonged bleeding of gums or cuts fainting, unusual or persistent tiredness vitamin K consistent Persistent, frequent nosebleeds that don’t Bloody or black stools Beef or pork liver stop within 7 minutes Pain in joints or back Green tea Parsley, basil, thyme Signs of a clot Chickpeas In the lung: chest pain, fast heart rate, coughing, shortness of breath, fever Green leafy vegetables, such as In the arm or leg: sudden leg, arm, or back pain, swelling, redness, warmth, tenderness spinach, kale, turnip greens, In the brain: headache, vision changes, seizure, slurred speech, weakness on one side of Swiss chard, cabbage body, dizziness Broccoli and Brussels sprouts In the heart: chest pain, shortness of breath, sweating, nausea and vomiting Many cooking oils In the abdomen: abdominal pain, vomiting, diarrhea For more: www.ismp.org/sc?k=foods

Topics Fast Facts Generic name warfarin (pronounced WAR far in) (generic available) Common brand names Coumadin and Jantoven Common uses Prevent and treat blood clots in certain conditions that increase the risk of clots: surgery, heart attack, heart rhythm problem, heart valve replacement, immobility after an accident Prevent transient ischemic attacks (mini strokes, brief episodes of low oxygen to the brain) Usual dose Up to 10 mg daily for adult patients; your dose may be based on a lab test that shows how sensitive you are to the medicine Doses are periodically adjusted based on INR blood test results What to do if you miss a dose If it is still the same day, take the dose as soon as you remember it If it is the next day, skip the missed dose and take your normal dose Do not double the dose to catch up Contact your doctor if you miss two or more doses in a row Special instructions and precautions Take exactly as prescribed, the same time each day Avoid alcohol, keep eating habits and exercise regular You will have a tendency to bleed easily, so use a soft toothbrush, waxed dental floss, electric razor; avoid sharp objects and fall risks, such as climbing a ladder Do not start or stop any medicine, including nonprescription medicines, herbals, and vitamins, without letting your doctor or pharmacist know Safety during pregnancy/breastfeeding Do not take when pregnant, may cause fetal bleeding or abnormalities May take while breastfeeding, but let the infant’s doctor know for proper monitoring Tell your doctor if you have: Diseases: bleeding disorders, kidney disease, liver disease, thyroid disease, severe high blood pressure, diabetes Conditions: surgery, history of falls or if you are at risk for falls, open wound Storage and disposal Store at room temperature, protect from light and moisture (do not store in bathroom) Dispose of tablets securely in the trash; do not flush down the toilet Side effects to report to your doctor Signs of bleeding or clot (see top of page), skin irritation, painful red-purple patches immediately on skin (toe, breast, abdomen), unusual fever, unhealed wounds, yellowing eyes or skin Other conditions to report to your doctor Accidents or falls (even if you feel fine), new or stopped medicines (including antibiotics, nonprescription drugs, herbals, vitamins), changes in smoking/eating habits, infection Nonprescription medicines/herbals/vitamins that Aspirin (unless prescribed by your doctor), nonsteroidal anti-inflammatory drugs should not be taken with warfarin (ibuprofen [Advil, Motrin], naproxen [Aleve]), most herbals (particularly cranberry, fenu- greek, garlic, ginkgo biloba, glucosamine, American ginseng, ginger, goldenseal, coen- zyme Q10, St. John’s wort, alfalfa, anise, bilberry), cimetidine (Tagamet), vitamins A or E Prescription medicines that should not be taken Check with your doctor, as many prescription medicines interact with warfarin with warfarin Tell your doctor and pharmacist about all the medicines you take Special tests your doctor may prescribe You must have blood tests (called INR) checked regularly Your doctor will determine the right INR level (usually between 2 and 3.5) for you This information does not replace the need to follow your doctor’s instructions and read the drug information leaflet provided with your prescription . This project was supported by grant number R18HS017910 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not represent the official views of the Agency for Healthcare Research and Quality.