Six steps to taking warfarin safely and effectively

Step 1: Learn about warfarin

Generic Name: Warfarin Sodium

Chinese trade name: Warfarin sodium, Warfarin; Coumadin; Benzylpropionate coumarin; Benzylpropionate coumarin sodium

Specifications: 2.5 mg; 3 mg; 5 mg;

What it does: It's an anticoagulant, which prevents blood clots from forming.

Dosage and Usage: The dosage varies from person to person. The doctor will adjust the dosage according to the coagulation function test results to achieve the best therapeutic effect. Please take the dosage as instructed by the doctor, usually once a day, preferably at the same time every day.

Step 2: Precautions before taking the medicine

Before taking warfarin, please inform your doctor of any allergies, past medical history, especially bleeding problems (ulcers or prolonged menstruation, heavy menstrual bleeding), diabetes, liver and kidney disease, high blood pressure, epilepsy, arthritis, thyroid dysfunction, and any recent infections or surgeries. Women of childbearing age should inform their doctor of their pregnancy, pregnancy plans, and whether they are breastfeeding before starting the medication. If you become pregnant while taking the medication, please inform your doctor immediately.

Step 3: Precautions when taking medication

During medication, follow the doctor's instructions to monitor the INR value regularly. Do not change different brands of medicines on your own. If you accidentally take an overdose, please seek medical attention immediately. Avoid cutting yourself and engaging in dangerous activities that are prone to bruises and sprains (such as collision sports such as football, rugby, boxing, etc.). If severe joint swelling or skin bruising occurs, please seek medical attention immediately. Before planning surgery, tooth extraction or invasive examination, please take the initiative to inform your doctor that you are taking warfarin. Please carry the warfarin warning card with you. In the event of an accident, medical staff can immediately know that you are taking warfarin. Please make sure you have enough medicine with you to avoid interrupting treatment and worsening the disease. Do not give warfarin to others to take, and store the medicine where it is not easily accessible to children. If you have any other questions, please contact your doctor or pharmacist immediately.

Step 4: Diet and other medication considerations

Because there are many factors that affect the efficacy of warfarin, which may affect the correct interpretation of the test values, eating habits and medication should remain fixed. If there are any changes, please inform the doctor when you return for a visit. Vitamin K will affect the efficacy of warfarin, so do not increase or decrease foods containing a lot of vitamin K (such as liver, green leafy vegetables, etc.) on your own, and maintain a fixed amount. Avoid drinking alcoholic beverages. If you need to use it, be sure to ask your doctor for the amount of drinking allowed. Cranberries will increase the anticoagulant effect and cause severe bleeding, so avoid using cranberry juice or other cranberry products. Concentrated garlic essence or ginger powder used with warfarin may cause bleeding. If you use such health products, you should actively inform your doctor and pay attention to whether bleeding occurs. Ginkgo, angelica, salvia miltiorrhiza, royal jelly, chamomile tea and high-dose fish oil (more than 2g per day) will increase the risk of bleeding. Do not use them without the permission of a doctor.

Warfarin can interact with many drugs, thereby increasing or decreasing the anticoagulant effect, so please do not stop taking the drugs you are currently taking or take any other drugs (especially aspirin, nonsteroidal anti-inflammatory drugs, vitamin K, high-unit vitamin E, etc.) on your own. The use of high-dose acetaminophen (2-4g/day) or glucosamine (greater than 500mg/day) with warfarin may increase the anticoagulant effect, so you should actively inform your doctor and monitor the coagulation function to avoid bleeding.

Step 5: What to do if you forget to take your medication

If you forget to take the medicine, please take it immediately. However, if you find that you forgot to take the medicine the next day, you only need to take the amount of medicine prescribed by the doctor on that day. Please do not take two doses at a time, which may cause bleeding. Remember to tell the doctor at the next outpatient visit. If you forget to take the medicine for two days or more, please tell the doctor immediately.

Step 6: Side effects and treatments

See your doctor right away if you have bleeding (for example, coughing up blood, vomiting blood or brown material that resembles coffee grounds, bloody or black stools, blood in the urine, red or dark brown urine, bleeding from the eyes, sudden bruising on the skin, bleeding gums, nosebleeds, heavy menstrual bleeding), headaches that you have never had before, abdominal or back pain, diarrhea that lasts for several days, fever that lasts for several days, sore throat or mouth, rash or itching, dizziness, fatigue, vasculitis, loss of appetite, stomach discomfort, stomach cramps, severe nausea, joint pain, stiffness or swelling, numbness or tingling in the hands or feet, facial numbness, sudden weakness, hair loss, or other symptoms or if they persist.

References:

[1] Institute for Safe Medication Practices: ISMP's list of confused drug names. Institute for Safe Medication Practices. Horsham, PA. 2009.

[2] Product Information: COUMADIN(R) oral tables, intravenous injection, warfarin sodium oral tables, intravenous injection. Bristol-Myers Squibb Company (per FDA), Princeton, NJ, 2017.

[3] Product Information: COUMADIN(R) oral tables, warfarin sodium oral tables. Bristol-Myers Squibb Company (per FDA), Princeton, NJ, 2017.