Coumadin Side Effects, Overdose and Pregnancy Information

Coumadin side effects include bleeding, increased time taken to stop bleeding, and bruising. Rare Coumadin side effects may include diarrhea, nausea and vomiting, rash, fever, anemia, hepatitis, sore throat, red or orange urine, hair loss, liver disorders, purple toe syndrome, yellowing of the skin and eyes (jaundice), inflammation of the pancreas, and painful or persistent erection.

COUMADIN SIDE EFFECTS REPORTING

If you experience any Coumadin side effects not mentioned above you should report it to your primary health care provider or FDA 1-800-FDA-1088 in the United States, Health Canada 1-866-225-0709 in Canada, MHRA 020 3080 6000 in UK, or TGA 1800 020 653 in Australia.

Coumadin is a type of drug known as an oral anticoagulant(blood thinner). Coumadin is used to stop blood clots forming within the blood vessels, reducing the risk of small-cell carcinoma of the lung, repeated heart attack or stroke and transient ischemic attack (TIA). Coumadin takes about three days to produce its full anticoagulant effect because, while it prevents the production of new vitamin-k-dependent clotting factors, it takes about this long for vitamin-k-dependent clotting factors that have already been produced to be used up. For this reason, when treating blood clots such as deep vein thrombosis (DVT) or pulmonary embolism, a fast-acting injectable anticoagulant is often used instead.

COUMADIN OVERDOSE

Coumadin overdose symptoms may include bleeding (most common), blood in urine or stool, and bleeding gum. In case of Coumadin overdose, seek medical help right away. If you miss a dose of Coumadin, take it as soon as you can. However, if it is just about time for your next dose, skip the one you forgot and go on with your regular schedule. Never take a double dose of Coumadin.

Coumadin and Pregnancy

Coumadin should not be used during pregnancy, especially during the first three months, as it passes into fetal circulation and causes bleeding, brain and other abnormalities and even stillbirth. Pregnant women are often given heparin instead as it does not pass into fetal blood circulation. Coumadin passes into breast milk and nursing mothers should switch to bottle-feed while taking Coumadin.

Coumadin Warning

Take extra care when participating in physical activities while taking Coumadin, as even minor injury may result in bleeding/bruising.

Because Coumadin prevents blood clotting, too much can increase your risk of bleeding. On the other hand, too little will not be effective at preventing clotting. It is therefore important that you have regular blood tests to monitor your blood clotting ability (INR) so that your dose can be altered if necessary. Consult your physician about when your INR will need checking.

As Coumadin works by inhibiting the action of vitamin K, changes to your dietary intake of vitamin K can alter the effect of your Coumadin. For this reason, avoid making sudden major changes to your diet, particularly your consumption of green tea, salad and green vegetables (eg broccoli, brussel sprouts, or spinach), which contain large amounts of vitamin K. Large amounts of green vegetables (more than 500g daily) can reduce the effect of Coumadin and should be avoided. Changes to your consumption of fats and oils can also alter the effect of Coumadin, as vitamin K is a fat soluble vitamin.

The effects of Coumadin can also be altered by other foods, for example soy products can reduce the effect of Coumadin, and avocados and large amounts of ice cream have also been reported to have this effect. Cranberry juice should be avoided, as should large amounts of alcohol, as these may increase the effect of Coumadin. Coumadin's effect can also be altered by sudden increases or decreases in your body weight. For these reasons you should avoid making sudden major changes to your diet during treatment with Coumadin. For more information talk to your pharmacist.

Consult your physician right away if you experience any bruising, bleeding, dark stools, blood in the urine, vomiting, diarrhea, fever or acute illness while taking Coumadin, so that your INR can be checked.

You should be given an anticoagulant treatment booklet when you start treatment with this medicine. This will contain details of your Coumadin dose and INR and will also give advice on your anticoagulant treatment.

Inform any health care professional including your dentist, that you are taking Coumadin before surgery/dental work.

Coumadin Caution

Small dosage may be needed in the following group:


Seniors.
People with decreased kidney function.
People with decreased liver function.
People who have had recent surgery, bleeding or major injury.

Coumadin should not be given to the following group :

People who are more prone to bleeding than normal, eg due to the blood clotting disorder haemophilia.
Active bleeding.
Severe kidney disease.
Severe liver disease.
Bacterial infection of the heart valves and the lining surrounding the heart (bacterial endocarditis).
Uncontrolled high blood pressure (hypertension).
Peptic Ulcer.
Pregnant women.
Coumadin should not be used if you are allergic to one or any of its ingredients.

Coumadin Interaction

The following drugs may enhance the effects of Coumadin (increased INR; Coumadin dose may need reducing):


Allopurinol
Amiodarone
Antibiotic drugs
Antifungal drugs
Anabolic steroids
Aspirin (may also irritate the stomach lining, which can result in bleeding from the stomach or intestine in people taking Coumadin)
Certain chemotherapy regimens
Cimetidine
Danazol
Dextropropoxyphene
Diflunisal
Dipyridamole
Disulfiram
Fibrate drugs
Flutamide
Glucagon (large doses)
Glucosamine supplements
NSAIDs, eg ibuprofen.
Omeprazole
Long-term regular use of Acetaminophen(paracetamol) (occasional doses should not affect Coumadin radically)
Proguanil
Propafenone
Statins
Sulfinpyrazone
Tamoxifen
Thyroxine
Zafirlukast.

The following drugs may reduce the effect of Coumadin (decreased INR; Coumadin dose may need increasing):


Aminoglutethimide
Azathioprine
Barbiturates
Carbamazepine
Certain chemotherapy regimens
Colestyramine
Griseofulvin
Oestrogens
Progestogens
Raloxifene
Rifampicin
Sucralfate
Herb St John's Wort
Vitamin K.


The following drugs may also alter the effect of Coumadin and the dose of Coumadin may need to be adjusted up or down.
Corticosteroids
Phenytoin
Quinidine
Ritonavir.


Coumadin may enhance the blood sugar lowering effect of antidiabetic tablets.
There may be an increased risk of bleeding if Coumadin is taken in combination with any of the following drugs:


Antiplatelet or 'blood thinning' drugs such as low-dose aspirin.
Heparin
Low molecular weight heparins
SSRI antidepressants
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