What is the most important information I should know about Coumadin?

• This medication can cause birth defects in an unborn baby. Do not use if you are pregnant. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment.
• Never take a double dose of this medication.
• If you need to have a lumbar puncture (spinal tap) or any type of surgery, you may need to temporarily stop using Coumadin. Be sure the surgeon knows ahead of time that you are using this medicaton.
• Carry an ID card or wear a medical alert bracelet stating that you are taking Coumadin, in case of emergency. Any doctor, dentist, or emergency medical care provider who treats you should know that you are taking Coumadin.
• Coumadin interacts with many other drugs, and these interactions can be dangerous, even fatal. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.
• Do not take aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) unless your doctor has told you to. NSAIDs include celecoxib (Celebrex), diclofenac (Voltaren), ibuprofen (Motrin, Advil), indomethacin, naproxen (Aleve, Naprosyn), piroxicam (Feldene), and others.These medicines can affect blood clotting and may cause serious bleeding in your stomach or intestines.
• Avoid sudden changes in your diet. Vitamin K decreases the effects of Coumadin. Large amounts of vitamin K are found in foods such as liver, broccoli, brussels sprouts, spinach, Swiss chard, coriander, collards, cabbage, and other green leafy vegetables. Do not change the amount of these foods in your diet without first talking to your doctor.
• Avoid eating cranberries, drinking cranberry juice, or taking cranberry herbal products.
• Avoid drinking alcohol, which can increase some of the side effects of this medication.
• Avoid smoking cigarettes or chewing tobacco. Tobacco can alter the effects of Coumadin and cause problems with your therapy.

What is Coumadin?

• Coumadin is an anticoagulant (blood thinner). Coumadin reduces the formation of blood clots.
• Coumadin is used to prevent heart attacks, strokes, and blood clots in veins and arteries.
• Coumadin may also be used for purposes other than those listed in this medication guide.

What should I discuss with my healthcare provider before taking Coumadin?

• You should not take Coumadin if you have:
  • a bleeding disorder such as hemophilia;
  • a blood cell disorder such as anemia;
  • a stomach ulcer or bleeding in the stomach;
  • a history of aneurysm or blood clot in your brain; or
  • an infection of your heart, fluid or swelling around your heart.
• FDA pregnancy category X. This medication can cause birth defects. Do not use Coumadin if you are pregnant. Tell your doctor right away if you become pregnant during treatment. Use an effective form of birth control while you are using this medication.
• Before taking Coumadin, tell your doctor if you have:
  • kidney disease;
  • liver disease;
  • celiac sprue (an intestinal disorder);
  • a recent injury, surgery, or medical emergency;
  • high blood pressure;
  • severe or uncontrolled diabetes;
  • polycythemia vera;
  • congestive heart failure;
  • cancer; or
  • a seizure disorder for which you take an anticonvulsant such as phenytoin (Dilantin) or phenobarbital (Luminal).
• If you have any of these conditions, you may not be able to use Coumadin, or you may need a dosage adjustment or special tests during treatment.
• It is not known whether Coumadin passes into breast milk, or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.
• Older adults and people who are severely ill or debilitated may have a greater risk of bleeding while taking Coumadin. Talk with your doctor about your individual risk.
• Coumadin should not be given to anyone younger than 18 years old.
• Tell your doctor (or dentist) that you are taking Coumadin before you take an antibiotic or before having surgery.

How should I take Coumadin?

• Take this medication exactly as it was prescribed for you. Do not take the medication in larger or smaller amounts, or take it for longer than recommended by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from this medication.
• Never take a double dose of this medication.
• Your body's response to Coumadin can be affected by changes in your diet, changes in your environment, other medicines or herbal (botanical) products you use, and your physical well-being.
• Take each dose with a full glass of water.
• It is important to take Coumadin at the same time every day. Coumadin can be taken with or without food.
• It is important to take Coumadin regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.
• Do not stop taking Coumadin without first talking to your doctor.
• To be sure this medication is helping your condition, your blood will need to be tested on a regular basis. It is important that you not miss any scheduled visits to your doctor.
• If you need to have a lumbar puncture (spinal tap) or any type of surgery, you may need to temporarily stop using Coumadin. Be sure the surgeon knows ahead of time that you are using this medicaton.
• Carry an ID card or wear a medical alert bracelet stating that you are taking Coumadin, in case of emergency. Any doctor, dentist, or emergency medical care provider who treats you should know that you are taking Coumadin.
• Store this medication at room temperature away from moisture and heat.

What happens if I miss a dose?

• Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

• Seek emergency medical attention if you think you have used too much of this medicine.
• Symptoms of a Coumadin overdose may include bruising; small, broken blood vessels under the skin; excessive bleeding from cuts or wounds; bleeding from the gums; blood in the stools, urine, or vomit; and heavy menstrual periods in women.

What should I avoid while taking Coumadin?

• Do not take aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) unless your doctor has told you to. NSAIDs include celecoxib (Celebrex), diclofenac (Voltaren), ibuprofen (Motrin, Advil), indomethacin, naproxen (Aleve, Naprosyn), piroxicam (Feldene), and others.These medicines can affect blood clotting and may cause serious bleeding in your stomach or intestines.
• Avoid sudden changes in your diet. Vitamin K decreases the effects of Coumadin. Large amounts of vitamin K are found in foods such as liver, broccoli, brussels sprouts, spinach, Swiss chard, coriander, collards, cabbage, and other green leafy vegetables. Do not change the amount of these foods in your diet without first talking to your doctor.
• Avoid eating cranberries, drinking cranberry juice, or taking cranberry herbal products.
• Avoid drinking alcohol, which can increase some of the side effects of this medication.
• Avoid smoking cigarettes or chewing tobacco. Tobacco can alter the effects of Coumadin and cause problems with your therapy.
• Avoid hazardous activities and sports that may cause injury or broken skin. You may be more likely to bruise or bleed while taking Coumadin, especially at the start of therapy. Call your doctor if you bruise easily or have any excessive bleeding.

What are the possible side effects of Coumadin?

• Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
• Call your doctor at once if you have any of these serious side effects:
  • skin changes or discoloration anywhere on your body;
  • purple toes or fingers;
  • pain in your stomach, back, or sides;
  • severe dizziness, headache, or weakness;
  • diarrhea;
  • easy bruising or bleeding that will not stop
  • blood in your urine;
  • black, bloody, or tarry stools;
  • coughing up blood;
  • nosebleeds or bleeding gums;
  • urinating less than usual;
  • sudden headache, confusion, problems with vision, speech, or balance;
  • sudden leg or foot pain; or
  • sudden numbness or weakness, especially on one side of the body.
• Other less serious side effects are more likely to occur, such as:
  • excessive gas or bloating;
  • diarrhea, nausea, or vomiting;
  • hair loss; or
  • loss of appetite, weight loss.
• Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect Coumadin?

• Coumadin interacts with many other drugs, and these interactions can be dangerous, even fatal. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.
• Coumadin can interact with the following herbal (botanical) products:
  • bromelains;
  • coenzyme Q10;
  • cranberry;
  • danshen;
  • dong quai;
  • garlic;
  • ginkgo biloba;
  • ginseng; or
  • St. John's wort.
• Do not use any of these products without first asking your doctor. Some of these herbal products can cause you to bleed while you are also taking Coumadin.