Warfarin

The dose of warfarin is individualized by your doctor according to blood clotting time. Blood clotting time is determined by a laboratory test, called an INR, which should be performed at regular intervals. It is very important to keep your lab appointments, as there is a narrow range between too much and too little of the medication. Too much medication may cause you to bleed more. Too little medication may lead to harmful clots forming.

Different circumstances in your life (e.g., eating certain foods or using certain medications) can cause the medication to work more or less effectively. Ask your doctor or pharmacist for a list of these foods and medications.

It is important to manage your lifestyle and habits appropriately when taking warfarin:

• do not make drastic changes in your diet, such as eating large amounts of green, leafy vegetables
• do not attempt to change your weight by dieting without first checking with your doctor or pharmacist
• do not participate in any activity or sport that may result in serious injury
• avoid drinking alcohol
• avoid drinking cranberry juice or consuming other products that contain cranberries
• avoid cutting yourself

It is very important that you take warfarin exactly as prescribed by your doctor. Take your dose of warfarin at the same time each day. If you miss a dose of warfarin, notify your health care provider right away. Take the missed dose as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store Warfarin at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Aside from the risk of bleeding, this product has few adverse effects. If you think this medication may be causing adverse effects, talk to your health care professional. He or she can help you to determine whether or not the medication is the source of the problem.

1 mg
Each pink, single-scored tablet, with "WARFARIN1" on one side and "TARO" on the other, contains 1 mg of warfarin sodium. Nonmedicinal ingredients: D&C Red No. 6 Lake, lactose, magnesium stearate, and pregelatinized cornstarch.

2 mg
Each lavender, single-scored tablet, with "WARFARIN2" on one side and "TARO" on the other, contains 2 mg of warfarin sodium. Nonmedicinal ingredients: FD&C Blue No. 2 Lake, FD&C Red No. 40 Lake, lactose, magnesium stearate, and pregelatinized cornstarch.

2.5 mg
Each green, single-scored tablet, with "WARFARIN2½" on one side and "TARO" on the other, contains 2.5 mg of warfarin sodium. Nonmedicinal ingredients: D&C Yellow No. 10 Lake, FD&C Blue No. 2 Lake, lactose, magnesium stearate, and pregelatinized cornstarch.

3 mg
Each tan, single-scored tablet, with "WARFARIN3" on one side and "TARO" on the other, contains 3 mg of warfarin sodium. Nonmedicinal ingredients: D&C Yellow No. 10 Lake, FD&C Blue No. 2 Lake, FD&C Red No. 40 Lake, lactose, magnesium stearate, and pregelatinized cornstarch.

4 mg
Each blue, single-scored tablet, with "WARFARIN4" on one side and "TARO" on the other, contains 4 mg of warfarin sodium. Nonmedicinal ingredients: FD&C Blue No. 1 Lake, lactose, magnesium stearate, and pregelatinized cornstarch.

5 mg
Each peach, single-scored tablet, with "WARFARIN5" on one side and "TARO" on the other, contains 5 mg of warfarin sodium. Nonmedicinal ingredients: D&C Red No. 6 Lake, D&C Yellow No. 10 Lake, lactose, magnesium stearate, and pregelatinized cornstarch.

6 mg
Each teal, single-scored tablet, with "WARFARIN6" on one side and "TARO" on the other, contains 6 mg of warfarin sodium. Nonmedicinal ingredients: FD&C Blue No. 2 Lake, FD&C Yellow No. 10 Lake, lactose, magnesium stearate, and pregelatinized cornstarch.

7.5 mg
Each yellow, single-scored tablet, with "WARFARIN7½" on one side and "TARO" on the other, contains 7.5 mg of warfarin sodium. Nonmedicinal ingredients: D&C Yellow No. 10 Lake, lactose, magnesium stearate, and pregelatinized cornstarch.

10 mg
Each white, single-scored tablet, with "WARFARIN10" on one side and "TARO" on the other, contains 10 mg of warfarin sodium. Nonmedicinal ingredients: lactose, magnesium stearate, and pregelatinized cornstarch. The 10 mg does not contain dye.

Do not take warfarin if you:

• are allergic to warfarin or any ingredients of the medication
• are pregnant
• are undergoing certain types of surgery
• do not have access to an adequate lab facility to get regular blood tests done
• have a high risk of abortion, eclampsia, and preeclampsia (complications of pregnancy often associated with sudden onset of very high blood pressure)
• have bleeding tendencies associated with active ulcers or overt bleeding of the stomach, genitourinary, or respiratory tracts; heart infection; brain Aneurysm; or bleeding associated with many other medical conditions
• have certain blood disorders
• have malignant hypertension
• have recently had or are planning to have surgery of the central nervous system or the eye or surgery associated with trauma resulting in large open surfaces
• have senility, Alcoholism, or psychosis, or other conditions where you may not be able to cooperate with taking the medication and having the necessary lab tests on a regular basis

Anticoagulation (blood thinning) should not take place in any situation where the risk of bleeding might be greater than the potential benefits of anticoagulation.

There may be an interaction between warfarin and any of the following:

• Acetaminophen
• acetylsalicylic acid (ASA)
• Adalimumab
• alcohol
• Allopurinol
• alteplase
• aminosalicylic acid
• Amiodarone
• Anagrelide
• androgens (e.g., Danazol, oxandrolone, testosterone)
• anticancer medications (e.g., Carboplatin, Cyclophosphamide, Fluorouracil)
• Apixaban
• Aprepitant
• atovaquone
• Azathioprine
• "azole" antifungals (e.g., fluconazole, ketoconazole, Voriconazole)
• barbiturates (e.g., pentobarbital, Phenobarbital)
• Bezafibrate
• Bicalutamide
• birth control pills
• Bosentan
• Carbamazepine
• cephalosporins (e.g., cefaclor, cefazolin, cefotetan, cefoxitin, Cephalexin)
• Celecoxib
• chloral hydrate
• Cholestyramine
• Cimetidine
• Clopidogrel
• Cobicistat
• coenzyme Q10
• Colestipol
• corticosteroids (e.g., Dexamethasone, Hydrocortisone, Prednisone)
• cranberry
• dabigatran
• Dasatinib
• Deferasirox
• dexmethylphenidate
• Dipyridamole
• disulfiram
• dong quai
• Dronedarone
• Entacapone
• Enzalutamide
• Erlotinib
• estrogens (e.g., conjugated estrogen, Estradiol, ethinyl estradiol)
• ethacrynic acid
• Exenatide
• Ezetimibe
• Fenofibrate
• garlic
• Gemfibrozil
• ginger
• ginkgo biloba
• ginseng
• Glucagon
• glucosamine
• green tea
• Heparin
• Hepatitis C antivirals (e.g., daclatasvir, dasabuvir, ledipasvir, letermovir, ombitasvir, simeprevir, sofosbuvir)
• HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., delavirdine, efavirenz, etravirine, nevirapine)
• HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
• imatinib
• Ivacaftor
• Leflunomide
• Linezolid
• Lomitapide
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• Mefloquine
• Methimazole
• methyl salicylate
• Methylphenidate
• Metronidazole
• mifepristone
• milk thistle
• Mirtazapine
• multivitamins with vitamin A, E
• nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., Diclofenac, ibuprofen, Naproxen)
• Obinutuzumab
• omega-3 fatty acids
• Orlistat
• penicillins (e.g., ampicillin, penicillin G, piperacillin, ticarcillin)
• Pentoxifylline
• Phenytoin
• phytonadione (Vitamin K)
• Prasugrel
• primidone
• progestins (e.g., Dienogest, Levonorgestrel, medroxyprogesterone, Norethindrone)
• proguanil
• Propafenone
• Propylthiouracil
• proton pump inhibitors (PPIs; e.g., Esomeprazole, Lansoprazole, Omeprazole)
• Quetiapine
• quinidine
• quinine
• quinolone antibiotics (e.g., ciprofloxacin, Norfloxacin, Ofloxacin)
• Ranitidine
• rifabutin
• rifampin
• ribavirin
• Rivaroxaban
• Romidepsin
• Ropinirole
• St. John's wort
• saw palmetto
• selective serotonin reuptake inhibitors (SSRIs; e.g., Citalopram, Fluoxetine, Paroxetine, Sertraline)
• serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g., Desvenlafaxine, Duloxetine, Venlafaxine)
• Sorafenib
• "statins" (e.g., Fluvastatin, Lovastatin, Simvastatin)
• streptokinase
• Sucralfate
• Sulfasalazine
• sulfonamide antibiotics (e.g., sulfadiazine, sulfamethoxazole)
• sulfonylurea Diabetes medications (e.g., chlorpropamide, Gliclazide, Glyburide, Tolbutamide)
• Tamoxifen
• tetracyclines (e.g., doxycycline, Minocycline, Tetracycline)
• Thyroid hormones (e.g., Levothyroxine, Liothyronine, thyroid)
• Ticagrelor
• Ticlopidine
• Tolterodine
• Tramadol
• Trazodone
• tricyclic antidepressants (e.g., Amitriptyline, Clomipramine, Desipramine, Trimipramine)
• urokinase
• vitamin A
• vitamin C
• vitamin E
• Zafirlukast

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Warfarin. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription) and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or illegal drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medication conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Warfarin.

Bleeding: The most serious risk associated with warfarin is bleeding in any tissue or organ. The risk of bleeding is related to how much is taken and for how long.

It is extremely important to have regular blood tests (as recommended by your doctor) to ensure that the correct level of blood thinning is occurring. These blood tests measure your INR level to determine the dose of warfarin. Your health care provider will adjust the dose of warfarin depending on the INR level to ensure you are not receiving too little medication (which may result in blood clots forming) or too much medication (which may result in bleeding).

Congestive heart failure: People with congestive heart failure may be more sensitive to the effects of warfarin. If you have any heart problems, discuss with your doctor how Warfarin may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Warfarin, and whether any special monitoring is needed.

Dental or surgical treatment: It may be necessary to stop taking warfarin briefly before scheduled dental or surgical procedures. Make sure that everyone involved in your health care is aware that you are taking Warfarin.

Liver function: Liver disease or reduced liver function may cause Warfarin to build up in the body, causing side effects, including severe bleeding. If you have liver problems, discuss with your doctor how Warfarin may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Warfarin, and whether any special monitoring is needed.

Medical conditions and other medications: If you have other medical conditions and are taking medications, discuss with your doctor how Warfarin may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Warfarin, and whether any special monitoring is needed.

Some conditions and medications affect the way warfarin works and may affect the dosing of warfarin. Your doctor will recommend you get regular lab tests done.

Non-steroidal anti-inflammatory medications (NSAIDs): It is recommended that anyone taking NSAIDs such as acetylsalicylic acid (Asa) or Ibuprofen should be closely monitored to ensure that no change in anticoagulation dosage is required. NSAIDs can cause stomach ulcers or bleeding. If you notice any signs of bleeding, such as frequent nosebleeds, unexplained bruising, or black and tarry stools, notify your doctor as soon as possible.

Purple toes syndrome: Purple toes syndrome is a complication of warfarin treatment and consists of a dark, purplish or mottled colour of the toes, usually occurring 3 to 10 weeks (or later) after starting treatment with warfarin. Major features of this syndrome include:

• increasing and decreasing of the colour over time
• pain and tenderness of the toes
• purple colour of bottom surfaces and sides of the toes that turns white under moderate pressure and fades with elevation of the legs

Inform your doctor at once if you notice these symptoms.

Pregnancy: Warfarin should not be used during pregnancy. It may pass to the developing fetus and cause birth defects or death as a result of bleeding. If you become pregnant while taking Warfarin, contact your doctor immediately.

Breast-feeding: It is not known if warfarin passes into breast milk. If you are a breast-feeding mother and are taking Warfarin, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of Warfarin have not been established for children less than 18 years of age. However, the use of warfarin by children is necessary in certain situations.

Because this medication thins the blood, prolonged bleeding may occur if you injure yourself. Be careful when using sharp instruments or when you practice any activity or sport that may result in serious injury. The use of a soft-bristled toothbrush and an electric razor is recommended. Report any excessive or unusual bleeding to your doctor. Signs indicating that the dosage may be too high include: the presence of black or reddish stools red or dark brown urine bruising that occurs easily gums bleeding while brushing your teeth in women, abnormally abundant and prolonged menstrual bleeding Contact a doctor immediately if you notice sudden unusual headaches, weakness of an arm or leg, crooked mouth or difficulty speaking.<br/><br/>The dosage of this medicine is adjusted according to the result of your blood test (INR). Regular blood tests are therefore essential. Advise the personnel taking the sample if you have forgotten to take one or more doses. While undergoing this treatment, do not consume alcohol, make any significant dietary changes, or take any medication containing acetylsalicylic acid (ASA, e.g., Aspirin) unless prescribed by your doctor. This medication is typically used only once a day. However, your pharmacist may have suggested a different schedule that is more appropriate for you. It must be used regularly and continuously to maintain its beneficial effects. Be sure to keep an adequate supply on hand. If you forget a dose, contact your pharmacist. This medication may be taken with or without food.