COUMADIN

Coumadin is a brand name of a generic blood-thinning medicine called Warfarin. It is a prescription drug that got FDA approval in 1954 for the treatment or prevention of blood clots formed in the veins of arteries.

Coumadin tablets contain warfarin sodium as its active ingredient. The primary function of warfarin sodium is to inhibit the clotting factors in the blood, specifically factors II, VII, IX, and X. This helps prevent the formation of blood clots. Warfarin sodium is commonly prescribed to patients who are at risk of developing or have a history of blood clots, deep vein thrombosis (DVT), pulmonary embolism, atrial fibrillation, or mechanical heart valve replacement.

The following inactive ingredients are present in this medicine like starch, lactose, and magnesium stearate. Warfarin sodium is an odorless, white crystalline powder chemically designated as 3-(α-acetonylbenzyl)-4-hydroxycoumarin sodium salt. It is an isopropanol clathrate, a racemic mixture of the S and R enantiomers.

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Coumadin belongs to the pharmacological class: Anticoagulants/ Blood thinners.

Anticoagulants are the class of drugs that can treat or prevent blood coagulation- the formation of blood clots. These work by interfering with the process involved in blood clot formation and targeting clotting factors such as fibrin, thrombin, and Vitamin K.

Coumadin specifically is a Coumarin- a polyphenolic compound that inhibits the activity of an enzyme, Vitamin K epoxide reductase responsible for recycling oxidized Vitamin K. Vitamin K activates the blood clotting factors II, VII, IX, and X. Coumadin acts to reduce the Vitamin K availability, thereby preventing blood coagulation.

Coumadin comes in the form of single-scored tablets with the following 9 strengths:

• 1 mg pink colored tablets containing D&C Red No. 6 Barium Lake
• 2 mg lavender colored tablets containing FD&C Blue No. 2 Aluminum Lake and FD&C Red No. 40 Aluminum Lake
• 2.5 mg green colored tablets containing D&C Yellow No. 10 Aluminum Lake and FD&C Blue No. 1 Aluminum Lake
• 3 mg tan colored tablets containing FD&C Yellow No. 6 Aluminum Lake, FD&C Blue No. 2 Aluminum Lake, and FD&C Red No. 40 Aluminum Lake
• 4 mg blue colored tablets containing FD&C Blue No. 1 Aluminum Lake
• 5 mg peach colored tablets containing FD&C Yellow No. 6 Aluminum Lake
• 6 mg teal colored tablets containing FD&C Yellow No. 6 Aluminum Lake and FD&C Blue No. 1 Aluminum Lake
• 7.5 mg yellow colored tablets containing D&C Yellow No. 10 Aluminum Lake and FD&C Yellow No. 6 Aluminum Lake
• 10 mg white colored, dye-free tablets.

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Coumadin is given by doctors for prophylaxis or treatment of the following medical conditions caused by blood coagulation:

• Myocardial infarctions: It is a heart attack due to the clogging of arteries that supplies blood to the myocardium (heart muscles). With deprived blood circulation, the myocardial tissues experience changes, mainly their necrosis.
• Ischemic Strokes: This happens when blood flow to the brain gets interrupted because of the traveling of clots formed in the arteries or veins of the heart.
• Deep venous thrombosis: This condition occurs because of the formation or presence of blood clots within the deep veins of the body, usually that of the legs.
• Pulmonary embolism: It is the sudden blockage of the pulmonary artery or its branches because of the formation of blood clots. It results in little to no blood flow to a portion of the lungs.
• Thromboembolic complications associated with cardiac valve replacement and/or atrial fibrillation: Atrial fibrillation is an irregular heartbeat that can promote the formation of blood clots in arteries. Heart patients who have artificial heart valves are at greater risk of blood coagulation.

• The suggested initial or maintenance dose is personalized for every patient according to their International Normalised Ratio (INR) response to the drug. INR is a WHO-standardised lab test that is globally recognized. It measures how quickly blood clots form.
• The dose is given by the doctor as per the patient’s INR and the patient’s medical condition to be treated.
• The factors that influence the dose of Coumadin include the patient’s age, body weight, race, sex, response to the medication, genetics, and comorbidities.
• The minimum suggested dose is 1mg while the maximum is 10 mg tablet once daily.

Coumadin is prescribed as a tablet for oral use or as an injection for intravenous use. The route of administration of Coumadin differs for every patient based on the patient’s INR response to the drug. Patients are instructed to take the tablets by mouth with water. The oral route of administration is convenient and allows for self-administration at home. It is the most common route for long-term use of Coumadin.

The common side effects of Coumadin may include:

• Skin bruising and bleeding
• Nausea, Vomiting
• Stomach Pain, Gas, Bloating
• Altered Taste

Some adverse side effects are:

• An Allergic Reaction
• Severe Risk of Bleeding
• Serious Eye Symptoms
• Serious Heart Symptoms
• Skin Discolorations or Changes Anywhere on the Body.
• Pain and Swelling
• Sudden or Intense Foot or Leg Pain.

Coumadin may interact with other medications, supplements, or substances such as:

• Other anticoagulants/blood thinners
• Antifungals
• Antibiotics
• Sulfa-drugs
• Antidepressants or seizure medications
• Medications to treat tuberculosis
• Secobarbital
• Barbiturates
• Vitamin K supplements
• Botanical products include St. John's wort, ginkgo biloba, echinacea, garlic, coenzyme Q10, cranberry, ginseng, or goldenseal

Coumadin is unsafe for people who have any general or localized physical condition or unique circumstance wherein the hemorrhage-related health hazard is more than the potential clinical benefits of taking an anticoagulant.

These include:

• Pregnant women
• Women who have threatened abortion, preeclampsia, or eclampsia
• Patients who have bleeding tendencies associated with active ulceration or apparent bleeding of the aneurysms-cerebral, dissecting aorta; bacterial endocarditis; pericarditis; cerebrovascular hemorrhage; gastrointestinal, genitourinary or respiratory tracts; and pericardial effusions.
• Individuals who have blood dyscrasias or hemorrhagic tendencies.
• Patients who have undergone recent or complicated surgery of the eye or central nervous system or traumatic surgery leading to large open surfaces.
• Patients who are unsupervised with senility, alcoholism, or psychosis, or who lack cooperation.
• Patients who have received major regional, lumber block/epidural anesthesia.
• People who suffer from malignant hypertension.
• Individuals who have known hypersensitivity to warfarin sodium or any other ingredients of the medicine.
• People aged above 65 years or those who cannot take Coumadin at the same time every day.

• Avoid drinking alcohol and juices of grapefruit, cranberry, noni, and pomegranate while taking Coumadin as these may interact with warfarin sodium.
• Talk to a doctor about the medications you are taking and any illness you have before starting to take Coumadin.
• Avoid getting indulged in any activities that increase the risk of injury or bleeding.
• Avoid changing your diet plan without taking the doctor’s advice. Limit the intake of food items that are loaded with Vitamin K such as leafy green vegetables and liver/vegetable oils.
• Never overdose and always take the medicine the same day daily with or without food.

Store Coumadin at a controlled temperature, between 15 to 30℃ in a tightly closed container. Keep Coumadin protected from direct light and moisture as well as out of reach of small children.

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