Warfarin

Description overdue on 19.10.2011

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Indirect anticoagulants. The liver Warfarin blocks clotting factors: 2, 7, 9 and 10. By reducing the concentration of these components in the blood slows down coagulation . The drug takes effect within 36-72ch maximum effect develops 5-7 days of therapy.

Indications:

Warfarin is used as the treatment and prevention embolism   pulmonary artery, venous thrombosis   (acute and recurrent course). The drug is prescribed for patients with atrial fibrillation for the prevention of thromboembolic complications after myocardial infarction, stroke , Ischemic attacks, post-operative thrombosis.

Contraindications:

Acute DIC, severe renal and hepatic systems thrombocytopenia , Acute bleeding, lack of proteins C and S, the presence of bleeding disorders, aortic aneurysm, esophageal varices, ulcerative lesions of the gastrointestinal tract, bacterial endocarditis, hemorrhagic stroke, intracranial hemorrhage, malignant hypertension.

Side effect:

Bleeding, dyspepsia, coumarin necrosis, hand-foot necrosis (more common in men with atherosclerosis), an allergy.

Mode of application:

Warfarin is taken daily at the same time. Before use, determine the level of INR (international normalized ratio). Control every 6 weeks. For those not previously treated with Warfarin starting dose is 2m. per day (5 mg per day). On the fifth day the dose change to 2, 5-7 and 5 mg per day depending on the INR. For those previously treated with Warfarin: the first four days appoint double maintenance dose. On day 5, the dose is adjusted depending on the level of INR. Ax children initial dose of warfarin is 0, 2 mg / kg per day. When violations Rabten hepatic system - 0, 1 mg / kg.

Overdose:

The effectiveness of the treatment of tight borders with the risk of bleeding, so patients should be warned about the possible minor bleeding: bleeding gums, microhematuria . Severe bleeding is administered intravenously Vitamin K , Fresh frozen plasma, clotting factor concentrates, give Activated carbon . Drug resistance develops over two weeks.

Special instructions:

Warfarin drug therapy involves full compliance with prescribed dosages. Be wary appoint patients with treatment dementia   and alcohol in mind the failure to comply with prescribed by doctors receive mode PM. The action of warfarin is enhanced in patients with febrile syndrome, cordial insufficiency hyperthyroidism , Diseases of the liver. At hypothyroidism   reduces the effectiveness of the drug. Moderate renal failure potentiates the effect of warfarin. Careful control of INR. In the appointment of warfarin is recommended for pain relief to take opioids, tramadol, paracetamol. If necessary, quick action antithrombotic treatment begins with an introduction Heparin , Followed by combination therapy of heparin and warfarin to achieve an INR target value. Starting concomitant warfarin dose should not exceed 5 mg. Elderly patients treated with caution prescribe, conduct regular monitoring of blood clotting and liver enzymes.

Drug Interactions:

Without consulting a doctor is not recommended to stop or start taking other drugs, change the dosage. Onovremenny clopidogrel, NSAIDs, acetylsalicylic acid , Dipyridamole, ticlopidine, Penicillin , Hloramfenikoloma, cimetidine, and other drugs that inhibit cytochrome P450 can lead to bleeding. Allopurinol , Bezafibrate, acetylsalicylic kisota, azithromycin , Vitamin A, vitamin E, glucagon, amitriptyline Glibenclamide, interferons, azapropazone, gemfibrozil, grepafloksatsin, heparin, diazoxide, dekstroproroksifen, disopyramide, ketoconazole , Ifosfamide, zafirlukast itraconazole , Nalidixic acid, clarithromycin , Codeine, metolazone, lovastatin, levamisole , Clofibrate, methotrexate, miconazole . metronidazole Paracetamol, omeprazole . ofloxacin . norfloxacin , Oxyphenbutazone, paroxetine, proguanin, piroxicam, roxithromycin . propranolol , Sulfaphenazole, sulfamethizole, sulphafurazole, steroid hormones , Sulindac, testosterone , Tegafur, tamoxifen, tetracyclines , Tolmetin, thienyl acid, ethanol, erythromycin   enhance the effects of warfarin.

Vitamin K, vitamin C, azathioprine, barbiturates, coenzyme Q10, cholestyramine, carbamazepine , Izopiramid, ritonavir, retinoids, trazodone, rofecoxib, rifampicin Cyclosporin weaken the effective action of the drug. Warfarin should not be taken simultaneously with drugs St. John's wort .