Managing Your Coumadin

Transcription

1 HANDBOOK Managing Your Coumadin Coumadin (generically known as warfarin) is a blood thinner. Your provider has prescribed this medicine because your medical condition benefits from your blood clotting more slowly than normal. Coumadin helps prevent clots from forming in blood vessels and in the heart. This is important in such conditions as stroke, an irregular heartbeat called atrial fibrillation, pulmonary emboli, deep venous thrombosis, and after some heart attacks. How Coumadin Works 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 hours to occur. The effects of a single dose of medication can last 2-5 days. This means when you first start taking coumadin you may have to have testing every day for a few days, then perhaps one time per week. Once stabilized, you will still receive testing at periodic intervals (such as one time per month) throughout your course of therapy to keep the blood thinned in the best range for your medical condition. 1

2 Taking Coumadin It is very important to take Coumadin exactly as directed by your physician. Too much Coumadin can cause bleeding, and not enough Coumadin can allow dangerous blood clots to form. Your provider will determine how much medicine you need by monitoring the blood clotting levels with the PT/INR. You will need to have this blood tested regularly, because the correct dose of warfarin for you can change over time. Based on the results, your 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) 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. Diet Diet and medications can alter the effect of warfarin on the blood. Many foods you eat have Vitamin K in them which help your blood make clots faster. Foods containing fat substitutes, such as Olestra (Olean) are supplemented with fat-soluble vitamins including Vitamin K. Herbal teas that have tonka beans, sweet woodruff or melilot should also be limited because of high content of Vitamin K. FOODS RICH IN VITAMIN K: Cauliflower Lettuce, parsley, watercress and endive Turnip greens, collard greens, mustard greens Scallions (green onions) Peas Garbanzo beans (chick peas) Asparagus Green/herbal teas, coffee Liverwurst, beef liver Soybean and canola oil Spinach Kale Brussels sprouts Broccoli Cabbage Mayonnaise 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. 2

3 Non-Prescription Medication Some medications can interact and/or interfere with warfarin causing serious side effects. 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, Nuprin) or naproxen (Aleve) Vitamin K, Vitamin C, Vitamin E, or other high potency vitamins Laxatives such as mineral oil or Ex Lax Antacids such as Maalox, Mylanta, or Gelusil with or just before taking warfarin *H2-receptor antagonists such as cimetidine (Tagamet) or ranitidine (Zantac) Herbal remedies or preparations YOU CAN USE: Low dose acetaminophen (Tylenol) NOTE: The amount of acetaminophen should be as low as possible and monitored carefully. High doses of acetaminophen can prolong the INR. Milk of Magnesia or Colace A general multivitamin that does not contain more than 100% RDA of various components and does not contain Vitamin K Always let your provider here at Pacific Medical Group know of any new non-prescription medications you wish to take before you begin taking them. Also, before any healthcare providers, including dentists, prescribe a new medication remind them you are taking Coumadin (warfarin). Side Effects of Coumadin The side effects of Coumadin are excessive bleeding 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: Red, dark, or cloudy urine Red or black color in your stool Bleeding from gums or nose Unexpected or unusual bruising Excessive bleeding from minor cuts i.e. shaving (bleeding doesn t stop after 10 to 15 minutes) Excessive menstrual bleeding Vomiting blood or coffee ground like material Coughing up blood Visual changes or loss of vision Weakness or loss of sensation Headache or dizziness Unusual pain or swelling 3

4 Frequently Asked Questions Q: What if I cut myself, get a cut that won t stop bleeding, or have an injury? A: Call your provider. Q: What if I become pregnant? A: Stop your medicine. Let us and/or your gynecologist know you are pregnant. Q: What if I forget to take a Coumadin (warfarin) tablet? A: Do not take another tablet to catch up if it is the next day. Call your provider for directions. If you realize the same day you were to take your pill, go ahead and take it. Wait 24 hours before taking your next pill. Q: What if Coumadin therapy is stopped? A: The clot blocking effect last for an additional 2-5 days, then your blood returns to normal. 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. You should also make sure you have enough medication to travel. Q: What if I want to participate in a sport or physical activity? A: Ask your healthcare provider first. You will want to avoid any activity or sport which may result in a serious fall or other injury. Q: Does cooking, freezing, or drying foods change how much Vitamin K is in them? A: There is little information about the effects of cooking, freezing, or drying the Vitamin K content of foods. It appears the content is about the same in fresh foods as is in prepared foods. 4

5 COUMADIN DO S Do take your coumadin as your health care provider tells you. Do take your Coumadin about the same time every day, preferably in the evening. Do keep eating habits and activities similar each day. Do get your bloodwork tested as instructed by your provider. Do refill your prescriptions according to your providers instructions Do notify all your physicians, your dentist, and 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. COUMADIN DON TS The providers at Pacific Medical Group hope this booklet has provided you information and answered questions you may have about the medication, Coumadin. Although a very valuable medication in the treatment of many medical conditions, it has significant risks involved in administration which we will need to monitor closely together. Thank you for allowing us to serve as your Healthcare Provider. 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. 5