Warfarin, pills 2.5 mg, 100 pcs.

Composition

1 tablet contains warfarin sodium 2.5 mg

. Pharmacological action

Warfarin Nicomed is an indirect anticoagulant. Blocks the synthesis of vitamin K-dependent blood clotting factors in the liver, namely II, VII, IX and X. The concentration of these components in the blood decreases, the blood clotting process slows down. The onset of anticoagulant action is observed in 36-72 hours after the start of Warfarin Nicomed application, with the development of the maximum effect on 5-7 days from the start of application. After discontinuation of the drug, the activity of vitamin K-dependent blood clotting factors is restored within 4-5 days.

Indications

• Treatment and prevention of thrombosis and embolism of blood vessels:
• acute and recurrent venous thrombosis, pulmonary embolism;
• transient ischemic attacks and strokes;
• secondary prevention of myocardial infarction and prevention of thromboembolic complications after myocardial infarction;
• prevention of thromboembolic complications in patients with atrial fibrillation, heart valve damage or with prosthetic heart valves;
• prevention of postoperative thrombosis.

Contraindications

• mounted or suspected hypersensitivity to the components of the drug;
• severe bleeding;
• pregnancy (I trimester and the last 4 weeks of pregnancy);
• severe liver disease or kidney disease;
• acute DIC;
• deficiency of proteins C and S;
• thrombocytopenia;
• patients with high risk of bleeding, including patients with hemorrhagic disorders;
• varicose veins of the esophagus;
• aneurysm of the arteries;
• lumbar puncture;
• ulcer disease of stomach and duodenal ulcers;
• wounds (including operating)

Side effects

Frequency: very often-more than 1/10, often-more than 1/100 and less than 1/10, infrequently-more than 1/1000 and less than 1/100, rarely-more than 1/10000 and less than 1/1000. Very often: increased bleeding. Often: increased sensitivity to warfarin after prolonged use. Infrequently: anemia, vomiting, abdominal pain, nausea, diarrhea. Rare: eosinophilia, increased activity of “liver” enzymes, jaundice, rash, urticaria, pruritus, eczema, skin necrosis, vasculitis, hair loss, nephritis, urolithiasis, tubular necrosis, palmar-plantar syndrome.

Interaction

It is not recommended to start or stop taking other medications, or to change the dosage of medications taken without consulting your doctor. Concomitant administration should also take into account the effects of stopping the induction and/or inhibition of warfarin by other drugs. The risk of severe bleeding increases when warfarin is co-administered with drugs that affect platelet levels and primary hemostasis: acetylsalicylic acid, clopidogrel, ticlopidine, dipyridamole, most NSAIDs (with the exception of COX-2 inhibitors), penicillin antibiotics in large doses. You should also avoid concomitant use of warfarin with drugs that have a pronounced inhibitory effect on cytochrome P450 isoenzymes (including cimetidine, chloramphenicol), when taken for several days, the risk of bleeding increases. In such cases, cimetidine can be substituted, for example, with ranitidine or famotidine. The effect of warfarin may be enhanced by concomitant use with the following medications: acetylsalicylic acid, allopurinol, amiodarone, azapropazone, azithromycin, alpha – and beta-interferon, amitriptyline, bezafibrate, vitamin A, vitamin E, glibenclamide, glucagon, gemfibrozil, heparin, grepafloxacin, danazol, dextropropoxifene, diazoxide, digoxin, disopyramide, disulfiram, zafirlukast, Indometacin, ifosfamide, itraconazole, ketoconazole, clarithromycin, clofibrate, codeine, levamizole, lovastatin, metolazone, methotrexate, metronidazole, miconazole (including in the form of oral gel), nalidixic acid, norfloxacin, ofloxacin, omeprazole, oxifenbutazone, paracetamol (especially after 1-2 weeks of continuous use), paroxetine, piroxicam, proguanil, propafenone, propranolol, flu vaccine, roxithromycin, sertraline, simvastatin, sulfafurazole, sulfamethisole, sulfamethoxazole/trimethoprim, sulfafenazole, sulfinpyrazone, sulindac, steroid hormones (anabolic and/or androgenic), tamoxifen, tegafur, testosterone, tetracyclines, thienylic acid, tolmetin, trastuzumab, troglitazone, phenytoin, phenylbutazone, fenofibrate, feprazone, fluconazole, fluoxetine, fluorouracil, fluvastatin, fluvoxamine, flutamide, quinine, quinidine, chloral hydrate, chloramphenicol, celecoxib, cefamandol, cephalexin, cefmenoxime, cefmetazole, cefoperazone, cefuroxime, cimetidine, ciprofloxacin, cyclophosphamide, erythromycin, etoposide, ethanol. Preparations of certain medicinal plants (official or non-official) can also enhance the effect of warfarin: for example, ginkgo (Ginkgo biloba), garlic (Allium sativum), angelica sinensis, papaya (Carica papaya), sage (Salvia miltiorrhiza); and reduce: for example, ginseng (Panax ginseng), St. John’s wort (Hypericum perforatum). You can not simultaneously take warfarin and any St. John’s wort preparations, but it should be borne in mind that the effect of inducing the action of warfarin may persist for another 2 weeks after stopping taking St. John’s wort preparations. If the patient is taking St. John’s wort medications, the MHO should be measured and stopped. Monitoring of MHO should be careful, as its level may increase when St. John’s wort is discontinued. After that, you can prescribe warfarin. Quinine, which is found in tonic drinks, can also enhance the effect of warfarin. Warfarin may enhance the effect of oral hypoglycemic agents of sulfonylureas. The effect of warfarin may be weakened by concomitant use with azathioprine, aminoglutetimide, barbiturates, valproic acid, vitamin C, vitamin K, glutetimide, griseofulvin, dicloxacillin, disopyramide, carbamazepine, colestyramine, coenzyme Q10, mercaptopurine, mesalazine, mianserin, mitotane, nafcillin, primidone, retinoids, ritonavir, rifampicin, rofecoxib, spironolactone, sucralfate, trazodone, phenazone, chlordiazepoxide, chlortalidone, cyclosporine. The use of diuretics in the case of a pronounced hypovolemic effect may lead to an increase in the concentration of clotting factors, which reduces the effect of anticoagulants. In the case of concomitant use of warfarin with other drugs listed in the list below, it is necessary to monitor MHO at the beginning and end of treatment, and, if possible,2-3 weeks after the start of therapy. Foods rich in vitamin K weaken the effects of warfarin; a decrease in vitamin K absorption caused by diarrhea or laxatives potentiates the effects of warfarin. Most vitamin K is found in green vegetables, so when treating with warfarin, you should carefully eat the following foods: amaranth greens, avocado, broccoli, Brussels sprouts, cabbage, canola oil, chaillot leaf, onion, coriander (coriander), cucumber peel, chicory, kiwi fruit, lettuce, mint, green mustard, olive oil, parsley, peas, pistachios, red seaweed, spinach greens, spring onions, soybeans, tea leaves (but not tea-drink), turnip greens, watercress.

How to take, course of administration and dosage

Inside,1 time a day, preferably at the same time of day.

The duration of treatment with Warfarin Nicomed is determined by the doctor in accordance with the indications for use. Monitoring during treatment. Before starting therapy, MHO is determined. In the future, laboratory monitoring is carried out regularly every 4-8 weeks.

The duration of treatment depends on the patient’s clinical condition. Treatment can be canceled immediately.

Patients who have not previously taken Warfarin Nicomed: the initial dose is 5 mg / day (2 tablets). per day) for the first 4 days. On the 5th day of treatment, MHO is determined and, in accordance with this indicator, a maintenance dose of the drug is prescribed. Usually, the maintenance dose of the drug is 2.5-7.5 mg / day (1-3 tables). per day).

Patients who have previously taken Warfarin Nicomed: the recommended starting dose is twice the known maintenance dose of the drug and is prescribed within the first 2 days.

Overdose

Symptoms: the indicator of treatment effectiveness is at the border of bleeding development, so the patient may have minor bleeding (including microhematuria, bleeding gums). Treatment: in mild cases, it is sufficient to reduce the dose of the drug or stop treatment for a short period of time. In case of minor bleeding, it is sufficient to stop taking the drug until the MHO target level is reached. In case of severe bleeding, intravenous administration of vitamin K, coagulation factor concentrate or fresh frozen plasma, and oral administration of activated carbon is recommended. If oral anticoagulants are indicated for use in the future, it is necessary to avoid large doses of vitamin K, since warfarin resistance develops within 2 weeks.

Special instructions

A prerequisite for Warfarin Nicomed therapy is strict compliance with the prescribed dose of the drug.

Patients suffering from alcoholism, as well as patients with dementia, may not be able to follow the prescribed Warfarin Nicomed regimen.

Storage conditions

The drug should be stored in a dry place protected from light at a temperature of not more than 25 C.

Active ingredient

Warfarin

Conditions of release from pharmacies

By prescription

Dosage form

of the tablet

Purpose

Nursing mothers as prescribed by a doctor, For adults as prescribed by a doctor

Indications

Myocardial infarction, Thrombosis prevention, Heart attack and stroke

prevention Weight

Weight: 30 gr.