H A N D B O O K
Managing Your Coumadin works by partially blocking the re-use of
Vitamin K in your liver. Vitamin K is needed to make clotting factors that help the blood to clot and
prevent bleeding. By blocking the Vitamin K, coumadin reduces the body’s ability to make clots and can stop harmful clots from forming or from getting larger. Coumadin does not break up existing blood clots.
Coumadin begins to reduce blood-clotting within 24 hours after starting the drug. The full effect may take
Coumadin (generically known as warfarin) is
72-96 hours to occur. The effects of a single dose of
a blood thinner. Your provider has prescribed
medication can last 2-5 days. This means when you
this medicine because your medical condition
first start taking coumadin you may have to have
benefits from your blood clotting more slowly
testing every day for a few days, then perhaps one
than normal. Coumadin helps prevent clots
from forming in blood vessels and in the heart.
Once stabilized, you will still receive testing at periodic
This is important in such conditions as stroke,
intervals (such as one time per month) throughout
an irregular heartbeat called atrial fibrillation,
your course of therapy to keep the blood thinned in
pulmonary emboli, deep venous thrombosis,
the best range for your medical condition.
It is very important to take Coumadin exactly as
Diet and medications can alter the effect of warfarin
directed by your physician. Too much Coumadin can
on the blood. Many foods you eat have Vitamin K
cause bleeding, and not enough Coumadin can allow
in them which help your blood make clots faster.
Foods containing fat substitutes, such as Olestra (Olean) are supplemented with fat-soluble vitamins
Your provider will determine how much medicine you
including Vitamin K. Herbal teas that have tonka
need by monitoring the blood clotting levels with
beans, sweet woodruff or melilot should also be
the PT/INR. You will need to have this blood tested
limited because of high content of Vitamin K.
regularly, because the correct dose of warfarin for you can change over time. Based on the results, your
FOODS RICH IN VITAMIN K:
physician will inform you what dosage of medicine you need and when these tests need to be done again.
Several things, such as sickness, diet, other
medications (both prescription and over-the-counter)
• Turnip greens, collard greens, • Spinach
or physical activities may affect your PT/INR.
You should inform your healthcare provider about
any significant changes in your health, medicine
or lifestyle to help them adjust your medication if
needed. Also if you are going to have any procedure outside of our clinic, please let the performing provider know as well as us here at PMG.
You may eat these foods and should because they are important to healthy diet. However you should try to eat about the same amount of them each week. Limit your alcohol intake to no more than one or two drinks per day.
Always let your provider here at Pacific
Some medications can interact and/or interfere with warfarin causing serious side effects.
to take before you begin taking them. YOU SHOULD AVOID THESE NON-PRESCRIPTION MEDICATIONS:
• Aspirin or any aspirin-containing products (acetylsalicylic
acid). Many cold remedies contain aspirin.
• *Anti-inflammatories such as ibuprofen (Advil, Motrin,
• Vitamin K, Vitamin C, Vitamin E, or other high potency
• Laxatives such as mineral oil or Ex Lax• Antacids such as Maalox, Mylanta, or Gelusil with or just
The side effects of Coumadin are excessive bleeding
• *H2-receptor antagonists such as cimetidine (Tagamet)
and allergic reactions. The most common side effect
is bleeding into any tissue or organ.
Notify your physician if you develop any of the following symptoms:
YOU CAN USE: NOTE: The amount of acetaminophen should be as low as possible and monitored carefully. High doses of acetaminophen can prolong the INR.
• A general multivitamin that does not contain more than
100% RDA of various components and does not contain
(bleeding doesn’t stop after 10 to 15 minutes)
Q: What if I cut myself, get a cut that won’t stop
Q: What if I want to travel while I take Coumadin?
A: Make sure you let your healthcare provider
know. You will need to have your testing at its regular schedule and may need to have
a test prior to leaving or while on your trip.
A: Stop your medicine. Let us and/or your
You should also make sure you have enough
Q: What if I want to participate in a sport or
A: Do not take another tablet to catch up if it is
A: Ask your healthcare provider first. You will
the next day. Call your provider for directions.
want to avoid any activity or sport which may
If you realize the same day you were to take
result in a serious fall or other injury.
your pill, go ahead and take it. Wait 24 hours before taking your next pill.
Q: Does cooking, freezing, or drying foods change
A: There is little information about the effects
A: The clot blocking effect last for an additional
of cooking, freezing, or drying the Vitamin
2-5 days, then your blood returns to normal.
K content of foods. It appears the content is about the same in fresh foods as is in prepared foods. COUMADIN DO’S
• Do take your coumadin as your health care provider
• Do take your Coumadin about the same time every day,
may have about the medication, Coumadin.
• Do keep eating habits and activities similar each day. • Do get your bloodwork tested as instructed by your
• Do refill your prescriptions according to your providers
• Do notify all your physicians, your dentist, and
conditions, it has significant risks involved
pharmacists that you are taking Coumadin or warfarin. You may want to wear a Medic Alert bracelet.
• Do watch for signs of bleeding. • Do tell your healthcare provider when you are sick, hurt,
or get a cut that won’t quit bleeding.
Thank you for allowing us to serve as your
COUMADIN DON’TS • Do not take generic warfarin with Coumadin pills unless
specifically directed by your healthcare provider. They are the same medicine. • Do not skip a pill and never double up on pills if you have
missed a dose. Notify your physician if you have missed any pills. • Do not take any medication, including over-the-counter
(non-prescription) medications without informing your doctor. • Do not take coumadin if you become pregnant.
Pregnancy requires special restrictions and management of coumadin. Notify your physician immediately if you become pregnant while on warfarin.
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