My father's coumadin prescription

[Betsy-Wiliams]

  Dear Doctors:  My father is 73 years old.  He is currectly taking four different medications:  mestinon, lanoxin, coumadin, and atenolol.  He and my family are extremely frustrated because we believe the coumadin prescription is causing him to have stiffness in his joints making it hard for him to walk, stand up from sitting, get in and out of cars...  We think it is the coumadin because whenever he is off of the medication even for a very short period of time, he can move as if he is a vibrant 20 year old.  His doctors laughed when he told them of this.  
  He underwent an MRI and other tests to see if it might be Parkinsons disease but he has no other parkinson-like symptonns.  He is physically fit and has a personal trainer working with him several times a week.  
  Have you ever heard of coumadin having these side effects?  Is there a possibility that it is the interaction between the four drugs together?  Is there another blood thinner he could try that is as effective as coumadin?
  I would appreciate any suggestions you might have.  My family and I feel that we need to become proactive in fighting his situation.
  Thank you.

[Cleveland Clinic, MD]

Dear Betsy,
Thank you for your question. I am sorry to hear of your frustration and you should share your feelings with your father’s doctors at his next visit.  In addition it is always wise to take a proactive role in one’s medical care.  You will always be your own best medical advocate.  
I have not heard of coumadin causing any of the symptoms that you mention and it does not usually  interact with the drugs you mentioned.  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).  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.

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