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Heart Disease (Expert Forum)
coumadin, blood pressure medication, and excerize
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve, Pacemaker, PAD, Stenosis, Stress Tests
coumadin, blood pressure medication, and excerize
by tom, Dec 22, 1999 12:00AM
My father, 62 has had 4 episodes of arhythmia over the past 3 year, two of which required electrical shocks to get back in place. He has been taking Coumadin since May '99, the time of the last shock treatment.
The current prescription calls for 5 mg tablets daily, with 1.5 tablets taken on mondays and thursdays. He is also taking Amidorane @ 200 mg daily, as well as the following blood pressure medications:
Cartia XT - 180 mg daily
Tenex - 1mg daily
Monopril - 20 mg daily.
My father is scheduled to retire and wants to return to a rigorous exercize program that includes weight lifting, stairmaster and biking. I have a couple of questions:
1) Is there any risk associated with excersize, especially when taking Coumadin?
2)In your opinion are the amount of drugs being taken considered to be excessive?
3) Coumadin appears to be a very dangerous medication that has risks when taken inproperly or with other medication. Are there alternative drugs avaialble that provide the same benefit, with less risk?
The current prescription calls for 5 mg tablets daily, with 1.5 tablets taken on mondays and thursdays. He is also taking Amidorane @ 200 mg daily, as well as the following blood pressure medications:
Cartia XT - 180 mg daily
Tenex - 1mg daily
Monopril - 20 mg daily.
My father is scheduled to retire and wants to return to a rigorous exercize program that includes weight lifting, stairmaster and biking. I have a couple of questions:
1) Is there any risk associated with excersize, especially when taking Coumadin?
2)In your opinion are the amount of drugs being taken considered to be excessive?
3) Coumadin appears to be a very dangerous medication that has risks when taken inproperly or with other medication. Are there alternative drugs avaialble that provide the same benefit, with less risk?
Doctor's Answer
by CCF CARDIO MD - CRC, Dec 22, 1999 12:00AM
Coumadin (generic name Warfarin) is a anticoagulant (blood thinner) that is used for a variety of conditions. Common reasons for coumadin use are in atrial fibrillation to reduce the risk of stroke, in persons with clotting disorders, in persons with mechanical heart valves, and sometimes in people with severe heart failure. The usual dosage is somewhere between 1 and 15 mg a day. Potential side effects include bleeding, hair loss, nausea, vomiting, stomach cramps, diarrhea and leukopenia (low blood cell count). The half life (amount of time for half the drug to be cleared from the body is 42 hours but varies widely depending on the individual).
Many drugs interact with coumadin and may cause more anticoagulation effect (clofibrate, diazoxide, ethacrynic acid, nalidixic acid, phenylbutazone, salicylates, aspirin, sulfonamides, alcohol, allopurinol, amiodarone, cimetidind, phenytoin, erythromycin, gemfibrozil, propranolol, thyroid drugs) or decreased anticoagulation effect (smoking, estrogens, vitamin K, aluminum hydroxide - antiacids, cholestipol, spironolactone). See complete list below. The effects of coumadin must be carefully monitored by a blood test called an INR. Usually this is checked more often at the onset of taking the drug and less often once a steady state has been reached. Therapeutic INR is usually 2 to 3 depending on the condition being treated.
Pregnant women and those with a hypersensitivity to coumadin should not take this medication.
The medication should not be taken with food and any signs of bleeding should be reported to your doctor. Use a soft toothbrush, avoid hazardous activities, carry Medi-Alert ID identifying drug useage and notify your doctor if you have any dark brown urine or red or tarry black stools.
Known Drug interactions with Warfarin
Increased Effect :
Highly Probable
Alcohol (if concomitant liver disease)
Amiodarone
Cimetadine
Clofibrate
Cotrimoxazole
Erythromycin
Fluconazole
Isoniazid
Metronidazole
Miconazole
Omeprazole
Phenylbutazone
Piroxicam
Propafenone
Propanolol
Sulfinpyrazone
Probable
Acetaminophen (Tylenol®)
Anabolic steroids
Aspirin
Chloral Hydrate
Ciprofloxacin
Dextropropoxyphene
Disulriam
Quinidine
Phenytoin (Dilantin®)
Simvastatin
Tamoxifen
Tetracycline
Influenza vaccine
Possible
Disopyramide
5-Fluorouracil
Ifosphamide
Lovastatin
Metolazone
Nalidixic Acid
Norfloxacin
Ofloxacin
Topical salicylates
Sulindac
Tometin
Doubtful
Cefamandole
Cefazolin
Gemfibrozil
Heparin
Indomethacin
Sulfisoxazole
Decreased Effect
Highly Probably
Barbiturates
Carbamazepine
Chlorodiazepoxide
Cholestyramine
Griseofulvin
Nafcillin
Rifampin
Sucralfate
Probable
Dicloxacillin
Possible
Azathioprine
Cyclosporine
Etrelinate
Trazodone
No Effect
Highly Probable
Alcohol (if no liver disease)
Antacids
Atenolol
Bumetanide
Diflunisal
Enoxacin
Famotidine
Felodipine
Fluoxetine
Ketorolac
Metoprolol
Moricizine
Naproxen
Nitrazepam
Nizatidine
Psyllium
Ranitidine
Probable
Ibuprofen
Ketoconazole
Ketoprofen
Doubtful
Diltiazem
Tobacco
Vancomycin
Other Web Sites:
http://search.excite.com/search.gw?c=web&s=coumadin+or+warfarin&showSummary=false&start=20&perPage=20&prev=Previous+Results
Package insert and patient information:
http://www.dupontmerck.com/coumadin/cnsmindx.htm
Food interactions with coumadin:
http://www.rncentral.com/library/health/warfarin.html
Patient information and links:
http://www.hsforum.com/HeartSurgery/TLC/Coumadin/Coumadin.hsf
Home testing
http://www.boehringer-mannheim.com/rapid/coagulation/Coag_EN.html
Low-impact exercise is generally OK if cleared by his doctor. As far as specific medication doses his doctor can answer your questions.
Many drugs interact with coumadin and may cause more anticoagulation effect (clofibrate, diazoxide, ethacrynic acid, nalidixic acid, phenylbutazone, salicylates, aspirin, sulfonamides, alcohol, allopurinol, amiodarone, cimetidind, phenytoin, erythromycin, gemfibrozil, propranolol, thyroid drugs) or decreased anticoagulation effect (smoking, estrogens, vitamin K, aluminum hydroxide - antiacids, cholestipol, spironolactone). See complete list below. The effects of coumadin must be carefully monitored by a blood test called an INR. Usually this is checked more often at the onset of taking the drug and less often once a steady state has been reached. Therapeutic INR is usually 2 to 3 depending on the condition being treated.
Pregnant women and those with a hypersensitivity to coumadin should not take this medication.
The medication should not be taken with food and any signs of bleeding should be reported to your doctor. Use a soft toothbrush, avoid hazardous activities, carry Medi-Alert ID identifying drug useage and notify your doctor if you have any dark brown urine or red or tarry black stools.
Known Drug interactions with Warfarin
Increased Effect :
Highly Probable
Alcohol (if concomitant liver disease)
Amiodarone
Cimetadine
Clofibrate
Cotrimoxazole
Erythromycin
Fluconazole
Isoniazid
Metronidazole
Miconazole
Omeprazole
Phenylbutazone
Piroxicam
Propafenone
Propanolol
Sulfinpyrazone
Probable
Acetaminophen (Tylenol®)
Anabolic steroids
Aspirin
Chloral Hydrate
Ciprofloxacin
Dextropropoxyphene
Disulriam
Quinidine
Phenytoin (Dilantin®)
Simvastatin
Tamoxifen
Tetracycline
Influenza vaccine
Possible
Disopyramide
5-Fluorouracil
Ifosphamide
Lovastatin
Metolazone
Nalidixic Acid
Norfloxacin
Ofloxacin
Topical salicylates
Sulindac
Tometin
Doubtful
Cefamandole
Cefazolin
Gemfibrozil
Heparin
Indomethacin
Sulfisoxazole
Decreased Effect
Highly Probably
Barbiturates
Carbamazepine
Chlorodiazepoxide
Cholestyramine
Griseofulvin
Nafcillin
Rifampin
Sucralfate
Probable
Dicloxacillin
Possible
Azathioprine
Cyclosporine
Etrelinate
Trazodone
No Effect
Highly Probable
Alcohol (if no liver disease)
Antacids
Atenolol
Bumetanide
Diflunisal
Enoxacin
Famotidine
Felodipine
Fluoxetine
Ketorolac
Metoprolol
Moricizine
Naproxen
Nitrazepam
Nizatidine
Psyllium
Ranitidine
Probable
Ibuprofen
Ketoconazole
Ketoprofen
Doubtful
Diltiazem
Tobacco
Vancomycin
Other Web Sites:
http://search.excite.com/search.gw?c=web&s=coumadin+or+warfarin&showSummary=false&start=20&perPage=20&prev=Previous+Results
Package insert and patient information:
http://www.dupontmerck.com/coumadin/cnsmindx.htm
Food interactions with coumadin:
http://www.rncentral.com/library/health/warfarin.html
Patient information and links:
http://www.hsforum.com/HeartSurgery/TLC/Coumadin/Coumadin.hsf
Home testing
http://www.boehringer-mannheim.com/rapid/coagulation/Coag_EN.html
Low-impact exercise is generally OK if cleared by his doctor. As far as specific medication doses his doctor can answer your questions.
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