- A Visual Guide to Heart Disease
- Medical Illustrations of the Heart Image Collection
- Take the Heart Disease Quiz!
- What is warfarin, and how does it work (mechanism of action)?
- What brand names are available for warfarin?
- Is warfarin available as a generic drug?
- Do I need a prescription for warfarin?
- What are the uses for warfarin?
- What are the side effects of warfarin?
- What is the dosage for warfarin?
- Which drugs or supplements interact with warfarin?
- Is warfarin safe to take if I'm pregnant or breastfeeding?
- What else should I know about warfarin?
What is warfarin, and how does it work (mechanism of action)?
- Warfarin is an oral anticoagulant, a drug that inhibits the clotting of blood. It prevents the formation of blood clots by reducing the production of factors by the liver that promote clotting, factors II, VII, IX, and X, and the anticoagulant proteins C and S. The production of these factors by the liver are dependent on adequate amounts of vitamin K. Warfarin reduces the production of the factors because it antagonizes vitamin K. Blood clots can occur in the veins of the lower extremities (deep venous thrombosis [DVT]), often after periods of immobility. These clots can break off and become lodged in the blood vessels of the lung (pulmonary embolism), causing shortness of breath, chest pain, and even life-threatening shock. Blood clots can also occur in the atria of the heart during atrial fibrillation and around artificial heart valves. These clots also can break off and obstruct blood vessels in the brain, causing an embolic stroke with paralysis. Warfarin is important in preventing the formation of blood clots, preventing extension of clots already formed, and minimizing the risk of embolization of blood clots to other vital organs such as the lungs and brain.
- The FDA approved warfarin in June 1954.
What are the uses for warfarin?
- Warfarin is used in treating patients with deep vein thrombosis (DVT) to prevent extension of the clot, and to reduce the risk of pulmonary embolism.
- Patients with pulmonary embolism are treated with warfarin to prevent further emboli.
- Warfarin also is used in patients with atrial fibrillation or artificial heart valves to reduce the risk of strokes, and after a heart attack.
- It also is helpful in preventing blood clots from forming in certain orthopedic surgeries such as knee or hip replacements.
- Warfarin is used in preventing closure of coronary artery stents due to clotting.
What are the side effects of warfarin?
The two most serious side effects of warfarin are:
- Necrosis (gangrene) of the skin
Bleeding can occur in any organ or tissue. Bleeding around the brain can cause severe headache and paralysis. Bleeding in the joints can cause joint pain and swelling. Bleeding in the stomach or intestines can cause weakness, fainting spells, black tarry stools, vomiting of blood, or coffee ground material. Bleeding in the kidneys can cause back pain and blood in urine.
Other side effects include:
Quick GuideHeart Disease: Symptoms, Signs, and Causes
What is the dosage for warfarin?
- Warfarin may be taken with or without food.
- Since warfarin is metabolized (inactivated) by the liver and then excreted by the kidneys, dosages need to be lowered in patients with liver and kidney dysfunction.
- Frequent blood tests (INR test) are performed to measure the effect of warfarin and to adjust dosing.
- There are published INR ranges for the various uses of warfarin.
- Treatment usually is started at 2 to 5 mg once daily and the dose is adjusted based in INR tests.
- Patients typically require 2 to 10 mg of warfarin daily.
Which drugs or supplements interact with warfarin?
- Many drugs, both prescription and nonprescription (OTC), can affect the anticoagulant action of warfarin or increase the risk of bleeding. Patients on warfarin should regularly consult their doctor before instituting any medications on their own.
- It also is advisable for patients on warfarin to carry identification such as bracelets to alert other health professionals to the presence of anticoagulation.
- A few examples of drugs that interact with warfarin are:
- Drugs that increase the effect of warfarin by reducing the breakdown of warfarin include amiodarone (Cordarone), trimethoprim/sulfamethoxazole (Bactrim), fluconazole (Diflucan), itraconazole (Sporanox), fluvastatin, fluvoxamine, metronidazole miconazole, voriconazole (Vfend), zafirlukast (Accolate), ciprofloxacin (Cipro), cimetidine, atorvastatin (Lipitor), clarithromycin (Biaxin), fluoxetine (Prozac), indinavir (Crixivan), and ritonavir (Norvir).
- Drugs that may reduce the effect of warfarin by increasing its breakdown include St. John's wort, carbamazepine (Tegretol, Tegretol XR, Equetro, Carbatrol), rifampin, bosentan (Tracleer), and prednisone.
- Bleeding is increased by other anticoagulants such as heparin, argatroban (Acova), dabigatran (Pradaxa), and others; antiplatelet drugs such as aspirin and other nonsteroidal anti-inflammatory drugs (for example, ibuprofen [Motrin], naproxen [Alleve]), clopidogrel (Plavix), and prasugrel (Effient); serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) and paroxetine (Paxil). Garlic and ginkgo also increase the risk of bleeding because they cause bleeding when taken alone.
- Foods with high vitamin Ka> content (for example, green leafy vegetables) reduce the effect of warfarin. Maintenance of a consistent intake of vitamin K containing foods is important to avoid fluctuations in the effect of warfarin.
Is warfarin safe to take if I'm pregnant or breastfeeding?
What else should I know about warfarin?
What preparations of warfarin are available?
- Tablets: 1, 2, 2.5, 3, 4, 5, 6, 5, 7.5 and 10 mg.
- Powder for Injection: 5 mg/vial
How should I keep warfarin stored?
Warfarin should be stored at room temperature, 59 F to 86 F (15 C to 30 C), in tight, light resistant container.
Warfarin (Coumadin, Jantoven) is an anticoagulant drug that inhibits the blood from clotting, thus preventing blood clots. It is prescribed for the treatment of patients with deep vein thrombosis, the reduction of pulmonary embolism, and in patients with atrial fibrillation to reduce the risk of strokes and heart attack. Common side effects of warfarin include:
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- Heart Disease FAQs
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- Atrial Fibrillation A-Fib FAQs
- Medication Disposal
- Dangers of Mixing Medications
- Drugs: Buying Prescription Drugs Online Safely
- Drugs: The Most Common Medication Errors
- How To Reduce Your Medication Costs
- Pharmacy Visit, How To Get The Most Out of Your Visit
- Indications for Drugs: Approved vs. Non-approved
- What Pain Medication Can I Take While on Warfarin?
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- Nosebleeds: First Aid
- Herbs: Toxicities and Drug Interactions
- Head Injury Symptoms, Types, and Severity
- Generic Drugs, Are They as Good as Brand-Names?
Medications & Supplements
Prevention & Wellness
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Healthy Heart Resources
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
Top warfarin Related Articles
Atrial Fibrillation QuizLearn the causes, symptoms, and treatments of the common heart abnormality known as atrial fibrillation (A-fib).
A-Fib SlideshowAtrial fibrillation is the most common type of abnormal heart rhythm. Atrial fibrillation or AF can lead to serious heart complications like stroke. Risks associated with AFib are related to heart rhythm changes. Treating atrial fibrillation addresses these changes in heartbeat.
Blood ClotsBlood clots can occur in the venous and arterial vascular system. Blood clots can form in the heart, legs, arteries, veins, bladder, urinary tract and uterus. Risk factors for causes of blood clots include high blood pressure and cholesterol, diabetes, smoking, and family history.
Symptoms of a blood clot depend on the location of the clot. Some blood clots are a medical emergency. Blood clots are treated depending upon the cause of the clot. Blood clots can be prevented by lowering the risk factors for developing blood clots.
BronchoscopyBronchoscopy is a procedure during which a patient's lung, airways, voice box, vocal cord, trachea, and many branches of the bronchi may be evaluated. There are two types of bronchoscopies: a flexible fiberoptic bronchoscope and a rigid bronchoscope. Bronchoscopy can be used for diagnosis and treatment. Some indications for bronchoscopy include:
- persistent unexplained cough,
- bloody sputum,
- abnormal chest x-ray,
- evaluation of possible lung infection,
- remove foreign bodies in the airway,
- place a stent to open a collapsed lung,
- or to remove a mass or growth blocking the airway.
Congestive Heart Failure (CHF) OverviewCongestive heart failure (CHF) refers to a condition in which the heart loses the ability to function properly. Heart disease, high blood pressure, diabetes, myocarditis, and cardiomyopathies are just a few potential causes of congestive heart failure. Signs and symptoms of congestive heart failure may include fatigue, breathlessness, palpitations, angina, and edema. Physical examination, patient history, blood tests, and imaging tests are used to diagnose congestive heart failure. Treatment of heart failure consists of lifestyle modification and taking medications to decrease fluid in the body and ease the strain on the heart. The prognosis of a patient with congestive heart failure depends on the stage of the heart failure and the overall condition of the individual.
Deep Vein Thrombosis
Deep vein thrombosis (DVT) is a blood clot in the deep veins, and can be caused by broken bones, trauma to a limb, immobility, medications, smoking, cancer, genetic predisposition, and cancer. Symptoms of a deep vein thrombosis in a leg are swelling, tenderness, redness, warmth, and pain.
Treatment for DVT include medications and surgery.
DVT SlideshowDeep vein thrombosis (DVT) is a dangerous and sometimes fatal blood clot that occurs deep within the lower leg or thigh. Understand the symptoms, treatment and prevention of deep vein thrombosis (DVT).
Heart Attack Symptoms and Early Warning SignsRecognizing heart attack symptoms and signs can help save your life or that of someone you love. Some heart attack symptoms, including left arm pain and chest pain, are well known but other, more nonspecific symptoms may be associated with a heart attack. Nausea, vomiting, malaise, indigestion, sweating, shortness of breath, and fatigue may signal a heart attack. Heart attack symptoms and signs in women may differ from those in men.
CAD SlideshowWhat is heart disease (coronary artery disease)? Learn about the causes of heart disease. Symptoms of heart disease include chest pain and shortness of breath. Explore heart disease diagnosis, treatment, and prevention.
Heart Disease SlideshowLearn about heart disease and heart attack symptoms and signs of a heart attack in men and women. Read about heart disease diagnostic tests, treatments, and prevention strategies.
Heart Disease QuizTake our Heart Disease Quiz to get answers and facts about high cholesterol, atherosclerosis prevention, and the causes, symptoms, treatments, testing, and procedures for medically broken hearts.
Illustrations of the HeartThe muscle that pumps blood received from veins into arteries throughout the body. See a picture of the Heart and learn more about the health topic.
Internal BleedingInternal bleeding occurs when an artery or vein is damaged and blood to escapes the circulatory system and collects inside the body. Internal bleeding can be caused by a variety of situations such as blunt trauma, deceleration trauma, medications, fractures, and spontaneous bleeding. Treatment of internal bleeding depends on the cause of the bleeding.
Peripheral Vascular Disease
Peripheral vascular disease (PVD) refers to diseases of the blood vessels (arteries and veins) located outside the heart and brain. While there are many causes of peripheral vascular disease, doctors commonly use the term peripheral vascular disease to refer to peripheral artery disease (peripheral arterial disease, PAD), a condition that develops when the arteries that supply blood to the internal organs, arms, and legs become completely or partially blocked as a result of atherosclerosis. Peripheral artery disease symptoms include intermittent leg pain while walking, leg pain at rest, numbness in the legs or feet, and poor wound healing in the legs or feet.
Treatment for peripheral artery disease include lifestyle measures, medication, angioplasty, and surgery.
Pulmonary EmbolismA pulmonary embolism (PE) occurs when a piece of a blood clot from deep vein thrombosis (DVT) breaks off and travels to an artery in the lung where it blocks the artery and damages the lung. The most common symptoms of a pulmonary embolism are shortness of breath, chest pain, and a rapid heart rate. Causes of pulmonary embolism include prolonged immobilization, certain medications, smoking, cancer, pregnancy, and surgery. Promt medical attention should be sought if you think you or someome you know has a pulmonary embolus.
Take the Stroke QuizTake the Stroke Quiz to learn about stroke risks, causes, treatment, and most importantly, prevention.
Stroke Symptoms and Treatment
A stroke is an interruption of the blood supply to part of the brain caused by either a blood clot (ischemic) or bleeding (hemorrhagic).
Symptoms of a stroke may include:
- double vision or vision loss,
- difficulty speaking or understanding speech.
A physical exam, imaging tests, neurological exam, and blood tests may be used to diagnose a stroke. Treatment may include administration of clot-busting drugs, supportive care, and in some instances, neurosurgery. The risk of stroke can be reduced by controlling high blood pressure, high cholesterol, diabetes, and stopping smoking.
Total Hip ReplacementDuring total hip replacement, diseased hip cartilage and bone is replaced with artificial materials. Risks of the surgery include blood clots in the lower extremities, difficulty with urination, infection, bone fracture, scarring, limited range of motion, and prosthesis failure.