- 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.
Reference: FDA Prescribing Information
Quick GuideHeart Disease: Symptoms, Signs, and Causes
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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- Herbs: Toxicities and Drug Interactions
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- How To Reduce Your Medication Costs
- Pharmacy Visit, How To Get The Most Out of Your Visit
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- Dangers of Mixing Medications
Medications & Supplements
Prevention & Wellness
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Heart-Healthy FoodsSee 25 foods loaded with heart-healthy nutrients that help protect your cardiovascular system. Plus, find easy meal/recipes and menu ideas for heart health.
Antiphospholipid SyndromeAntiphospholipid syndrome (phospholipid antibody syndrome or Hughes syndrome) is an immune system disorder with symptoms that include:
- excessive blood clotting,
- unexplained fetal death,
- or premature birth.
Aortic StenosisAortic valve stenosis is an abnormal narrowing of the aortic valve of the heart. The causes of aortic stenosis are wear and tear of the valve in the elderly, congenital, or scarring or scarring of the aortic valve from rheumatic fever. Symptoms include angina, fainting, and shortness of breath. Treatment is dependant upon the severity of the condition.
Atrial fibrillation (AF or AFib) is an abnormality in the heart rhythm which involves irregular and often rapid beating of the heart. Symptoms may include:
- Shortness of breath
- Chest pain
Treatment may include medication or procedures like cardioversion or ablation to normalize the heart rate.
Atrial Fibrillation QuizLearn the causes, symptoms, and treatments of the common heart abnormality known as atrial fibrillation (A-fib).
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.
Heart AttackHeart attack happens when a blood clot completely obstructs a coronary artery supplying blood to the heart muscle. A heart attack can cause chest pain, heart failure, and electrical instability of the heart.
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.
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Marfan syndrome is hereditary (genetic) condition affecting connective tissue. A person with Marfan syndrome may exhibit the following symptoms and characteristics:
- Dislocation of one or both lenses of the eye
- A protruding or indented breastbone
- Flat feet
- Aortic dilatation
- Dural ectasia (a problem with the sac surrounding the spinal cord)
- Stretch marks
- Collapsed lung
Though there is no cure for Marfan syndrome, there are treatments that can minimize and sometimes prevent some complications.
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
Treatment for peripheral artery disease includes: lifestyle measures, medication, angioplasty, and surgery.
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,
- vertigo, and
- 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.