TAKING COUMADIN

WHY IS THIS DRUG PRESCRIBED?

Coumadin is an anticoagulant. Anticoagulants help to prevent blood clots from forming in your blood vessels, lungs and around the heart. Coumadin does not dissolve blood clots or thin your blood.

HOW SHOULD THIS DRUG BE TAKEN?

Coumadin comes in tablets that can be taken by mouth. The dose of Coumadin can vary depending on your blood tests. Take your Coumadin at the same time each day, preferably in the evening, with a full glass of water. Never stop taking your Coumadin unless directed by your doctor.

WHAT IS THE PT and INR?

Your doctor uses a blood test, called a Protime (PT) or International Normalized Ratio (INR) to adjust your Coumadin dose. The blood test measures the time it takes your blood to clot. The target INR range depends on the medical condition being treated. Coumadin works by causing the PT and INR to increase, which prevents clots from forming easily. If your PT or INR result is too high, you may have problems with bleeding. The blood tests are the only way to measure the balance between bleeding and clotting. This is why it is very important to keep your lab and doctor appointments. At first, your blood will be drawn frequently to check your PT and INR results. After you are on Coumadin for a while, the blood test will be done less often.

WHAT ARE THE SIDE EFFECTS?

Call your doctor if you notice any of these side effects:

Unusual bleeding

Vomiting blood or brown material that looks like coffee grounds

Nose bleeds

Black or red bowel movements

Bruises that appear without injury

Bleeding from cuts that does not stop with pressure

Red or dark urine

Frequent bleeding from gums

Excessive vaginal bleeding or menstrual flow

Nausea, vomiting or diarrhea lasting more than 2 days

Tiredness, fever, chills, sore throat, itching rash or mouth sores

Other side effects not listed also may occur. Check with your doctor if you notice any other unusual side effects.

WHAT FOOD-DRUG INTERACTIONS ARE THERE?

Eat your normal balanced diet while you are on Coumadin. Your diet can affect the way Coumadin works. Changing the amount of green, leafy vegetables in your diet can change the PT and INR blood test. Keeping the amount of greens in your diet steady helps avoid ups and downs in the blood test results.

Coumadin should not be taken within 2 hours of liquid food supplements that contain vitamin K like Ensure or Sustacal.

WHAT DRUG-DRUG INTERACTIONS ARE THERE?

Drugs that can increase the INR	Drugs that can decrease the INR
Acetaminophen (Tylenol) in high doses	Carbamazepine
Advil	Cholestyramine
Allopurinol	Griseofluvin
Amiodarone	Phenobarbitol
Aspirin	Phenytoin
Bactrim	Primidone
Biaxin	Rifampin
Cimetidine (Tagamet)	Sucralfate
Ciprofloxacin	Vitamin K
Erythromycin
Feldene
Fluconazole
Isoniazid
Lopid
Motrin
Omeprazole
Propranolol
Thyroid hormones

This is only a partial listing of drug-drug interactions. Please contact your doctor if you change any of your medications.

WHAT OTHER PRECAUTIONS SHOULD I FOLLOW WHILE USING THIS DRUG?

Coumadin can cause very serious birth defects. Women taking coumadin should use reliable birth control measures. Notify your doctor IMMEDIATELY if you suspect that you have become pregnant or if you intend to become pregnant.

Tell all your doctors, dentists or pharmacists that you are on Coumadin.

You may want to purchase a MedicAlert bracelet if you will be on coumadin for a long time.

Avoid activities that may cause injury. Report any falls or blows to the head to your doctor immediately.

Do not allow anyone else to take this medicine.

Prepared by Ruthann Kennedy, R.N., Division of Pulmonary and Critical Care Medicine