Coumadin Online - Prescriptions Through Accessmednet Listings

Anticoagulants, or blood thinners, such as Coumadin act to prevent blood from clotting. They will not break up existing blood clots, nor do they literally 'thin' blood. They should not be used by individuals with bleeding problems like hemophillia or ulcers, and patients using Coumadin should be especially careful to avoid cuts and care for any injuries quickly.

Coumadin is used to treat acute pulmonary embolism, atrial fibrillation (prevents clotting of the blood inside the heart), deep vein thrombosis, prevent clotting after the replacement of a heart valve, used after a heart attack or stroke to prevent a recurrence.

This medication is currently underprescribed as a stroke preventative in patients with atrial fibrillation, and has been shown to be highliy effective for this purpose.

You will need to test your INR while using this medication. If you want to monitor your INR at home, CoaguChek and ProTime monitors are available by prescription.

There are a number of commonly used drugs which may cause bleeding, and their use in combination with Coumadin could lead to a serious hemorrhage. Discuss any prescription or over the counter medication that you use or intend during treatment with your prescribing physician. Always wear an alert bracelet or carry a card to let emergency personnel know that you use this medication.

Coumadin is only available by prescription.

Coumadin Side Effects

If you experience unusual bleeding while using Coumadin, speak to your doctor immediately. If the problem is severe, seek emergency treatment. Always inform medical personnel that you are using this medication. Carry a card or MedicAlert jewelry so that emergency personnel will know you're using Coumadin even if you're unconscious.

Less Common Side Effects: Cold intolerance, loss of appetite, stomach pain or cramping. If these side effects occur, they will usually be mild and go away over the course of treatment. If they persist or are bothersome, speak to your doctor.

Infrequent to Rare Side Effects: Change in amount of urine, chills, cough or hoarseness, dark urine, difficult urination, difficulty breathing, fever, gangrene or necrosis (dead tissue, noted by black patches anywhere on the body), lower back pain, painful red sores (esp. on breasts, buttocks, penis, or thighs), painful urination, skin problems (blisters, hives, itching, rash), sores or white spots in mouth, swelling of face or extremities, toes (blue or purple, painful), yellow eyes or skin (jaundice). Contact your doctor as soon as possible if any of these effects occur, seek medical treatment if they are severe.

Dose Related Bleeding: Bleeding gums after brushing teeth, blood in urine, 'breakthrough' menstrual bleeding at unexpected times, heavy bleeding from cuts, nosebleeds, pinpoint red spots on skin, unusual bruising, unusually heavy menstrual bleeding, wounds don't stop bleeding. Speak to your doctor as soon as possible about any unusual or heavy bleeding, your dose may be set too high. If the bleeding is severe, you should seek medical treatment.

Internal Bleeding: Abdominal pain or swelling, black or tarry stools, bleeding in eyes, blood in urine (severe), bloody or black vomit, bloody stools, blurry vision, chest pain, confusion, constipation, coughing up blood, decreased appetite, dizziness or fainting, headache (severe or unusually long-lasting), joint pain or swelling, nausea and vomiting (severe), nervousness, numbness or tingling in face or extremities, paralysis, shortness of breath, sudden and severe diarrhea, sudden weakness, unusual back pain. Any of these symptoms (particularly if you have no prior history of the condition, or if an existing symptom suddenly worsens) indicate that you should seek immediate treatment, perhaps emergency treatment. Your dose may be set too high, your doctor will advise you whether to continue treatment.

Cautions: This prescription medication may not be suitable for everyone. If you have any of the following conditions, or a history of them, fully discuss treatment options with your doctor.

• Allergies: If you have an allergic reaction to Coumadin, you will have to discontinue use and will not be able to use it in the future.
• Arterial Aneurysm: Do not use.
• Bleeding Disorder: Consult your physician and evaluate all available options.
• Blood Disorders or Diseases: This medication is probably unsuitable for you, speak with your doctor.
• Bruising, Excessive: Risk of additional bleeding and slow healing.
• Cancer of Internal Organs: Increased risk of bleeding.
• Congestive Heart Failure: Speak to your doctor.
• Diabetes: Increased risk of bleeding.
• Diverticulitis: Increased risk of bleeding.
• Esophageal Varices: Speak to your doctor, warfarin may not be suitable for you.
• Falls, Blows, or Head Injuries: Have your doctor verify that you are fully recovered before using this medication.
• Heavy Menstruation: This medication may not be suitable for you, speak to your doctor about precautions or warning signs over the course of your treatment.
• High Blood Pressure: Speak to your doctor.
• Indwelling Catheter: Increased risk of bleeding.
• Infective Pericarditis or Edocarditis: If you have a heart infection of any kind, do not use.
• Inflamed Blood Vessels: Do not use.
• Intestinal Problems: If you have a disorder which inhibits proper absorption of food or nutrients, speak to your doctor about the risks of treatment.
• Kidney or Liver Impairment: Speak with your doctor about your particular case. Warfarin may cause tiny kidney stones.
• Liver Disease: Do not use.
• Low Blood Platelets: Do not use.
• Malignant Hypertension: Do not use.
• Other Medications: Speak to your doctor concerning any and all prescription or over the counter treatments you use.
• Pregnant, Planning to Become Pregnant, or Recently Given Birth : This medication should not be used if you are pregnant or intend to become pregnant. It may be dangerous to use this treatment soon after the birth of a child.
• Recent Stroke: Do not use, speak to your doctor about how long you should wait.
• Spinal Anasthesia: If you've recently been given a lumbar block, you should not use this medication.
• Spinal Tap: If this procedure has been performed recently, you should not use this treatment.
• Surgery on Dental Work: Consult your doctor, and discuss it with your surgeon or dentist.
• Ulcer (Colon, Lung, or Stomach): Do not use if you have active ulcers of any type.
• Unhealed Wounds or Surgical Incisions: Increased risk of bleeding, may slow healing.
• Vitamin K Deficiency: Increased risk of bleeding.

Coumadin Online - Prescriptions Through Accessmednet Listings

While you are using Coumadin (warfarin), do not begin taking any type of medication without your doctor's consent. Over the counter and prescription treatments alike may cause problems. If you take, or plan to take, any of the following, discuss options and risks with your doctor. The following medications all increase the likelihood of increased bleeding problems when mixed with this treatment, unless otherwise specified.

• Accolate (zafirlukast)
• Acetaminophen (Tylenol, others)
• Activase (alteplase)
• Acova (argatroban)
• Alcohol - Limit to one drink daily. If your liver is damaged due to heavy drinking, your doctor may suggest a lower dose.
• Anabolic steroids like Anabolin (nandrolone), Anadrol (oxymetholone), Anavar (oxandrolone), or Winstrol (stanozolol).
• Androgens - Any male hormone substitutes.
• Antabuse (disulfiram)
• Antidiabetic drugs - various
• Anti-seizure medication like Cerebyx (fosphenytoin) or Dilantin (phenytoin) may have their effectiveness altered when used with warfarin, along with increasing the risk of bleeding.
• Antithyroid treatments may decrease the effectiveness of warfarin.
• Anturane (sulfinpyrazone)
• Aspirin (salicylic acid) or other salicylates
• Atromid-S (clofibrate)
• Azulfidine (sulfasalazine)
• Bactrim (cotrimoxazole)
• Barbiturates like Phenobarbitol, Fioricet (butalbital, acetaminophen, and caffeine), Fiorinal, Seconal, or others may decrease the effectiveness of warfarin.
• Biaxin (clarithromycin)
• Calcium channel blockers - Medications like Bepadin (bepridil), Calan (verapamil), Cardene (nicardipine), Cardizem (diltiazem), DynaCirc (isradipine), Nimotop (nimodipine), Plendil (felodipine), Procardia (nifedipine), or Sibelium (flunarizine) may increase risk of gastrointestinal hemorrhage on their own. This risk would be increased when used with warfarin. Not all of these drugs work exactly the same, and some pose lower risks than others.
• Carafate (sucralfate) - Decreases effectiveness of warfarin treatment.
• Cephalosporins like Ceclor (cefaclor), Moxam (moxalactam), Zefazone (cefmetazole), and others.
• Chloromycetin (chloramphenicol)
• Cinchophen
• Cloxacillin
• Cordarone (amiodarone)
• Corticosteroids - Decrease effectiveness of warfarin treatment.
• Cox II inhibitors like Celebrex (celecoxib) and Vioxx (rofecoxib) increase the risk of gastrointestinal bleeding.
• Danocrine (danazol)
• Dextrothyroxine
• Diflucan (fluconazole)
• Dilantin (phenytoin) - Decreases effectiveness of warfarin treatment.
• Doriden (glutethimide) - Decreases effectiveness of warfarin treatment.
• Erythromycin
• Estrogens, various - Decrease effectiveness of warfarin treatment.
• Evista (roloxifene)
• Felbatol (felbamate)
• Flagyl (metronidazole)
• Flomax (tamsulosin)
• Flu vaccine - various
• Fulvicin, Gris-PEG (griseofulvin) - Decreases effectiveness of warfarin treatment.
• Glucagon
• Heparins like Lovenox (enoxaparin).
• Herbal medications - Do not combine, many have anticoagulant properties. Supplement strength dosing and herbal teas are especially of concern. Verify the safety of any herbal product with your doctor before using, but avoid them if possible. Food enzyme preparations should also be avoided, as certain enzymes may change clotting.
• Herceptin (trastuzumab)
• HMG-CoA reductase inhibitors (statins) - Drugs like Lescol (fluvastatin), Lipitor (atorvastatin), Mevacor (lovastatin), Pravachol (pravastatin), or Zocor (simvastatin).
• Inderal (propranolol)
• INH (isoniazid)
• Imuran (azathioprine) - Decreases effectiveness of warfarin treatment.
• Integrelin (eptifibatide)
• Lamisil (terbinafine)
• Librium (chlordiazepoxide) - Decreases effectiveness of warfarin treatment.
• Lopid (gemfibrozil)
• Macrolide antibiotics such as Biaxin (clarithromycin), E-Mycin (erythromycin), Dynabac (dirithromycin), TAO (troleandomycin), or Zithromax (azithromycin).
• Mesnex (mesna)
• Methyltestosterone
• Micardis (telmisartan) - Slightly decreases effectiveness of warfarin treatment.
• Minocycline
• Monistat (miconazole)
• Mysoline (primidone) - Decreases effectiveness of warfarin treatment.
• Nicotine, Tobacco - Heavy smokers may require larger doses of warfarin.
• Nipolept (zotepine)
• Nizoral (ketoconazole)
• Noctec (chloral hydrate)
• Nolvadex (tamoxifen)
• Non-Steroidal Anti-Inflammatories, or NSAIDs, such as Butazolidine (phenylbutazone), Clinoril (sulindac), Ibuprofen (Motrin), Indocin (indomethacin), Naprosyn (naproxen), Toradol (ketorolac), and others may increase risk of gastrointestinal bleeding or stomach irritation.
• Norpace (disopyramide)
• Oral contraceptives - May decrease warfarin's effectiveness.
• Pain medication - Any non-narcotic pain treatment will increase the risk of bleeding. Narcotic analgesics are safe to use by themselves, but many of them are prescribed as combination products with ibuprofen or acetaminophen. Consult your doctor about pain treatment options.
• Pepto-Bismol (bismuth subsalicylate)
• Placidyl (ethchlorvynol) - Decreases effectiveness of warfarin treatment.
• Plavix (clopidogrel)
• Prilosec (omeprazole)
• Precose (acarbose)
• Propoxyphene
• Propulsid (cisapride)
• Protease inhibitors such as Agenerase (amprenavir), Norvir (ritonavir), and perhaps others, may increase bleeding.
• Questran (cholestyramine) - Decreases effectiveness of warfarin treatment.
• Quinaglute, Quinidex (quinidine)
• Quinolone antibiotics like Cipro (ciprofloxacin)
• Reopro (abciximab)
• Refludan (lepirudin)
• Rifadin, Rifamate (rifampin) - Decreases the effectiveness of warfarin.
• Rythmol (propafenone)
• Sandimmune (cyclosponine) - This medication's effects may be decreased by warfarin.
• Seroquel (quetiapine)
• Selective serotonin reuptake inhibitors (SSRIs) like Celexa (citalopram), Paxil (paroxetine), Prozac (fluoxetine), Luvox (fluvoxamine), or Zoloft (sertraline).
• Spironolactone - Decreases effectiveness of warfarin treatment.
• Sporanox (itraconazole)
• Streptokinase
• Sulfapyridine
• Sulfonamide drugs - various
• Tagamet (cimetidine)
• Tegretol (carbamazepine) - Decreases the effectiveness of warfarin.
• Testosterone
• Tetracyclines like demeclocycline, doxycycline, methacycline, minocycline, oxytetracycline, and tetracycline.
• Thiazide diuretics like Anhydron (cyclothiazide), Diuril (chlorothiazide), Enduron (methyclothiazide), Metahydrin (trichlormethiazide), Naturetin (bendroflumethiazide), Renese (polythiazide), and others may decrease the effectiveness of warfarin by causing it to clear from the body more quickly.
• Thrombolytics like alteplase.
• Thyroid hormones - various
• Ticlid (ticlopidine)
• Tricyclic antidepressants such as Elavil (amitriptyline), Asendin (amoxapine), Anafranil (clomipramine), Pertofrane or Norpramin (desipramine), Sinequan (doxepin), Tofranil (imipramine), Aventyl or Pamelor (nortriptyline), Vivactil (protriptyline), and Surmontil (trimipramine).
• Ultram (tramadol)
• Vancoled (vancomycin)
• Vitamin E (d-alpha tocopherol) - Consult your doctor for appropriate dosages. High doses will increase the risk of bleeding.
• Vitamin K (phytonadione) - Consult your doctor for appropriate dosages. High doses will decrease the effectivenes of warfarin.
• Xenical (orlistat)
• Zantac (ranitidine)
• Zithromax (azithromycin)
• Zyflo (zileuton)
• Zyloprim (allopurinol)

Coumadin Dosages

The usual starting dose is 2 mg to 5 mg for up to four days, after which your doctor will determine further dosage adjustments based on a blood test.

Coumadin is available in 1 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7 mg, 7.5 mg, and 10 mg tablets. Speak to your doctor if you have any food or dye allegies.

If you start treatment using either the brand name medication or the generic drug, try to stay with the same form. Switching brands may necessitate a dosage adjustment.

Coumadin Directions

Always inform medical personnel that you are using Coumadin. Carry a card or MedicAlert jewelry so that emergency personnel will know even if you become unconscious. Inform your pharmacist, dentist, and any other doctors you see.

Speak to your doctor immediately if you experience any unusual bleeding.

You must take utmost care to avoid injury while using this medication. Avoid cutting yourself, shaving with a razor, or using a hard toothbrush. Avoid contact sports or other high risk activities, and report any falls or blows (especially head injuries) to your doctor. Serious internal bleeding could occur without your knowledge.

Minimize alcohol consumption, as heavy drinking may increase the risk of bleeding. Have no more than one or two drinks per occasion, and avoid drinking daily.

It's very important that you do not change your eating habits while using this medication. Eat consistent amounts of dark green leafy vegetables, which contain high amounts of the blood clotting aid vitamin K. Do not stop or start vitamin supplements, and consult with your doctor about their proper use before beginning treatment.

Coumadin should be stopped gradually, and only under the guidance of your physician. It will take some time after you stop using it for your blood's clotting ability to return to normal, so continue to take precautions for as long as your doctor suggests.

Keep a written record of your doses, and take your medicine as soon as possible if you should miss a dose. Do not double doses if you forget until the next day, as bleeding may result. Skip missed doses of this medication, and report missed doses to your doctor.

Store Coumadin away from direct light and heat. Store in a dry location; avoid storing it in the bathroom, near sinks, or other areas where it may become damp. Do not use after the expiration date.

Keep Coumadin away from children; both when storing it, and when discarding any unused medication.

Coumadin and Pregnancy

Do not take this drug during pregnancy, or become pregnant while taking it. Risks to the fetus include physical or mental birth defects and miscarriage. This medication is unsafe during all trimesters of pregnancy, and may cause an unborn child to fatally bleed in later stages of pregnancy.

Breast feeding does not seem to pose a problem, as this medication does not pass in active forms to the infant. Coumadin should not be taken too soon after the birth of a child, as internal bleeding is more likely at this time.

Coumadin and Children

Young babies are more sensitive to this medication. Your child's physician will have to make dosage and care decisions on an individual basis.

Coumadin and Seniors

Seniors are at increased risk for unusual bleeding during treatment, and should be carefully monitored. Have any injuries or falls, no matter how minor, attended by a physician. There is a higher risk of internal hemorrhage.

Coumadin Online - Prescriptions Through Accessmednet Listings

Coumadin is a trademark of DuPont

Generic Warfarin Sodium is manufactured by Geneva and Taro

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This document is provided for information only. It is not a substitute for consultation with a physician, either to diagnose symptoms or prescribe treatment. Any dosages mentioned are general guidelines only, please follow the directions of your doctor or pharmacist exactly when taking medication. We have made every effort to ensure that this information is accurate, but only your doctor can say if a medication, or drug combination, is safe for you. Information intended for US residents only.