Let's learn more about Warfarin, a blood thinner.

Your doctor may have prescribed you a medicine called Warfarin to prevent blood clots in your body or for certain heart conditions. This is a very important medicine, but it can also cause problems if not used correctly. So today, let's talk about what you need to know about these Warfarin pills.

What kind of medicine is Warfarin?

Simply put, Warfarin is a blood thinner . That is, it prevents the formation of unnecessary blood clots in the blood vessels inside your body. Imagine, sometimes if blood clots form inside our blood vessels, it can cause very dangerous conditions. For example, things like heart attack and stroke.

Warfarin is mainly used for:

• Stop existing blood clots from getting bigger and prevent new ones from forming.
• Reduce the risk of stroke in people with certain heart conditions, such as atrial fibrillation (AFib).
• Prevent blood clots in people who have had heart valve replacements.

Doctors may sometimes use this medicine for other reasons. If you have any questions, ask your doctor or pharmacist.

This medication is usually marketed under the names Coumadin or Jantoven. However, it may also be available under other names. The name your doctor prescribes is important.

What are the things I need to tell the doctor before starting to take this medicine?

This is very important. Before you start taking Warfarin, there are some things you need to tell your doctor. This is because your doctor will decide whether or not this medicine is right for you, and what dose to give you.

Here are some such things:

• If you are addicted to alcohol (Alcoholism).
• If you have anemia.
• If you have bleeding disorders.
• If you have cancer.
• If you have diabetes (Diabetes Mellitus).
• If you have other heart diseases.
• If you have high blood pressure.
• If you have ever had bleeding in the stomach or intestines (bleeding in the gastrointestinal tract).
• If you have had a previous stroke, or if you have another brain-related disorder or disease.
• If you have kidney or liver disease.
• If you have conditions like Protein C deficiency or Protein S deficiency.
• If you have memory problems, such as psychosis or dementia.
• If you have recently had an injury, or are planning to have surgery or another medical procedure in the future.
• If you have an allergic reaction to warfarin, other medications, foods, dyes, or preservatives.
• It's okay if you're pregnant or trying to get pregnant.
• If you are a breastfeeding mother.

It is very important for your own safety to tell the doctor these things without hiding them.

How do you use this Warfarin pill exactly?

It is very important to know exactly how to use this medicine.

• Take with a glass of water: Warfarin tablets are to be taken orally, with a glass of water.
• Just like the doctor said: Follow the instructions on the prescription label exactly.
• Before or after meals: You can take this medicine either before or after meals. It doesn't matter.
• At the same time every day: This is very important. Try to take the medicine at the same time every day. That way, the medicine will work the same way in the body.
• Do not take more than prescribed: Do not take more than the dose prescribed by your doctor.
• Do not stop taking this medicine without your doctor's advice: Do not stop taking this medicine suddenly unless your doctor tells you to. Doing so may increase your risk of developing blood clots.
• Replenish your medication before it runs out: Don't forget to get a new supply of medicine from the pharmacy before your medication runs out.
• If you change your dose: Suppose your doctor calls and changes your warfarin dose. If so, write down the new dose and other instructions on a piece of paper. Make sure you understand it, and then go over the instructions with your doctor. Tell your doctor the strength of the pills you have. Ask how many pills you need to take to get to the new dose. Write the new instructions on the paper, along with the date, and keep them with your medicine. Sometimes you may be asked to stop taking the medicine until your next blood test. If this happens, if you do not hear back from your doctor within 24 hours of your test, call your doctor to ask about the new dose and when to start taking the old dose again.
• MedGuide: Every time you get medicine from the pharmacy, you will be given a MedGuide about the medicine. Always read it carefully. It contains a lot of important information for you.

Important: This medicine is for you only. Do not give it to anyone else, even if they have the same symptoms you have.

Should this medicine be given to children?

Children need special care when taking warfarin, so be sure to discuss this with your doctor.

What if I take too much medicine?

If you think you have taken too much of this medicine, call a poison control center or the nearest hospital emergency room immediately.

What to do if you miss a dose of medicine?

It is very important not to skip a dose of warfarin , as it can alter the blood's ability to thin.

• If you miss a dose of medication, call your doctor immediately.
• If possible, take the missed dose as soon as you remember on the same day .
• However, if it is almost time for your next dose, do not take the missed dose. Just take your next dose at the scheduled time.
• Never take a double dose to make up for a missed dose.

What other medications may interact with Warfarin?

This is also something to be very careful about. Warfarin is a drug that can interact with many other medications, herbs, and even dietary supplements. These interactions can increase or decrease the effects of Warfarin. If this happens, there may be a risk of bleeding or blood clots.

Do not take Warfarin with the following medications for any reason:

• Defibrotide

Additionally, the following medications may interact with Warfarin:

• Acyclovir
• Allopurinol
• Aspirin and other NSAIDs (e.g., ibuprofen, naproxen)
• Some antibiotics (e.g. Erythromycin, Clarithromycin, Ciprofloxacin)
• Some antivirals given for diseases such as HIV or hepatitis
• Other medications that prevent blood clotting (e.g., Heparin, Enoxaparin, Clopidogrel)
• Some medications for blood pressure, heart disease, and heart rhythm disorders
• Some cholesterol-lowering medications (e.g., atorvastatin, simvastatin)
• Some medications for depression, anxiety, or other mental illnesses
• Some medications for fungal infections (e.g., Fluconazole, Ketoconazole)
• Some medications for seizures (e.g., Carbamazepine, Phenytoin)
• Female hormones, including birth control pills
• Herbs or supplements such as garlic, ginkgo, ginseng, green tea, and St. John's Wort
• Supplements containing Vitamin K
• Medicines that reduce stomach acid (e.g. Omeprazole, Ranitidine)
• Steroid-type medications (e.g., Prednisone)

This list is not exhaustive. Therefore, tell your doctor about all the medications you take (prescribed by a doctor, purchased from a pharmacy, herbs, vitamins, supplements), and if you smoke, drink alcohol, or use other drugs. Some things can interact with your warfarin medication.

What are the things we need to be especially careful about when taking Warfarin?

There are several factors that can affect your safety and the effectiveness of the medication while taking Warfarin.

• Regular blood tests (PT/INR): When you take warfarin, you will need to have a blood test called PT/INR regularly. This is how your doctor checks to see if the dose of warfarin you are taking is correct. Do not skip these blood tests. These tests will need to be done more frequently when you first start taking the medication. Once you find the right dose for you, the frequency of these tests will decrease.
• Medical ID: Wear a medical ID bracelet or chain that says you are taking warfarin. Also, always carry a card with you that lists your condition, the name of the medication, the dosage, and the times you take it. This can be very important in an emergency.
• When starting/stopping other medications: Do not start any new medication or stop taking any medication you are taking without your doctor's advice. This includes over-the-counter medications.
• Diet and Vitamin K: Talk to your doctor about your diet. Don't make big changes all at once. This is because a nutrient called Vitamin K affects the way Warfarin works. Many foods contain Vitamin K. Therefore, it is important to eat foods containing Vitamin K in the same way, in a consistent amount. For example, green vegetables like spinach, cabbage, broccoli, kale, spinach, green tea, asparagus, and brussel sprouts. Don't increase or decrease the amount of these foods all at once.
• Protect yourself from injuries: When taking warfarin, the risk of bleeding is higher. Therefore, be very careful when using sharp objects such as knives. Protect yourself from falls and bruises. Be careful when playing sports. Use an electric razor if possible. Be careful when brushing and flossing your teeth. Tell your doctor if you see any wounds, bruises, or red spots on your skin.
• If you get sick: Tell your doctor if you have been sick for more than a few days with vomiting, diarrhea, or fever. Also, tell your doctor if you are unable to eat properly for several days. These things can change the effect of warfarin.
• Even after stopping the medication: Even after you stop taking warfarin, it will take several days for your body's natural ability to clot blood to return to normal. Ask your doctor how long you should be careful. If you are going to have surgery or dental work, be sure to tell them that you are taking warfarin.

How does Warfarin affect pregnant and breastfeeding mothers?

This is a very important matter.

• During pregnancy: Warfarin is a medication that can cause birth defects and bleeding in the unborn baby. Therefore, women of childbearing age should use effective birth control if they are taking warfarin.
• If you become pregnant while taking warfarin, talk to your doctor immediately and discuss the potential risks and your options.
• During breastfeeding: If you are a breastfeeding mother, you should also talk to your doctor about taking warfarin.

What are the possible side effects of this medicine?

Like any medication, warfarin can cause some side effects. Some are serious and should be reported to your doctor immediately. Some are not so serious.

Side effects that you should report to your doctor immediately:

• Allergic reactions: Skin rash, itching, hives, swelling of the face, lips, tongue, or throat.
• Bleeding:
• Black, tarry stools, or blood in the stool.
• Vomiting blood, or vomiting something brown like coffee grounds.
• Urine turning red or dark brown.
• Small red or purple spots on the skin.
• Unusual bruising or bleeding (e.g. nosebleeds, bleeding gums).
• Bleeding in the brain: Severe headache, stiff neck, confusion, dizziness, vision changes, numbness or weakness in the face, arm, or leg, difficulty speaking, difficulty walking, vomiting.
• Dark or purple painful toes.
• Heavy periods in women.
• Painful swelling, heat, redness, blisters, or sores on the skin.

Side effects that usually do not require medical advice, but should be reported to your doctor if they persist or are bothersome:

• Diarrhea
• Hair loss

This list does not include all possible side effects. If you notice anything unusual in addition to these, please consult your doctor.

How do you store these Warfarin pills?

• Keep it out of reach of children and pets. This is very important.
• Store at room temperature. That is, between 15 and 30 degrees Celsius (59 and 86 degrees Fahrenheit).
• Protect from light.
• Throw away expired medicine.
• Do not flush it down the toilet.

The most important things for you to remember (Take-Home Message)

Warfarin is a drug that can be life-saving if used correctly, but it can also be dangerous if used incorrectly. Therefore,

• Take the medicine exactly as the doctor tells you, at the right time and in the right dose.
• Be sure to get your PT/INR blood tests done on the scheduled days.
• Inform your doctor about all other medications, herbs, and changes in diet and drink you are taking.
• Be aware of any signs of bleeding. Tell your doctor, even if it's just a little.
• If you are pregnant, trying to get pregnant, or are a breastfeeding mother, be sure to tell your doctor.
• If you have any questions or doubts, ask your doctor or pharmacist. Don't be afraid or embarrassed to ask.

I hope this information has helped you gain a better understanding of Warfarin. Stay healthy!

` Warfarin, blood clotting, blood thinning, heart disease, stroke, PT/INR, vitamin K