Coumadin (Warfarin Sodium) – Complete Product Guide for EZ Chemist Online Pharmacy

Coumadin, generically known as Warfarin, is an oral anticoagulant prescribed to prevent and treat blood clots in conditions such as deep vein thrombosis (DVT), pulmonary embolism (PE), and to reduce the risk of stroke in patients with atrial fibrillation. It works by inhibiting vitamin K-dependent clotting factors, thereby thinning the blood and preventing clot formation.

Coumadin (Warfarin Sodium)

Available in tablet strengths: 1 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg, 10 mg

Warfarin Sodium

Other Common & Brand Names:
Generic Name: Warfarin

Brand Names: Coumadin, Jantoven

INN/USAN: Warfarinum

Coumadin is a vitamin K antagonist (VKA) that inhibits the synthesis of vitamin K-dependent clotting factors II, VII, IX, and X in the liver. It also inhibits anticoagulant proteins C and S. This reduces the blood’s ability to form clots, thus preventing thromboembolic events.

FDA-Approved Indications:
Prophylaxis and treatment of venous thromboembolism (VTE) including DVT and PE

Prevention of thromboembolic complications in patients with atrial fibrillation or prosthetic heart valves

Secondary prevention of myocardial infarction and stroke in high-risk cardiovascular patients

Off-Label Uses (Supported by Clinical Practice):
Antiphospholipid syndrome

Thrombophilia management

Cancer-associated thrombosis (when DOACs not suitable)

Condition Starting Dose (Typical Adult) Maintenance Dose (Individualized)
Atrial Fibrillation, VTE, Mechanical Valves 2–5 mg once daily Adjust to maintain INR 2.0–3.0 or 2.5–3.5 (mechanical valves)
Elderly or Hepatic Impairment 1–2 mg once daily Adjust based on INR and response

Dosage Must Be Individualized Based on INR Monitoring

Target INR ranges:

DVT/PE/Afib: 2.0–3.0

Mechanical heart valves: 2.5–3.5

Pediatric Use: Adjusted carefully by weight and indication
Elderly Patients: Start at lower doses due to increased sensitivity

Prescription Required: Yes

Route of Administration: Oral

Time to Peak Effect: 36–72 hours (onset); full effect may take several days

Half-life: 20–60 hours (highly variable between individuals)

Side Effects of Coumadin (Warfarin):
Common Side Effects:
Easy bruising

Bleeding gums or nosebleeds

Prolonged bleeding from cuts

Fatigue

Major bleeding (gastrointestinal, intracranial)

Warfarin-induced skin necrosis

Purple toe syndrome

Hematuria or melena

Teratogenicity (fetal warfarin syndrome)

Pregnancy Warning: Category X – Contraindicated in pregnancy (except in mechanical valve cases under strict monitoring)

Lactation: Generally considered safe

Requires Frequent INR Monitoring to prevent under- or over-anticoagulation

Bleeding Risk Increases With:

Elderly age

Liver disease

Concurrent NSAIDs or antiplatelets

Vitamin K-rich foods (spinach, kale, broccoli) can interfere with efficacy

Major Drug Classes That Interact With Warfarin:
Interacting Drug/Class Effect
Antibiotics (e.g., metronidazole, erythromycin) ↑ INR and bleeding risk
NSAIDs, Aspirin ↑ Bleeding risk
Antifungals (e.g., fluconazole) ↑ INR
Anticonvulsants (e.g., phenytoin) ↑ or ↓ INR (variable)
Herbal supplements (e.g., ginseng, garlic, St. John's Wort) Alter INR unpredictably
Vitamin K supplements ↓ INR, reducing efficacy

A 2016 meta-analysis published in The Lancet confirmed warfarin’s efficacy in preventing stroke in atrial fibrillation. The RE-LY and ENGAGE AF-TIMI 48 trials have shown warfarin to be comparable or superior to DOACs in certain populations (e.g., mechanical valves or severe renal impairment).

Pharmacologic Class: Vitamin K Antagonist

Therapeutic Class: Anticoagulant

ATC Code: B01AA03

Store at room temperature (15°C – 30°C)

Keep in original container, tightly closed

Protect from moisture and heat

Keep away from children

Frequently Asked Questions (FAQ)
Q: What foods should I avoid while taking Coumadin?
A: Avoid large and inconsistent intake of vitamin K-rich foods (e.g., spinach, kale, Brussels sprouts), as they can reduce the effectiveness of Coumadin.

Q: How often do I need to get my INR checked?
A: Initially 2–3 times per week; once stable, monitoring every 2–4 weeks is typical. INR testing is essential to maintain safety and efficacy.

Q: Can I take over-the-counter medications with Coumadin?
A: Always consult your doctor before using OTC medications, especially NSAIDs, aspirin, or cold medicines, as many interact with Coumadin.

Q: What happens if I miss a dose?
A: Take it as soon as you remember the same day. If it’s the next day, do not double the dose. Resume your regular schedule and inform your doctor.

Q: Can Coumadin be reversed in case of emergency bleeding?
A: Yes, Vitamin K, Fresh Frozen Plasma (FFP), or Prothrombin Complex Concentrates (PCCs) may be used to reverse its anticoagulant effect in emergencies.

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