Warfarin

Brand Grindex

In stock 624 Items

Available since: 2019-09-19

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Clinical Pharmacology

Warfarex belongs to the group of anticoagulants - drugs that prevent blood clotting, and is intended for prolonged use. It has an indirect anticoagulant effect, inhibiting the synthesis of a number of factors involved in the regulation of blood coagulation in the liver. Warfarex prevents the formation of new blood clots and prevents the increase in already formed.

Indications

Prevention and treatment of diseases caused by the formation of blood clots in the vessels:

deep vein thrombosis;
pulmonary thromboembolism;
atrial fibrillation;
myocardial infarction;
prosthetic heart valves.

Composition

1 tablet contains sodium warfarin (in the form of clathrate) 3 mg;Excipients: lactose; MCC; crospovidone; magnesium stearate; the dye is indigo carmine.

Warfarin is marketed under different brands and generic names, and comes in different dosage forms:

Brand name	Manufacturer	Country	Dosage form
Warfarex	Grindex	Latvia	pills
Warfarin	Canonpharma	Russia	pills
Warfarin	Takeda GmbH	Japan	pills

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Dosage and Administration

For oral use Once a day, preferably at the same time of day. The doctor determines the dose, mode and duration of use of Warfarex for each patient individually, guided by the severity of the disease and the results of blood coagulation control (INR). Without the permission of the physician, it is impossible to change the dose without permission or to stop treatment with warfarin. The initial dose is 2.5–5 mg per day for the first 2 days, then it is gradually adjusted according to the patient’s individual blood coagulation reaction (INR). After reaching the desired level of INR (2.0–3.0, and in some cases 3.0–4.5), a maintenance dose is prescribed. Older, debilitated, or at-risk patients are prescribed lower initial doses and use caution when raising them. Children Varfereks usually not prescribed. At the beginning of treatment, laboratory monitoring of the INR is carried out every day, for the next 3-4 weeks monitoring is carried out 1–2 times a week, and later every 1–4 weeks. More frequent additional control is necessary in cases when the patient’s state of health changes, before a planned surgery or other procedure, and also when any other medication is prescribed or canceled.

Adverse reactions

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.
Rarely: eosinophilia, increased activity of "liver" enzymes, jaundice, rash, urticaria, pruritus, eczema, skin necrosis, vasculitis, hair loss, nephritis, urolithiasis, tubular necrosis, palm-foot syndrome.

Contraindications

hypersensitivity to warfarin components;
bleeding (or the threat of its development) in some serious diseases;
bacterial endocarditis;
severe deficiency and severe liver or kidney disease;
obstructive jaundice;
diabetes;
acute DIC;
deficiency of proteins C and S;
hemorrhagic diathesis;
thrombocytopenia;
peptic ulcer and duodenal ulcer in the acute stage;
cerebral hemorrhage;
alcoholism;
severe arterial hypertension;
recent or suspected complex surgery and diagnostic procedures;
lack of assessment of the state of the blood coagulation system using laboratory methods;
childhood.

Drug interactions

High levels of vitamin K in foods (spinach, broccoli, lettuce, and other leafy vegetables) can reduce the effects of warfarin. However, one should not change the diet too abruptly, use vitamins and nutritional supplements without consulting a doctor. Smoking can reduce the anticoagulant effect of the drug. The effect of Warfarin may vary under the influence of a large number of drugs. NSAIDs, dipyridamole, valproic acid, cytochrome P450 inhibitors, cimetidine, chloramphenicol, laxatives - increase the risk of bleeding. The combined use of these drugs and warfarin should be avoided (cimetidine can be replaced by ranitidine or famotidine). If treatment with chloramphenicol is necessary, anticoagulant therapy may be temporarily stopped. Diuretics can reduce the effect of anticoagulants (in the case of pronounced hypovolemic action, which can lead to an increase in the concentration of coagulation factors). Weaken the effect: barbiturates, vitamin K, gluthethimide, griseofulvin, dicloxacillin, carbamazepine, mianserin, paracetamol, retinoids, rifampicin, sucralfate, phenazone, cholestyramine. Enhance the action: allopurinol, amiodarone, anabolic steroids (alkylated at the C-17 position), acetylstechracidic acid and other NSAIDs, heparin, glibenclamide, glucagon, danazol, diazoxide, disopyramide, disulfiram, isoniazid, ketoconazole, clarithmicine, clarithimethyne, and disithiramide, disulfiram, isoniazid, ketoconazole, clarithmicine, and clarithimethyne, and disithiramide, disulfiram, isoniazid, ketoconazole, clarithmicine, and clarithimethyne, and disithiramide, disulfiram, isoniazid, ketoconazole, clarithmicine, and glycine chyne, and disithiramide, disulfiram, isoniazid, ketoconazole, clarithycidine, and glycine chyne, as well as glyphenyl acetate; miconazole, nalidixic acid, nilutamide, omeprazole, paroxetine, proguanil, oral hypoglycemic agents - sulfonamide derivatives, sulfonamides, tamoxifen, thyroxin, quinine, quinidine, fluvoxamine, fluconazole, fluorouracil, quinolone , Chloral hydrate, chloramphenicol, cephalosporins, cimetidine, erythromycin, ethacrynic acid, ethanol.When using warfarin in combination with the above drugs, it is necessary to monitor the INR at the beginning and end of treatment and, if possible, 2-3 weeks from the start of therapy. When using drugs that can increase the risk of bleeding due to a decrease in normal coagulation (inhibition of blood coagulation factors or liver enzymes), the strategy of anticoagulant therapy should be determined by the possibility of carrying out laboratory monitoring. If frequent laboratory control is possible, then with the need for therapy with such agents, the dose of warfarin can be reduced by 5-10%. If carrying out laboratory control is difficult, then treatment with warfarin should be discontinued if necessary, the appointment of these drugs.

Pregnancy and Lactation

Warfarin should not be prescribed to pregnant women in connection with the identified teratogenic effects, the development of bleeding in the fetus and its death. The drug is excreted with maternal milk in small quantities and has almost no effect on blood coagulation in a child, so this medicine can be used during lactation, but it is desirable to refrain from breastfeeding in the first 3 days of warfarin therapy.

Special instructions

The use of anticoagulants increases the risk of bleeding. In order to monitor the state of the blood coagulation system, during the period of treatment with warfarin, you should regularly visit the doctor and carry out prescribed tests. When referring to doctors, dentists or pharmacists, you must inform them that you are taking warfarin. You should consult your doctor if digestive disorders occur, accompanied by diarrhea (diarrhea), fever. Pregnancy during treatment with warfarin is very undesirable, so it is necessary to use effective methods of its prevention. It is necessary to be careful when handling sharp and traumatic objects, to avoid activities associated with the risk of injury and subsequent bleeding. During the period of treatment it is necessary to refrain from the use of ethanol (the risk of hypoprothrombinemia). The safety of the drug in children in clinical studies has not been studied enough. There is no data on the adverse effects of warfarin on the ability to drive vehicles and maintain other mechanisms.

Overdosage

Symptoms of chronic intoxication: bleeding from the gums, nasal bleeding, excessive menstrual bleeding, severe or prolonged bleeding with minor superficial lesions, hemorrhages in the skin, the presence of blood in urine and feces, etc.

Treatment: with minor bleeding, it is necessary to reduce the dose of the drug or stop treatment for a short period. In the case of the development of severe bleeding, transfusion of concentrates of factors of the prothrombin complex, or fresh frozen plasma, or whole blood.