SAMPLE ONLY. Your Child s Health. A Pediatric Patient s Guide to Using Warfarin. Please order from Documents, Media and Mail: 415/
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1 Physician Referral Service: 888/689-UCSF Your Child s Health A Pediatric Patient s Guide to Using Warfarin Warfarin (WAR-far-in) Brand Name: Coumadin The purpose of this brochure is to inform you about your child s anticoagulation therapy to ensure its effectiveness and your child s safety.
2 What is Warfarin? Warfarin belongs to a class of drugs called anticoagulants. Warfarin decreases the blood s ability to clot, which helps prevent harmful clots from forming in the body. Why does my child need warfarin? Your child s body naturally forms blood clots to help stop bleeding. However, your child s body may also be making clots that are not needed which can cause serious medical problems. Your child needs to take warfarin either to prevent a blood clot from forming or to treat a blood clot that has already formed. Warfarin is used in patients who have clots in the legs and lungs, or in patients at risk of developing clots because of irregular rapid heartbeats or heart surgeries. If you are not sure why your child needs warfarin, make sure to ask your child s healthcare provider. How does warfarin work? Warfarin slows down the production of certain blood clotting proteins that depend on Vitamin K. This decreases the chance of a blood clot from forming. Warfarin begins to reduce clotting within 24 hours. The full effect may take 72 to 96 hours to occur. How much warfarin does my child take? The amount of warfarin your child takes is determined by blood tests. The test result is reported as an International Normalized Ratio (INR). It tells your healthcare provider how fast your blood is clotting and whether the dose needs to be changed. The dose of warfarin may change from time to time depending on the blood test. It is important to recognize that warfarin comes in tablets of different strengths and colors. Be sure to give exactly the dose as directed by your child s healthcare provider. 2
3 When does my child take the medicine? It is important for your child to take warfarin at the same time everyday. It is preferred to give the dose in the evening or at bedtime. If necessary the pill can be crushed and mixed with a small amount of water. Will the dose change? The dose of warfarin for your child may change from time to time depending on the INR level and if it is not within your child s goal range. After each INR blood test, your child s healthcare provider will decide if the dose should stay the same or change. It is important to keep track or take note of any dose changes your child s healthcare provider informs you and your child about. When will my child have to take the INR test? Your child s healthcare provider will tell you what the normal INR level is for your child. When your child starts taking warfarin, your child may need to test the INR frequently. When your child s healthcare provider finds the dosage that is right for your child, the blood tests will be less frequent. What things may change my child s INR test results? Several things may affect the INR test result such as diet, physical activity, illness, medications, or supplements. Please notify your child s healthcare provider of any changes of these factors. 3
4 What side effects should I watch for? The primary side effect of warfarin is bleeding. The risk of bleeding is greater when your child s INR is higher that the desired level. If any of the following signs of bleeding occur, contact your healthcare provider immediately. Bleeding gums Nose bleeds Coughing up blood Vomiting blood Bruises not caused by any apparent reason Excessive bleeding from cuts or scratches Red or black (tarry) bowel movements Red or dark brown urine Very heavy menstrual bleeding (girls only) If any noticeable bleeding does not stop within a few minutes (i.e. nosebleed) your healthcare provider may ask your child to go to the emergency room at the nearest hospital. The warfarin dose may need to be held or changed as directed by your child s healthcare provider. What should I know about drug interactions and diet? Medications may change your child s INR. Always check with your child s healthcare provider before giving any new medications or stopping any medications your child has been taking. This includes any prescription medications, over-the-counter medications, and supplements. Some over-the-counter medications that may interact with warfarin include aspirin, ibuprofen, naproxen, some cold medicines, vitamin and herbal supple- 4
5 ments. Many medicines can affect your child s response to warfarin, so it is important to address any new medications with your child s healthcare provider. Keep a record of all medications that your child is taking, both prescription and nonprescription. The amount of vitamin K in your child s diet might also affect the INR. It is best to maintain a consistent diet for your child. This does not mean they have to avoid foods that contain vitamin K, rather the amount of these food items should be consistent from day to day. Foods that are highest in vitamin K are green leafy vegetables. It is important to avoid drastic changes in your child s dietary habits. Drinking alcohol can also change your child s INR and should be avoided. What should I do if my child misses a dose or if my child vomits the medicine? It is important to give the medicine exactly as ordered. If your child vomits the medication, do not give it again. Simply give the medication the next day at the correct time. If your child misses a dose, do not double-up on the dose. Simply give the medication the next day at the correct time. If two or more doses are missed, call your child s healthcare provider for instructions. Mark any missed doses on your calendar to keep track and inform your healthcare provider at your next visit or phone appointment. What other important information should I know about warfarin? It is important that all the doctors and dentists caring for your child know they are taking warfarin so that they can avoid giving other medications that might interfere with the warfarin. Your child may wear a MedicAlert or other special bracelet to let medical personnel know immediately about the medicine in case of an accident or emergency. 5
6 Although physical exercise and activity are important, your child should avoid contact and competitive sports that may result in a serious fall or injury. It may be necessary to modify your child s school physical education program. You should speak with your child s healthcare provider about any physical activity restrictions. Store the warfarin tablets at room temperature in a safe place, out of the reach of small children. What should be done if warfarin is taken accidentally by another person? Contact the California Poison Control Center , which is available 24 hrs per day, 7 days per week. Be prepared to bring the person who took the medicine accidentally and the bottle of the medication to the emergency room. What does warfarin look like? Warfarin is available in many different strengths and sizes. It is important to identify the correct tablet strength prior to taking each dose. Tablet Strength 1mg 2mg 2.5mg 3mg 4mg 5mg 6mg 7.5mg 10mg Tablet Color Pink Lavendar Green Tan Blue Peach Teal Yellow White 6
7 Notes 7
8 Access our patient education library online at SDPED0660 Rev. 5/10
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