Coumadin
For Consumers

Frequently Asked Questions

Learn more about COUMADIN (Warfarin Sodium Tablets, USP) and your health

What drugs interact with COUMADIN® (Warfarin Sodium Tablets, USP)?

COUMADIN® interacts with many drugs, including prescription and nonprescription (over-the-counter) drugs. For this reason, it is important for you to check with your healthcare provider before starting, changing, or stopping any drug. Some of the nonprescription drugs that may interact with COUMADIN® include: acetaminophen (Tylenol®*); aspirin and aspirin-containing ointments and skin creams; ibuprofen (Motrin®*, Advil®*, Nuprin®*); naproxen (Aleve®*, Orudis KT®*); H2-receptor antagonists, such as cimetidine (Tagamet®*) or ranitidine (Zantac®*); and vitamin supplements containing Vitamin K. Other drugs may affect your response to COUMADIN®. Please check with your healthcare provider for additional information.

* The brands listed are the registered trademarks of their respective owners and are not trademarks of Bristol-Myers Squibb Company.

Herbal medications may interact with COUMADIN®. Be aware that most herbal preparations are not standardized and potency may vary from one lot to another. Inform your healthcare provider if you intend to take herbal and/or natural products since you may need to be monitored more closely.

Important Safety Information
  
Back to top

Can I drink alcohol while taking COUMADIN® (Warfarin Sodium Tablets, USP)?

According to the prescribing information for COUMADIN®, you should avoid drinking alcohol while taking COUMADIN® since alcohol can change the way your body responds to the medicine.1 You should speak to your healthcare provider about the effect of alcohol on your COUMADIN® therapy.

REFERENCE

  1. COUMADIN® Package Insert.
Important Safety Information
  
Back to top

What should I know about the Vitamin K content of foods and COUMADIN® (Warfarin Sodium Tablets, USP) therapy?

The amount of Vitamin K in your diet can change the way COUMADIN® works for you. If you eat a lot of foods that are high in Vitamin K, you can decrease the effect of COUMADIN®. On the other hand, lowering your Vitamin K intake can increase the effect of COUMADIN®. You should try to eat a normal, balanced diet keeping the amount of Vitamin K the same everyday. It is important that you check with your healthcare provider before making any major changes to your diet. Tell your healthcare provider if there are sudden or drastic changes in your diet due to illness.

In general, leafy green vegetables and certain legumes and vegetable oils contain high amounts of Vitamin K. Some foods that are low in Vitamin K include roots, bulbs, tubers, the fleshy part of fruits, fruit juices, and other beverages. Cereal grains and other milled products are also low in Vitamin K.

It is important to note that the amount of Vitamin K that you take in a day adds up. Therefore, if you eat a lot of foods that contain a medium amount of Vitamin K in one day, your Vitamin K intake would be high for that day.

If you have any questions about what foods may affect your therapy with COUMADIN®, ask your healthcare provider.

Important Safety Information
  
Back to top

What should I do if I accidentally miss taking my daily dose of COUMADIN® (Warfarin Sodium Tablets, USP)?

The COUMADIN® prescribing information states, “If the patient forgets to take the prescribed dose of COUMADIN® at the scheduled time, the dose should be taken as soon as possible on the same day. The patient should not take the missed dose by doubling the daily dose to make up for missed doses but should refer back to his or her physician.” 1

Therefore, if you miss a dose of COUMADIN®, take the dose as soon as possible on the same day; but if it is the next day already, then skip the missed dose and continue with your usual daily dose. Do not take a double dose of COUMADIN® the next day to “catch up”; otherwise, you may end up having too much COUMADIN® in your body. It is important that you tell your healthcare provider right away if you missed a dose of COUMADIN®.

REFERENCE

  1. COUMADIN® Package Insert.
Important Safety Information
  
Back to top

Can I take COUMADIN® (Warfarin Sodium Tablets, USP) during pregnancy?

The prescribing information for COUMADIN® says “COUMADIN® is contraindicated in women who are or may become pregnant because the drug passes through the placental barrier and may cause fatal hemorrhage to the fetus in utero. Furthermore, there have been reports of birth malformations in children born to mothers who have been treated with warfarin during pregnancy. Spontaneous abortion and stillbirth are known to occur and a higher risk of fetal mortality is associated with the use of warfarin. Low birth weight and growth retardation have also been reported. Women of childbearing potential who are candidates for anticoagulant therapy should be carefully evaluated and the indications critically reviewed with the patient. If the patient becomes pregnant while taking this drug, she should be apprised of the potential risks to the fetus, and the possibility of termination of the pregnancy should be discussed in light of those risks.”1

In other words, do not take COUMADIN® during pregnancy and do not become pregnant while taking it. If you are of childbearing age and are taking COUMADIN®, make sure you use effective means to avoid pregnancy.

Important Safety Information
  
Back to top

What should I do if I am planning on having surgery?

Tell your doctor. Your doctor should then discuss your condition with your surgeon. It is very important to confirm that your doctor and surgeon have communicated regarding your COUMADIN (Warfarin Sodium Tablets, USP) therapy and upcoming surgery.

Anticoagulants such as COUMADIN can increase bleeding during surgery. Depending on your condition and what kind of surgery you are having, your doctor and surgeon will decide if anything needs to change in your COUMADIN therapy.

Important Safety Information
  
Back to top

What should I do if I am only planning on having dental surgery? Should I still tell my doctor?

You should always speak with your doctor if you are planning on having any surgery. Some dental procedures may require the interruption of your COUMADIN (Warfarin Sodium Tablets, USP) therapy. Only your doctor and surgeon can make this decision.

REFERENCE

  1. COUMADIN® Package Insert
Important Safety Information
  
Back to top

INDICATIONS:

  • COUMADIN® (Warfarin Sodium) is used to help prevent and treat blood clots in the legs, lungs, and those clots associated with heart-valve replacement or an irregular, rapid heartbeat called atrial fibrillation.
  • If you have had a heart attack, COUMADIN may be used to lower the risk of death, another heart attack, stroke, and blood clots moving to other parts of the body.

IMPORTANT SAFETY INFORMATION:

  • COUMADIN can cause serious and life-threatening bleeding. Bleeding is more likely to occur when you first start taking COUMADIN and with a higher dose.
  • Factors that can increase your risk of bleeding while on COUMADIN therapy include being 65 years of age or older, an INR greater than 4, highly variable INRs, history of bleeding involving the stomach or intestine, high blood pressure, certain diseases of the brain, heart or kidney, anemia, cancer, physical injury, taking other drugs, and a long duration of therapy.
  • The PT/INR test checks to see how fast your blood clots. Your healthcare provider will decide what PT/INR numbers are best for you. Your dose of COUMADIN will be adjusted to keep your PT/INR in a target range for you.
  • Tell your healthcare provider right away if you have any signs or symptoms of bleeding problems such as the following: pain, swelling or discomfort, headache, dizziness, or weakness, unusual bruising, nosebleeds, bleeding of gums, bleeding from cuts that take a long time to stop, menstrual flow or vaginal bleeding that is heavier than normal, pink or brown urine, red or black stools, coughing up blood, or vomiting blood or material that looks like coffee grinds.

Back to Top

  • Do not take COUMADIN (Warfarin Sodium) if you are pregnant or plan to become pregnant. COUMADIN can cause death or birth defects to an unborn baby. Use effective birth control if you can get pregnant.
  • Speak to your healthcare provider before breast-feeding while taking COUMADIN.
  • Tell your healthcare provider about all the medical conditions you may have, including recent or planned surgeries or medical or dental procedures.
  • Unsupervised patients with declining mental function due to aging or mental illness, and patients with alcoholism or increased risk of bleeding should not take COUMADIN.
  • Death of skin tissue (skin necrosis or gangrene) is a serious, side effect of COUMADIN. It happens because blood clots form and block blood flow to an area of your body. Call your healthcare provider right away if you have pain, color, or temperature change to any area of your body. You may need medical care right away to prevent death or loss (amputation) of your affected body part.
  • Call your healthcare provider right away if you have pain in your toes and they look purple or dark in color. You may be experiencing a serious condition known as purple toes syndrome.
  • Many factors alone or together such as changes in diet and medicines, including herbal supplements, may affect your response to COUMADIN. Tell your healthcare provider about your diet, all prescription and non-prescription medicines, vitamins, and herbal products you are taking or plan to take. Speak with your healthcare provider before starting, changing, or stopping any of these products. Many drugs, including aspirin and other pain medicines, may interact with COUMADIN (Warfarin Sodium).
  • Eat a normal balanced diet. Do not make changes in your diet, such as eating large amounts of leafy green vegetables, which contain Vitamin K without first talking to your healthcare provider.
  • Avoid alcohol consumption, cranberry juice, and cranberry products while taking COUMADIN.
  • Tell your doctor if you have any illness such as diarrhea, infection or fever.
  • Be aware that COUMADIN and generic warfarin tablets represent the same medication and should not be taken together, as overdosage may result.
  • If you take too much or miss a dose of COUMADIN, call your healthcare provider. Take the missed dose as soon as possible on the same day. Do not take a double dose of COUMADIN the next day to make up for a missed dose.
  • If you have any other questions about COUMADIN (Warfarin Sodium) and your condition, contact your healthcare provider.
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.