What is this medication?

WARFARIN (WAR far in) is an anticoagulant. It is used to treat or prevent clots in the veins, arteries, lungs, or heart.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): Coumadin

What should I tell my care team before I take this medication?

They need to know if you have any of these conditions:

• alcoholism
• anemia
• blood disease, bleeding disorders, hemorrhage, hemophilia or aneurysm
• bowel disease, diverticulitis, or ulcers
• cancer
• diabetes
• heart disease
• heart valve infection
• high blood pressure
• history of bleeding in the gastrointestinal tract
• history of stroke or other brain injury or disease
• kidney disease
• liver disease
• older than 65 years
• protein C deficiency
• protein S deficiency
• psychosis or dementia
• recent surgery or injury
• an unusual or allergic reaction to warfarin, other medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding

How should I use this medication?

This medicine is injected into a vein. It is given by a health care provider in a hospital or clinic setting.

A special MedGuide will be given to you before each treatment. Be sure to read this information carefully each time.

Talk to your health care provider about the use of this medicine in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

This does not apply.

What may interact with this medication?

Do not take this medicine with any of the following medications:

• defibrotide

This medicine may also interact with the following medications:

• acyclovir
• allopurinol
• aprepitant
• armodafinil
• aspirin
• bicalutamide
• bosentan
• caffeine
• capecitabine
• certain antibiotics like erythromycin, clarithromycin, ciprofloxacin, cotrimoxazole, metronidazole, norfloxacin, or tigecycline
• certain antivirals for HIV or hepatitis
• certain medicines for blood pressure, heart disease, irregular heart beat
• certain medicines for blood clots like argatroban, aspirin, bivalirudin, enoxaparin, fondaparinux, heparin, or lepirudin
• certain medicines for cholesterol like atorvastatin, lovastatin, and simvastatin
• certain medicines for depression, anxiety, or psychiatric disorders
• certain medicines for fungal infections like fluconazole, ketoconazole, itraconazole, posaconazole, or voriconazole
• certain medicines for seizures like carbamazepine, phenobarbital, phenytoin, rufinamide
• cilostazol
• clopidogrel
• conivaptan
• cyclosporine
• dipyridamole
• disulfiram
• female hormones, including contraceptive or birth control pills
• herbal or dietary products like garlic, ginkgo, ginseng, green tea, kava kava, red yeast rice, St. Johns Wort
• isoniazid
• methoxsalen
• modafinil
• nilotinib
• NSAIDs, medicines for pain and inflammation, like ibuprofen or naproxen
• oxandrolone
• phenylpropanolamine
• prasugrel
• rifampin
• steroid medicines like prednisone or cortisone
• stomach acid blockers like cimetidine, famotidine, ranitidine, or omeprazole
• sulfinpyrazone
• thiabendazole
• ticlopidine
• vitamin K
• zafirlukast
• zileutin

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medication?

Visit your healthcare professional for regular checks on your progress. You will need to have a blood test called a PT/INR regularly. The PT/INR blood test is done to make sure you are getting the right dose of this medicine. It is important to not miss your appointment for the blood tests. When you first start taking this medicine, these tests are done often. Once the correct dose is determined and you take your medicine properly, these tests can be done less often.

Wear a medical ID bracelet or chain, and carry a card that describes your disease and details of your medicine and dosage times.

Do not start taking or stop taking any medicines or over-the-counter medicines except on the advice of your healthcare professional.

You should discuss your diet with your doctor or healthcare professional. Do not make major changes in your diet. Vitamin K can affect how well this medicine works. Many foods contain vitamin K. It is important to eat a consistent amount of foods with vitamin K. Other foods with vitamin K that you should eat in consistent amounts are asparagus, basil, black-eyed peas, broccoli, brussel sprouts, cabbage, green onions, green tea, parsley, green leafy vegetables like beet greens, collard greens, kale, spinach, turnip greens, or certain lettuces like green leaf or romaine.

This medicine can cause birth defects or bleeding in an unborn child. Women of childbearing age should use effective birth control while taking this medicine. If a woman becomes pregnant while taking this medicine, she should discuss the potential risks and her options with her healthcare professional.

Avoid sports and activities that might cause injury while you are using this medicine. Severe falls or injuries can cause unseen bleeding. Be careful when using sharp tools or knives. Consider using an electric razor. Take special care brushing or flossing your teeth. Report any injuries, bruising, or red spots on the skin to your healthcare professional.

If you have an illness that causes vomiting, diarrhea, or fever for more than a few days, contact your healthcare professional. Also check with your healthcare professional if you are unable to eat for several days. These problems can change the effect of this medicine.

Even after you stop taking this medicine, it takes several days before your body recovers its normal ability to clot blood. Ask your healthcare professional how long you need to be careful. If you are going to have surgery or dental work, tell your healthcare professional that you have been taking this medicine.

What side effects may I notice from receiving this medication?

Side effects that you should report to your doctor or health care professional as soon as possible:

• allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
• heavy menstrual bleeding or vaginal bleeding
• painful, blue or purple toes
• painful skin ulcers that do not go away
• signs and symptoms of bleeding such as bloody or black, tarry stools; red or dark-brown urine; spitting up blood or brown material that looks like coffee grounds; red spots on the skin; unusual bruising or bleeding from the eye, gums, or nose
• signs and symptoms of a blood clot such as chest pain; shortness of breath; pain, swelling, or warmth in the leg
• signs and symptoms of a stroke such as changes in vision; confusion; trouble speaking or understanding; severe headaches; sudden numbness or weakness of the face, arm or leg; trouble walking; dizziness; loss of coordination
• stomach pain
• unusually weak or tired

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

• diarrhea
• hair loss

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medication?

This drug is given in a hospital or clinic and will not be stored at home.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.