Coumadin
For Healthcare Professionals

State-Specific Dispense as Written (DAW) Languages

The regulations listed below are current as of December 31, 2008.
Individual state law is subject to change and may allow other ways to indicate no substitution.
Examples of methods allowed by state law are provided on this list.

Dispense as Written by State
State Abbrev Legal Reference Language
AK Alaska Stat.§ 08.80.295 (2008) Handwrite: “Dispense Only as Written”
Orally Specify: “May not be substituted”
AL Ala. Code §
34-23-8 (2008)		 Sign “Dispense as Written” Line
AR Ark. Code Ann. § 17-92-503 (2008); 07-00 Ark. Code. R. § 0007; 07-00 Ark. Code. R. § 0001(c)(2) Handwrite: “No Substitution”
Orally Specify: Dispense as communicated
AZ Ariz. Rev. Stat. Ann. § 32-1963.01 (2008) Handwrite: “Dispense as Written”
CA Cal. Bus. & Prof, Code § 4073 (2008) Handwrite: “Do Not Substitute” or Mark Box Next to “Do Not Substitute” and Initial Next to Checkmark
Orally Specify: “Do not substitute”
CO Colo. Rev. Stat. Ann. § 12-22-124 (2008) Handwrite: “Dispense as Written” Or Initial in Box Marked “Dispense as Written”
Orally Specify: “Substitution is prohibited”
CT Conn. Gen. Stat. Ann. § 20-619 (2008) Handwrite: “Brand Name is Medically Necessary”
Orally Specify: “Brand is medically necessary”
DC D.C. Code § 48-803.03 (2008) Handwrite: “Dispense as Written”
Orally Specify: “Dispensed as communicated”
DE Del. Code. Ann. tit. 24 § 2549 (2008) Handwrite: “Brand Necessary” or “Brand Medically Necessary”
Orally Specify: “No substitutions”
FL Fla. Stat. Ann. § 465.025 (2008) Handwrite: “Medically Necessary”
Orally Specify: “Medically necessary”
GA Ga. Code Ann. § 26-4-81 (2008) Handwrite: “Brand Necessary”
GU Guam Code Ann. tit. 5. § 5271 (2007) Handwrite: “Do Not Substitute”
HI Haw. Rev. Stat. § 328-91 (2008); Haw. Code R. § 17-1739.1-11 Handwrite: “Brand Medically Necessary”
Orally Specify: “Brand is medically necessary”
IA Iowa. Code Ann. § 155A.32 (2008) Handwrite: “Dispense as Written”
Orally Specify: “No substitutions”
ID Idaho Admin. Code r. 27.01.01.188; Idaho Admin. Code r. 16.03.09.662 Handwrite: “Medically Necessary” or Check Box Labeled “Brand Only” on Front of Prescription
IL 225 Ill. Comp. Stat. Ann. 85/25 (2008) Mark Beside “May Not Substitute”
Orally Specify: “Do not substitute”
IN Ind. Code Ann. § 16-42-22-8 (2008); Ind. Code Ann. § 16-42-22-10 (2008) Handwrite: “Brand Medically Necessary;” Do Not Sign on Line Marked “May Not Substitute”
Orally Specify: “Do not substitute”
KS Kan. Stat. Ann. § 65-1637 (2007) Handwrite: “Dispense as Written”
Orally Specify: “Dispense as indicated”
KY Ky. Rev. Stat. Ann. § 217.822 (2008) Handwrite: “Do Not Substitute”
LA La. Rev. Stat. Ann. § 37:1241 (2008) Handwrite: “Brand Medically Necessary;” or Mark in Box Labeled “Dispense as Written”
Orally Specify: “Brand medically necessary”
MA Mass. Gen. Laws Ann. 112 § 12D (2008) Handwrite: “No Substitution”
Orally Specify: “No substitution”
MD Md. Code Ann., Health Occ. § 12-504 (2008); Md. Code Ann., Health - Gen., § 15-118 (2008) Handwrite: “Dispense as Written”
ME Me. Rev. Stat. Ann. tit 32, § 13781 (2008) Mark Box on Prescription Form or Handwrite: “Dispense as Written”
MI Mich. Comp. Laws Ann. § 333.17755 (2008) Handwrite: “Dispense as Written”
Orally Specify: “Dispense as communicated”
MN Minn. Stat. Ann. § 151.21 (2008) Handwrite: “Dispense as Written”
Orally Specify: “Dispensed as communicated”
MO Mo. Rev. Stat. § 338.056 (2008) Sign “Dispense as Written” Line
Orally Specify: “Dispense as communicated”
MS Miss. Code Ann. § 73-21-115 (2008) Handwrite or Sign Next to “Dispense as Written”
MT Mont. Code Ann. § 37-7-505 (2008) Handwrite: “Brand Name Drug Medically Necessary”
Orally Specify: “Medically necessary”
NC N.C. Gen. Stat. § 90-85.28 (2008); 10A N.C. Admin. Code 22O.0118 Handwrite or Sign Next to “Dispense as Written”
Orally Specify: “Dispense as written”
ND N.D. Cent. Code § 19-02.1-14.1 (2008) Handwrite: “Brand Necessary”
Orally Specify: “Dispense as communicated”
NE Neb. Rev. Stat. § 71-5403 (2008) Handwrite: “Dispense as Written”
Orally Specify: “Dispensed as communicated”
NH N.H. Rev. Stat. Ann. § 146-B:2 (2008) Handwrite: “Medically Necessary”
Orally Specify: “Drug product is medically necessary”
NJ N.J. Stat. Ann. § 24:6E-7 (2008); N.J. Admin. Code § 10:56-2.18 Initial Next to “Do Not Substitute”
Orally Specify: “Do Not substitute”
NM N.M. Stat. Ann. § 26-3-3 (2008) Handwrite: “No Substitution”
NV Nev. Rev. Stat. Ann. § 639.2583 (2008) Handwrite: “Dispense as Written”
Orally Specify: “Dispensed as communicated”
NY N.Y. (Educ.) § 6810 (2008) Handwrite: “D.A.W.” in the Box below Signature Line
OH Ohio Rev. Code Ann. § 4729.38 (2008) Handwrite: “Dispense as Written”
Orally Specify: “Medically necessary”
OK Okla. Stat. Ann. Tit. 59, § 353.13 (2008); Okla. Admin. Code § 317:30-5-76-77 (2008) Handwrite: “Brand Necessary”
Orally Specify: “Brand necessary”
OR OR. Rev. Stat. § 689.515 (2008) Handwrite: “No Substitution”
Orally Specify: “No substitution”
PA 35 Pa. Stat. Ann. § 960.3 (2008) Handwrite: “Brand Necessary” or “Brand Medically Necessary”
Orally Specify: “Substitution not allowed”
PR P.R. Laws Ann. tit. 24, § 3024 (2005) Handwrite: “Do Not Substitute”
Orally Specify: “Substitution not allowed”
RI R.I. Gen. Laws § 5-19.1-19 (2008) Handwrite: “Brand Name Necessary”
Orally Specify: “Brand is necessary”
SC S.C. Code Ann. § 39-24-40 (2007) Sign “Dispense as Written” Line
Orally Specify: “No substitutions”
SD S.D. Codified Laws § 36-11-46.2 (2008) Handwrite: “Brand Necessary”
Orally Specify: “Brand is necessary”
TN Tenn. Code Ann. § 53-10-204 (2008) Handwrite: “Dispense as Written”
Orally Specify: “Medically necessary”
TX Tex. Occ. Code Ann. § 562.015 (2007) Handwrite: “Brand Necessary” or “Brand Medically Necessary”
Orally Specify: “Brand necessary” or “Brand medically necessary”
UT Utah Code Ann. § 58-17b-605. (2008) Handwrite or Sign Next to “Dispense as Written”
Orally Specify: “Substitution is not permitted”
VA Va. Code Ann. § 54.1-3408.03 (2008) Handwrite: “Brand Medically Necessary”
Orally Specify: “Substitution is not allowed”
VT Vermont: 04 030 230 Vt. Code R. § 19.5.4 Handwrite: “Brand Necessary” and write that generic equivalent has not been, or is not expected to be, effective or may cause adverse effects.
Orally Specify: “Brand is necessary and substitution is not allowed”
WA Wash. Rev. Code Ann. 69.41.120 (2008) Sign “Dispense as Written” Line
Orally Specify: “Drug may not be substituted”
WI Wis. Stat. Ann. 450.13. (2007); Wis. Admin. Code HFS 107.10(3) Handwrite: “No Substitution”
WV W. Va. Code, § 30-5-12b (2008) Handwrite: “Brand Medically Necessary”
Orally Specify: “Brand necessary”
WY Wyo. Stat. Ann. § 33-24-149 (2008) Handwrite: “No Substitution”
Orally Specify: “No substitution”

INDICATIONS:

  • COUMADIN® (Warfarin Sodium):
    • For the prophylaxis and/or treatment of venous thrombosis and its extension and pulmonary embolism.
    • For the prophylaxis and/or treatment of the thromboembolic complications associated with atrial fibrillation and/or cardiac valve replacement.
    • To reduce the risk of death, recurrent myocardial infarction, and thromboembolic events such as stroke or systemic embolization after myocardial infarction.

IMPORTANT SAFETY INFORMATION:

WARNING: BLEEDING RISK

Warfarin sodium can cause major or fatal bleeding. Bleeding is more likely to occur during the starting period and with a higher dose (resulting in a higher INR). Risk factors for bleeding include high intensity of anticoagulation (INR>4.0), age ≥65, highly variable INRs, history of gastrointestinal bleeding, hypertension, cerebrovascular disease, serious heart disease, anemia, malignancy, trauma, renal insufficiency, concomitant drugs (see PRECAUTIONS), and long duration of warfarin therapy. Regular monitoring of INR should be performed on all treated patients. Those at high risk of bleeding may benefit from more frequent INR monitoring, careful dose adjustment to desired INR, and a shorter duration of therapy. Patients should be instructed about prevention measures to minimize risk of bleeding and to report immediately to physicians signs and symptoms of bleeding (see PRECAUTIONS: Information for Patients).

  • Anticoagulation is contraindicated in any localized or general physical condition or personal circumstance in which the hazard of hemorrhage might be greater than the potential clinical benefits of anticoagulation, such as:
    • patients who are or may become pregnant
    • hemorrhagic tendencies or blood dyscrasias
    • recent or contemplated surgery of the central nervous system, eye, or traumatic surgery resulting in large open surfaces
    • bleeding tendencies associated with active ulcerations or overt bleeding
    • threatened abortion, eclampsia and preeclampsia
    • inadequate laboratory facilities
    • unsupervised patients with senility, alcoholism, psychosis, or other lack of patient cooperation
    • spinal puncture and other diagnostic or therapeutic procedures with potential for uncontrollable bleeding
  • Caution should be observed when COUMADIN (Warfarin Sodium) is administered in any situation or in the presence of any predisposing condition where the added risk of necrosis and/or gangrene is present.
  • Systemic atheroemboli and cholesterol microemboli can occur with COUMADIN therapy. COUMADIN therapy should be discontinued if vascular compromise due to embolic occlusion is present including purple toes syndrome.
  • COUMADIN should be used with caution in patients with heparin-induced thrombocytopenia and deep venous thrombosis.
  • The decision to breast-feed while taking COUMADIN should be undertaken only after careful consideration of available alternatives.
  • COUMADIN should be used with caution in patients with severe to moderate hepatic insufficiency, indwelling catheters, known or suspected deficiency in protein C mediated anticoagulant response, polycythemia vera, vasculitis, and severe diabetes.
  • Numerous factors, alone or in combination, including changes in diet, medications, botanicals, and genetic variations in the CYP2C9 and VKORC1 enzymes may influence the patient’s response to warfarin.
  • Drugs may interact with COUMADIN (Warfarin Sodium) through pharmacodynamic or pharmacokinetic mechanisms. (Please see full Prescribing Information for the list of ENDOGENOUS and EXOGENOUS factors).
  • Identification of risk factors for bleeding and certain genetic variations in CYP2C9 and VKORC1 in a patient may increase the need for more frequent INR monitoring and use of lower warfarin doses.
  • Caution should be observed when COUMADIN is administered concomitantly with nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin.
  • The most common adverse event and serious risk of oral anticoagulation therapy with COUMADIN (Warfarin Sodium) is bleeding in any tissue or organ.
  • Patients should be informed that all warfarin sodium, USP, products represent the same medication and should not be taken together as overdosage may result.
  • The use of warfarin during pregnancy has been associated with the development of fetal malformations in humans.
Click here for full Prescribing Information

Back to Top

COUMADIN® is a registered trademark of Bristol-Myers Squibb Pharma Company.

COUMADIN (Warfarin Sodium), the COUMADIN color logo, COLORS OF COUMADIN, and the color and configuration of COUMADIN tablets are trademarks of Bristol-Myers Squibb Pharma Company.