Anticoagulants (Systemic)

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For anticoagulants, the following should be considered:

Allergies - Tell your doctor if you have ever had any unusual or allergic reaction to an anticoagulant. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy - Anticoagulants may cause birth defects. They may also cause other problems affecting the physical or mental growth of the fetus or newborn baby. In addition, use of this medicine during the last 6 months of pregnancy may increase the chance of severe, possibly fatal, bleeding in the fetus. If taken during the last few weeks of pregnancy, anticoagulants may cause severe bleeding in both the fetus and the mother before or during delivery and in the newborn infant.

Do not begin taking this medicine during pregnancy, and do not become pregnant while taking it , unless you have first discussed the possible effects of this medicine with your doctor. Also, if you suspect that you may be pregnant and you are already taking an anticoagulant, check with your doctor at once. Your doctor may suggest that you take a different anticoagulant that is less likely to harm the fetus or the newborn infant during all or part of your pregnancy. Anticoagulants may also cause severe bleeding in the mother if taken soon after the baby is born.

Breast-feeding - Warfarin is not likely to cause problems in nursing babies. Other anticoagulants may pass into the breast milk. A blood test can be done to see if unwanted effects are occurring in the nursing baby. If necessary, another medicine that will overcome any unwanted effects of the anticoagulant can be given to the baby.

Children - Very young babies may be especially sensitive to the effects of anticoagulants. This may increase the chance of bleeding during treatment.

Older adults - Elderly people are especially sensitive to the effects of anticoagulants. This may increase the chance of bleeding during treatment.

Other medicines - Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Many different medicines can affect the way anticoagulants work in your body . Therefore, it is very important that your health care professional knows if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine, especially:

• Amiodarone (e.g., Cordarone) or
• Cimetidine (e.g., Tagamet) or
• Metronidazole (e.g., Flagyl) or
• Omeprazole (e.g., Prilosec) or
• Zafirlukast (e.g., Accolate) - Effects of anticoagulants may be increased because of slower removal from the body

• Anabolic steroids (nandrolone [e.g., Anabolin], oxandrolone [e.g., Anavar], oxymetholone [e.g., Anadrol], stanozolol [e.g., Winstrol]) or
• Androgens (male hormones) or
• Antifungals, azole (e.g., Diflucan) or
• Antithyroid agents (medicine for overactive thyroid) or
• Aspirin or other salicylates, including bismuth subsalicylate (e.g., Pepto-Bismol) or
• Cephalosporins (medicine for infection) or
• Cinchophen or
• Clofibrate (e.g., Abitrate, Atromid-S) or
• Danazol (e.g., Danocrine) or
• Dextrothyroxine or
• Diflunisal or
• Disulfiram (e.g., Antabuse) or
• Fluvoxamine (e.g., Luvox) or
• Inflammation or pain medicine (except narcotics) or
• Lepirudin (e.g., Refludan) or
• Medications causing low platelet count or
• Paroxetine (e.g., Paxil) or
• Propafenone (e.g., Rythmol) or
• Quinidine (e.g., Quinidex) or
• Sertraline (e.g., Zoloft) or
• Sulfapyridine or
• Sulfasalazine (e.g., Azulfidine) or
• Thyroid hormones or
• Ticlopidine (e.g., Ticlid) or
• Zileuton (e.g., Zyflo) - These medications may increase the effects of anticoagulants and may increase the chance of bleeding

• Carbenicillin by injection (e.g., Geopen) or
• Dipyridamole (e.g., Persantine) or
• Divalproex (e.g., Depakote) or
• Moxalactam (e.g., Moxam) or
• Pentoxifylline (e.g., Trantal) or
• Plicamycin (e.g., Mithracin) or
• Sulfinpyrazone (e.g., Anturane) or
• Thrombolytic agents (medicine for blood clots) or
• Ticarcillin (e.g., Ticar) or
• Valproic acid (e.g., Depakene) - Using any of these medicines together with anticoagulants may increase the chance of bleeding

• Alcohol (with chronic use) or
• Barbiturates or
• Carbamazepine (e.g., Tegretol) or
• Corticosteroids (cortisone-like medicine) or
• Glutethimide (e.g., Doriden) or
• Griseofulvin (e.g., Fulvicin) or
• Phenylbutazone (e.g., Butazolidin) or
• Phenytoin (e.g., Dilantin) or
• Primidone (e.g., Mysoline) or
• Rifampin (e.g., Rifadin) - Effects of anticoagulants may be decreased because of faster removal from the body

• Vitamin K (e.g., AquaMEPHYTON) - Vitamin K helps produce some important blood clotting factors and may decrease the effects of anticoagulants if used at the same time

Other medical problems - The presence of other medical problems may affect the use of anticoagulants. Many medical problems and treatments will affect the way your body responds to this medicine. Make sure you tell your doctor if you have any other medical problems, or if you have recently had any of the following conditions or medical procedures, especially:

• Aneurysm (swelling in a blood vessel) especially in the head or chest or
• Bleeding in the brain or
• Blood disorders or diseases, especially thrombocytopenia (low platelet count), polycythemia (high red blood cell count), or leukemia or
• Bruising, excessive or
• Cancer of the internal organs, especially of the abdomen or
• Childbirth, recent or
• Diabetes mellitus (sugar diabetes) or
• Diverticulitis or
• Falls or blows to the body or head or
• Heart infection or
• Hemophilia or other bleeding problems or
• Hypertension (high blood pressure) or
• Inflammation of blood vessels or
• Intestinal problems, especially conditions that may affect the absorption of food or vitamins or
• Liver disease or
• Pregnancy, terminated or
• Spinal anesthetics or spinal puncture or
• Surgery, major, especially of the head or eye, or dental surgery or
• Toxemia of pregnancy or
• Ulcers, active, of the stomach, lung, or urinary tract or
• Vitamin K deficiency or
• Wounds, open, surgical or from an ulcer - These conditions may increase the chance of bleeding

In addition, it is important that you tell your doctor if you are now being treated by any other medical doctor or dentist.