Precautions for Coumadin

There are many important precautions patients should consider when taking Coumadin (warfarin). When Coumadin is prescribed, it is recommended to:

Carefully check your prescription for accuracy before ingesting

Take precisely as directed by your physician

Call your physician if you miss more than one dose

Avoid other blood thinners, such as aspirin

Avoid antacids, antihistamines and antibiotics unless directed by a doctor

Avoid dietary supplements, especially Ginkgo, St. John’s Wort, Garlic, Ginger, and Ginseng

Avoid alcohol

Follow your doctor’s orders regarding foods rich in Vitamin K, such as green vegetables, certain vegetable oils, legumes and herbs, some meats and green tea

Tell your doctor if you are pregnant or plan on becoming pregnant – Coumadin is associated with significant birth defects, including deformities of the face and bones⁵³

This list is meant as a guide, not as medical advice. If you have been prescribed Coumadin and you have any concerns about your prescription, please contact your prescribing physician for proper medical attention. For complete prescribing information for Coumadin presented by Bristol-Myers Squibb, please click here.

Maintaining the Appropriate INR

Patients who are on a Coumadin drug regimen must have frequent, regularly scheduled blood tests. The dosage and protocol for taking Coumadin is precise, and side effects and risks are involved with any deviation from the exact prescription.

In order for anticoagulation medications to be beneficial, an International Normalized Ratio (INR) range must be maintained.⁵⁴ Recent guidelines stipulate an INR between 2.0 and 3.0 with a target INR of 2.5.⁵⁵ Blood testing is used to monitor a patient’s INR.

When anticoagulation therapy begins, blood test monitoring is recommended on a daily basis until INR rates are consistent for two consecutive days. Once consistency is established, monitoring can be performed two or three times a week for the following two weeks. As INR ranges stabilize, monitoring can be modified to once every four to six weeks. If stability is not achieved, Coumadin dosages should be adjusted and monitoring continued at frequent intervals until an appropriate and stable INR range is achieved.⁵⁵

Those who take Coumadin should make sure their dentist and any other healthcare providers are aware that they take blood-thinning medication, and updated medical records should be sent to any appropriate health care personnel. Patients on Coumadin should talk to their prescribing physician before having a dental procedure or other health treatment in case dosage modification is necessary.

Lifestyle Modifications

Coumadin users must take care to avoid everyday situations that may cause the body to bleed. Patients may need to use a soft toothbrush, electric razor and waxed dental floss. Being careful with or avoiding sharp objects like scissors and knives is imperative. Other precautions include avoiding active sports in which you may fall, such as mountain or road biking, skiing, tennis, and skydiving. It is also important to avoid contact sports, such as soccer, football, and basketball. If you are a woman, and you plan on becoming pregnant, talk to your doctor first about potential risks. When traveling, always make sure to pack your medications in a carry-on bag and keep them with you at all times.

If you are unable to continue taking Coumadin or are resistant to it, you should discuss this with your doctor. Other options such as catheter ablation and surgical ablation are available for appropriate candidates.

Coumadin is a registered trademark of Bristol-Myers Squibb. For the most recent information about Coumadin, prescription information and precautions, please visit www.coumadin.com.

53. [PDF] COUMADIN TABLETS COUMADIN FOR INJECTION DESCRIPTION Rx only. U.S. Food and Drug Administration [Internet]
54. Ansell J. Review: Menendez-Jandula B, Souto JC, Oliver A, Montserrat I, Quintana M, Gich I, Bonfill X, Fontcuberta J. Comparing self-management of oral anticoagulant therapy with clinical management: a randomized trial. Ann Intern Med. 2005 Jan 4;142(1):1-10.
55. Horton JD, Bushwick BM. Clinical Pharmacology. Warfarin therapy: evolving strategies in anticoagulation. American Family Physician: Vol. 59/No. 3 (Feb 1, 1999).