Northwestern Memorial Hospital Patient Education ABOUT YOUR MEDICATIONS Follow the important diet guidelines in this brochure to keep your blood levels stable. Warfarin Sodium (Coumadin ) Warfarin sodium (Coumadin ) is a drug that prevents blood clots from forming in the blood. It may be called an anticoagulant or blood thinner. Warfarin does not actually thin the blood, but works to prevent new clots from forming, or existing clots from becoming bigger and causing more serious problems. Warfarin does not dissolve clots that already have formed. It is used to prevent harmful clotting related to certain blood vessel, heart and lung conditions. Dosage and Administration, PT/INR Testing Your doctor or pharmacist selects the correct dose of warfarin by doing blood tests called an international normalized ratio (INR) and a prothrombin time (PT or pro-time). These tests show how long it takes your blood to clot. If your clotting time is too high or low, the dose of warfarin will be changed. When you first start taking warfarin, your INR or PT will be checked often. This is to determine a safe and effective dose. Once your dose is set, you may not need your INR or PT checked as often. But it must still be done on a regular basis. This helps to ensure your dose is working properly. Too high of a dose may cause bleeding. Too low of a dose may not be enough to prevent blood clots from forming. Take this medicine only as directed by your doctor. Take warfarin at the same time each day. Evening is usually best, but check with your doctor or pharmacist. Warfarin can be taken with or without food. Take exactly the amount of Warfarin prescribed. Do not take more or less. Do not take warfarin more often than your doctor prescribed. Do not take it for a longer time than your doctor prescribed. Keep a log or record of each dose as you take it to avoid mistakes. Bring this to each doctor or clinic visit. Missed Dose If you miss a dose: Take it as soon as you remember, unless it is close to your next dose. If it is close to your next dose, skip the missed dose and take it at the scheduled time. This way, you do not take a double or extra dose. Then resume your regular dosing schedule. Always tell your doctor or pharmacist about each missed dose.
Food Interactions and Guidelines It is important to maintain a consistent diet. Foods that contain Vitamin K can affect the way this medicine works. Abrupt changes in your diet, especially crash diets, food fads, or diet supplements may change the amount of vitamin K in your body. This may then affect the way your body bleeds or clots. A consistent diet is best. Plan to eat the same types and amounts of foods that contain Vitamin K on a regular basis. For example, if you usually eat 3 salads each week, then it s good to continue eating 3 salads each week. It is best to avoid eating large amounts of foods that are high in vitamin K (see list below). However, you do not need to remove all such foods from your diet. Remember, consistency is the key! The following are some common sources of Vitamin K. If you eat these foods, try to stay with the same amount each time. Substitute foods from this list with others containing a similar amount of Vitamin K when you plan your meals. If you have any questions or change how often you eat these foods, contact your doctor, nurse or pharmacist. Food Amount Vit K Content (mcg) High to Moderate Vitamin K Foods Kale, cooked ½ cup 531 Spinach, cooked ½ cup 444 Collard greens, cooked ½ cup 418 Swiss chard, raw 1 cup 299 Swiss chard, cooked ½ cup 287 Mustard greens, raw 1 cup 279 Turnip greens, cooked ½ cup 265 Parsley, raw ¼ cup 246 Broccoli, cooked 1 cup 220 Brussels sprouts, cooked 1 cup 219 Mustard greens, cooked ½ cup 210 Collard greens, raw 1 cup 184 Spinach, raw 1 cup 145 Lower Vitamin K Foods Lettuce, green leaf, raw 1 cup 97 Cabbage, cooked ½ cup 81 Asparagus 4 spears 48 Broccoli, raw ½ cup 45 Kiwi fruit 1 medium 31 Blackberries or blueberries, raw 1 cup 29 Pickles, cucumbers, dill or kosher dill 1 pickle 25 Grapes, red or green 1 cup 23 Peas, cooked ½ cup 19 2
Alcohol Drinking too much alcohol may change the way this medicine works in your body. It is best to avoid alcohol. Please talk with your doctor if you have questions about alcohol intake. Drug/Herbal Interactions Some antibiotics affect the way warfarin works. Please be sure to tell your warfarin (Coumadin ) doctor or pharmacist before taking any new antibiotics. Some over-the-counter (OTC*) medicines can increase or decrease the effect of warfarin. It is important to talk to your doctor or pharmacist before you use: Any OTC medicines. Herbal medicines or supplements. Vitamins (many contain vitamin K). If you need to take vitamins, be sure to take them daily at the same time. Products containing vitamins A and E. Large amounts of A and E may affect warfarin. Ginkgo, ginseng, garlic tablets, St. John s Wort, co-enzyme Q10, fish oil, Dong Quai, feverfew, ginger, licorice, willow bark, wheat grass and flaxseed oil. Green tea, grapefruit or cranberry juice. Aspirin or other pain medicines known as NSAIDs (Non-steroidal anti-inflammatory drugs). When buying a pain reliever, always read the label ingredients and ask your doctor, nurse or pharmacist for advice if you are unsure what they contain. A few common OTC medicines to avoid are: Aspirin-Containing Medications Excedrin Anacin Bufferin Cold or sinus medicine; laxatives or antacids. Aspirin or NSAIDS may be a hidden ingredient in these. However, there are some conditions that are best treated with both warfarin and aspirin. Do not take both aspirin and warfarin unless your doctor has advised you to do so. *OTC refers to medicines bought without a prescription. NSAIDs Ibuprofen (Advil, Midol, etc.) Ketoprofen Naproxen (Aleve ) 3
Special Instructions Do not take this medicine if you are allergic to warfarin or any ingredients in warfarin (such as lactose, starch, magnesium stearate, and certain food dyes). Do not begin taking this medicine during pregnancy, and do not become pregnant while taking it. This medicine can cause birth defects. Consult your doctor if you plan to become pregnant. Do not change your weight by dieting without talking with your doctor. If you will be travelling for any length of time, inform your doctor. Tell all of your doctors (including your dentist) and pharmacists that you are taking warfarin. Keep all drugs out of the reach of children. Store medicine away from heat and direct light. Do not store in the bathroom, near the kitchen sink or in other damp places. Heat or moisture may cause the medicine to break down. Do not keep outdated medicine that is no longer needed. Be sure that any discarded medication is out of the reach of children. Be Safe! Warfarin can increase your risk of bleeding. Be sure to take caution when performing activities that could cause injury. Report to your doctor any falls, blows to the body or head or other injuries. Place a non-slip bath mat in the tub to prevent accidents. Be careful to avoid cutting yourself. This includes taking special care in brushing your teeth and in shaving. Use a soft toothbrush and use dental floss gently. Also, it is best to use an electric shaver rather than a razor blade. If you cut yourself, apply pressure to the area for 5 minutes to make sure the bleeding has stopped. It is important that you carry identification, such as a MedicAlert bracelet, stating that you are taking this medicine so that proper treatment can be given in case of an emergency. When to Call the Doctor Notify your doctor right away if any of the following occur: Signs of Bleeding: Prolonged bleeding from cuts or wounds Nosebleed Coughing up blood Blood in urine or stool 4
Black stool (if not taking iron supplements) Bloody gums Unusual bruising or change in skin color Dizziness, faintness Stomach or intestinal upset Continuing headaches Unusually heavy menstrual bleeding Signs of Clotting: Difficulty breathing Chest pain Dizziness Shortness of breath Swelling and/or redness in the legs or arms Pain when walking or pain and warmth of the arms or legs Less common side-effects include fever, nausea and other swelling. Please ask questions to make certain you understand how much medicine to take and when to take it. Please call your doctor if you have any questions. Northwestern Medicine Health Information Resources For more information, contact Northwestern Memorial Hospital s Alberto Culver Health Learning Center (HLC) at hlc@nm.org, or by calling 312.926.5465. You may also visit the HLC on the 3rd floor, Galter Pavilion at 251 E. Huron St., Chicago, IL. Health information professionals can help you find the information you need and provide you with personal support at no charge. For more information about Northwestern Medicine, please visit our website at nm.org. Para asistencia en español, por favor llamar al Departamento de Representantes para Pacientes al 312.926.3112. The entities that come together as Northwestern Medicine are committed to representing the communities we serve, fostering a culture of inclusion, delivering culturally competent care, providing access to treatment and programs in a nondiscriminatory manner and eliminating healthcare disparities. For questions, please call either Northwestern Memorial Hospital s Patient Representatives Department at 312.926.3112, TDD/TTY 312.926.6363, the Northwestern Lake Forest Patient Relations manager at 847.535.8282 and/or the Northwestern Medical Group Patient Representatives Department at 312.695.1100, TDD/TTY 312.926.6363. Developed by: NMH Department of Pharmacy, Clinical Nutrition and BCVI Nursing October 2016 Northwestern Memorial HealthCare 900364 (10/16) Warfarin Sodium (Coumadin )