Adult Dosing
Anticoagulation
- 2-10 mg daily depending on INR goal
- Start 2-5 mg PO daily for 2-4 days
- Adjust the dose according to INR
- Consider lower starting dose for elderly and/or debilitated patients
- Refer ACCP guidelines or institution protocols
Pulmonary embolism [Non-FDA Approved]
- 5 mg PO per day, adjust for INR goal 2-3
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
DVT [Non-FDA Approved]
- Target INR between 2 and 3
- Loading dose on day 1
- Baseline INR 1-1.3: 0.2 mg/kg/dose PO; Max. dose: 7.5 mg/dose
- Liver dysfunction, baseline INR >1.3, undergone Fontan procedure, NPO status/poor nutrition, using broad spectrum antibiotics, using medications that significantly inhibit CYP 450 2C9, or slow warfarin metabolizers: 0.1 mg/kg/dose PO; max. dose: 5 mg/dose
- Loading dose on days 2-4
- If INR 1.1-1.3: Repeat day 1 loading dose
- If INR 1.4-1.9: 50% of day 1 loading dose
- If INR 2-3: 50% of day 1 loading dose
- If INR 3.1-3.5: 25% of day 1 loading dose
- If INR >3.5: Hold doses until INR 3.5 and restart at 50% of previous dose
- Maintenance dose (day 5)
- If INR 1.1-1.4: Increase previous dose by 20%
- If INR 1.5-1.9: Increase previous dose by 10%
- If INR 2-3: No change
- If INR 3.1-3.5: Decrease previous dose by 10%
- If INR >3.5: Hold doses until INR 3.5 and restart at 20% lower than the last dose
- Usual maintenance dose: ~0.1 mg/kg/24 hr PO qd; range: 0.05-0.34 mg/kg/24 hrs
Pulmonary embolism [Non-FDA Approved]
- 0.05-0.34 mg/kg/day, adjust for INR goal 2-3
[Outline]
See Supplemental Patient Information
- Warfarin can cause hemorrhage in any tissue or organ, sometimes resulting in to death [US Black Box Warning]
- Necrosis and/or gangrene of skin and other tissues resulting in to death or permanent disability have been reported with warfarin therapy, usually within a few days of the starting anticoagulant therapy. Discontinue the drug if necrosis is suspected due to warfarin and consider heparin therapy for anticoagulation
- Control the dose of warfarin by monitoring prothrombin time (PT)/International Normalized Ratio (INR) periodically
- Release of atheromatous plaque emboli, thereby increasing the risk of complications from systemic cholesterol microembolization, including the purple toes syndrome has been observed with anticoagulation therapy with warfarin. Discontinue the drug if such phenomena occurs
- Purple toes syndrome, livedo reticularis, rash, gangrene, abrupt and intense pain in the leg, foot, or toes, foot ulcers, myalgia, penile gangrene, abdominal pain, flank or back pain, hematuria, renal insufficiency, hypertension, cerebral ischemia, spinal cord infarction, pancreatitis, symptoms simulating polyarteritis, or any other sequelae of vascular compromise are the presenting symptoms of systemic atheroemboli and cholesterol microemboli
- Venous limb ischemia, necrosis, and gangrene have occurred in patients with heparin-induced thrombocytopenia and deep venous thrombosis when heparin treatment was discontinued and warfarin therapy was started or continued. Hence use cautiously in these patients
- Hereditary or acquired deficiencies of protein C or its cofactor, protein S, have been associated with tissue necrosis following warfarin administration. Concomitant use of heparin for 5 to 7 days during initiation of warfarin therapy minimize the incidence of tissue necrosis
- Numerous factors, alone or in combination including changes in diet, medications, botanicals, and genetic variations in the CYP2C9 and VKORC1 enzymes, influence the response of the patient to warfarin
Cautions: Use cautiously in
- Moderate-severe renal impairment
- Moderate-severe hepatic impairment
- Lactation
- Infectious diseases or disturbances of intestinal flora
- Recent surgery or trauma
- Indwelling catheters
- Moderate-severe hypertension
- Known or suspected protein C deficiency
- Polycythemia vera
- Vasculitis
- Severe diabetes
Supplemental Patient Information
- Advise patients to avoid alcohol consumption
- Advise patients to avoid any activity or sport that may result in traumatic injury
- Instruct the patients to notify the physician immediately if the prescribed dose of warfarin is forgotten and to take the dose as soon as possible on the same day but do not take a double dose next day to make up for missed doses
- Advise patient to notify physician immediately if any unusual bleeding or symptoms occurs
- Advise patient to maintain a consistent diet
Pregnancy Category:X
Breastfeeding: Safety unknown. As per manufacturer's data, limited published data reports that warfarin has not been detected in the breast milk of mothers treated with warfarin, but prolonged prothrombin times was observed in breast-fed infants whose mothers were treated with warfarin. Carefully monitor mothers who are breastfeeding and are on warfarin therapy so that recommended PT/INR values are not exceeded. Also perform coagulation tests and evaluate vitamin K status in infants before advising women taking warfarin to breast-feed. The decision to breast-feed should be undertaken only after careful consideration of the available alternatives.
Pricing data from www.DrugStore.com in U.S.A.
- Jantoven 2 MG TABS [Bottle] (UPSHER-SMITH)
30 mg = $17.99
90 mg = $39.97 - Warfarin Sodium 2 MG TABS [Bottle] (TARO)
30 mg = $14.99
90 mg = $33.97 - Warfarin Sodium 5 MG TABS [Bottle] (TARO)
30 mg = $13.99
60 mg = $16.98 - Jantoven 4 MG TABS [Bottle] (UPSHER-SMITH)
30 mg = $17.99
90 mg = $39.97 - Warfarin Sodium 7.5 MG TABS [Bottle] (TARO)
30 mg = $23.99
90 mg = $61.97 - Coumadin 1 MG TABS [Bottle] (B-M SQUIBB U.S. (PRIMARY CARE))
30 mg = $46.99
90 mg = $116.97 - Warfarin Sodium 2.5 MG TABS [Bottle] (TARO)
30 mg = $14.99
90 mg = $33.97 - Warfarin Sodium 1 MG TABS [Bottle] (TARO)
30 mg = $13.99
90 mg = $30.99 - Coumadin 7.5 MG TABS [Bottle] (B-M SQUIBB U.S. (PRIMARY CARE))
30 mg = $62.99
90 mg = $165.98 - Coumadin 5 MG TABS [Bottle] (B-M SQUIBB U.S. (PRIMARY CARE))
30 mg = $49.99
90 mg = $129.97 - Coumadin 4 MG TABS [Bottle] (B-M SQUIBB U.S. (PRIMARY CARE))
30 mg = $49.99
90 mg = $128.97 - Jantoven 5 MG TABS [Bottle] (UPSHER-SMITH)
30 mg = $17.99
90 mg = $42.97 - Warfarin Sodium 4 MG TABS [Bottle] (TARO)
30 mg = $14.99
90 mg = $33.98 - Coumadin 10 MG TABS [Bottle] (B-M SQUIBB U.S. (PRIMARY CARE))
30 mg = $65.99
90 mg = $175.97 - Coumadin 6 MG TABS [Bottle] (B-M SQUIBB U.S. (PRIMARY CARE))
30 mg = $56.99
90 mg = $165.97 - Coumadin 3 MG TABS [Bottle] (B-M SQUIBB U.S. (PRIMARY CARE))
30 mg = $49.99
90 mg = $127.97 - Coumadin 2 MG TABS [Bottle] (B-M SQUIBB U.S. (PRIMARY CARE))
30 mg = $50.99
90 mg = $124.97 - Coumadin 2.5 MG TABS [Bottle] (B-M SQUIBB U.S. (PRIMARY CARE))
30 mg = $52.99
90 mg = $130.97 - Warfarin Sodium 3 MG TABS [Bottle] (TARO)
30 mg = $15.99
90 mg = $40.97
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
