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Heart Disease (Expert Forum)
Coumadin interactions
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Coumadin interactions
by Lisa__0__0, Jul 16, 1998 12:00AM
Is there a web page that exclusively addresses interactions with coumadin and other meds? I have a factor XII deficiency and will be on coumadin the rest of my life and Tues my INR was 7.1 - drawn Tues evening. Yesterday I was instructed to go to an ER and it was down to a whopping 5.9. The ER discharged me and I'm off to have another PT drawn this a.m. So, you see this information is urgent for me. I'm on string of meds and I HAVE to figure out what happened ASAP.... I haven't taken any meds since Tues morning simply because I was feeling tooo tired to get up and thank God I skipped the Tues coumadin dose. Can the HEAT do this? I'm an active 41 year old mom and was cleaning in the garage for the previous few days.... Well. I'm good and anemic now and grouchy... any information will be greatly appreciated!
Doctor's Answer
by Cleveland Clinic, MD, Jul 16, 1998 12:00AM
, Jul 16, 1998 12:00AMDear Lisa,
Thank you for your question. I am sorry to hear of the difficulties you have been having. Hopefully these problems with be smoothed out with continued monitoring and adjusting of your medication dose. The following is information on warfarin and it’s drug interactions.
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
Information provided here is for general educational purposes only. Only your doctor can provide specific diagnoses and treatments. If you would like to be seen at the Cleveland Clinic, please Call 1 - 800 - CCF - CARE for an appointment at Desk F15 with a cardiologist
