How not to turn Warfarin Nycomed into a poison: reviews of doctors and patients, instructions for use
The active ingredient Warfarin( Warfarina Nycomed) is the sodium salt of warfarin, amounting to 2.5 mg in each tablet.
The drug has an anticoagulant effect on the blood of an indirect type.
Group - anticoagulants.
- Pharmacokinetics of medication
- Mechanism of action
- When to take medicine
- When to not take Warfarin
- How to use
- Overdose and additional indications
- Reviews of patients and doctors
- Tips for taking the drug from patients
- Pros and Consmedicines
- Drug cost
- Conditions and shelf life, release of the drug
Pharmacokinetics of the drug
Warfarin(Warfarin Nycomed) or 4-hydroxycoumarin is an equimolecular mixture of two active, mirror-reflected stereoisomers of the S and R forms.
Each of the forms has its enzymes as catalysts for the metabolic process and exerts its own depressing effect on vitamin K( a group of fat-soluble vitamins).
S-warfarin is stronger than th
e R-form approximately 5-fold, but the second has a longer half-life. Each of the forms has its own way of excretion from the body.
Mechanism of action
The anticoagulant effect of Warfarin( Warfarina Nycomed) is by inhibiting or slowing the synthesis of vitamin K-dependent clotting factors in the liver( disrupting the biosynthesis of its clotting proteins).
Since the preparation does not act to coagulate directly the blood clots of the in the bloodstream, the effect of the medication begins approximately on the third or fifth day. Warfarin( Warfarin Nycomed) has a long half-life, high bioavailability( more than 90 percent).
When to take the medicine
The instructions for use indicate that warfarin nycomed is used in the following cases:
- with treatment and prevention of thrombosis and embolism of of various etiology - pulmonary embolism, cerebral vascular thrombosis, deep vein thrombosis, congenital thrombophilia;
- patients with atrial fibrillation and artificial heart valves - prevention of systemic embolism, complications in the transplantation of blood vessels, implantation of artificial valves;
- in the treatment of patients with manifestation of antiphospholipid syndrome , which can lead to renal pathology, damage to the nervous system, skin, liver;
- in patients with myocardial disease , at which the expansion of the heart cavity develops and its contractile function worsens.
When should not be taken Warfarin
Warfarin( Warfarin Nycomed) is an anticoagulant, therefore, it can not be used in any disease or condition with the threat of bleeding:
- surgery with a wide operating field - recent head injuries, eye surgery,serious injuries;
- blood disease and a tendency to bleeding - thrombocytopenia, congenital or acquired hemorrhagic diathesis( von Willebrand disease), hemophilia;
- chronic hypertension in severe form, cerebral hemorrhage;
- with severe liver or kidney failure;
- gastrointestinal diseases of the digestive tract, varicose veins of the esophagus, aneurysms of the arteries;
- alcoholism or such psychotic states of the nervous system, when it is difficult to determine the state of the blood clotting system with the help of laboratory studies;
- pregnancy( especially the first and last months).
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Instructions for Use
We offer to study the instructions for the use of Warfarin Nycomed tablets.
The drug is available in tablets. Warfarin is packed in plastic bottles of 30, 50, 100 or 250 pieces, Warfarin Nycomed - 50 or 100 pieces, or in blisters in the same packaging in cardboard boxes.
The drug is taken only as directed by a doctor.
The dose and duration of treatment is selected individually, regular monitoring of the blood state during the entire period of the drug intake - determination of the international normalized relationship( INR, evaluates the blood coagulation system).
It is recommended to take medicine once a day, regularly and, preferably, at the same time.
Dosage of medication
- Primary reception of preparation: from 1 to 4 days - daily intake of 5 mg( 2 tablets);from the 5th day - from 1 to 3 tablets.per day( according to the results of the blood test and the calculation recommendations of the attending physician).
- Secondary administration: 1st and 2nd days - dose of administration is possible from 5 to 10-15 mg / day.(2 to 6 tablets, double known maintenance dose of the previous administration);from the 3rd to the 4th - from 1 to 3 tablets per day and the control of INR;from 5 days reception of the corrected dose of a preparation in view of results MNO.
When taking this medication, it must be remembered that when INR is more than 3.5, the drug is stopped before the blood clotting index is less than 3.5( except for diseases for which this indicator is allowed up to 4 units).
In the course of treatment with Wafarin( Warfarin Nycomed), the choice of maintenance therapy or prophylaxis is performed by the attending physician depending on the diagnosis, the severity of the disease and the concomitant diseases of the patient.
Admission of this drug to children is carried out under the supervision of a specialist and more frequent blood testing( MNO).Initially, the recommended dose is 0.2 mg of the drug per kg of body weight per day for normally functioning liver( 0.1 mg for liver failure).
Diagram of dosage and duration of the drug the pediatrician paints individually.
Overdose and additional indications
The drug is administered on the verge of maximum concentrations and the possibility of bleeding, therefore laboratory monitoring of INR is necessary.
An occasional one-time administration of one or more tablets will constitute 2.5 to 10-15 mg of active ingredient , which is a shock dose of a second dose and will not result in death but may lead to large bleeding and abnormal blood clotting disorders.
As a restorative therapy - vitamin K, in severe cases - a transfusion of plasma( freshly frozen) or a product of coagulation factors.
Side effects of
Side effects of warfarin can appear:
- by bleeding, anemia or hematomas( blood coagulation system);
- feeling of nausea, vomiting, pain syndrome in the abdomen, diarrhea, rarely - increased activity of hepatic enzymes, jaundice( digestive system):
- sensation of chills, immunopathological inflammation of the vessels( cardiovascular system) - rarely;
- by allergic skin reactions in the form of rash and itching( rarely);
- by dizziness, fatigue, a taste disorder or a headache( central nervous system).
Especially pay attention to the reception of a large amount of food rich in vitamin K( spinach, greens, broccoli and Brussels, color and white cabbage, onions, celery, kiwi, etc.) - the effect of taking the drug can be reduced .
Patients with hereditary abnormalities( mutation of the gene responsible for the encoding of the enzyme CYP2C9) initial doses of the drug should be reduced to avoid bleeding
With prolonged use of the drug at high concentrations, the risk of bleeding increases.
Also should be remembered:
- Warfarin( Warfarin Nycomed), like other medications, is not compatible with alcohol .People who suffer from alcohol dependence may violate the regimen of the drug and as a consequence - have severe consequences in the form of uncontrolled bleeding.
- Renal failure does not require any specific recommendations in the dosage of the drug. Hepatic - increases the sensitivity to the drug. Carefully monitor the blood state and minimize the initial dose of the drug.
- It is impossible to combine( or discontinue) other medications with Warfarin ( Warfarin Nycomed) because some drugs enhance its effect, and some - weaken. Strengthen: non-steroidal anti-inflammatory drugs, heparin, erythromycin, sulfonamides derivatives, thyroxine, quinine, quinolones, fluconazole, penicillins and others. Weaken: retinoids, barbiturates, phenazone, vitamin K, contraceptives( tablets), ascorbic acid and others.
- Pregnancy is a contraindication for taking Warfarin( Warfarina Nycomed), but there is no direct evidence of the undeniable harm of taking the medication during breastfeeding. It is recommended to refrain from feeding in the first three days of taking the drug.
Reviews of patients and doctors
Let's study reviews about the drug Warfarin Nycomed.
I believe that taking any medication yourself, without prescribing a doctor is impossible, and Warfarin - even more so.
Without considering all the attendant factors of the disease, careful monitoring of INR and discipline with the time of intake, diet - the consequences may not be simple. Today Warfarin for many patients is the key to a full life.
Constantine S., 48 years old, 28. 07.14, cardiologist
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I prescribe Warfarin in the treatment of deep vein thrombosis. For many patients, he simply saves his life. On average, the intake of the drug takes up to 3 weeks, at which time it is mandatory to monitor the INR and fulfill all the prescriptions of the doctor in charge, especially on taking other medications.
If the blood test several times in a row showed the result of INR from two to two and a half - the therapeutic dose can be considered selected. And do not forget - avoid traumatic stresses, alcohol, stressful situations.
Lyudmila D., 36, phlebologist, 16.08.14
Four and a half months ago, an operation was performed to replace the aortic valve, I drink Warfarin all this time. There are no visible abnormalities, but control of MNO shows that the dose is still not selected, the indices are not stable. Although it is possible that a doctor is right, I have a lot of weight and need to reduce the burden on the body.
Marina S., 62, 02.09.14 g
Postoperative stenting after the second heart attack. I drink warfarin for two months, I am satisfied with my mobility. In the last week, we began to worry about the pain in the stomach, the results of the INR fell.
The attending physician offered to give up green tea( I drink a lot, it's easier to tolerate heat) and offered to visit a gastroenterologist.
Igor V., 59, 09/08/14
Tips for taking the drug from patients
It is worth considering such factors:
- to observe the reception time - hang on the refrigerator a schedule of daily admission and cross out the date;
- avoid intramuscular injection of other drugs - you can always find a replacement in tablet form;
- avoid repeated use of the dose of the drug - it is better to skip the reception than to drink twice;
- carefully look at the diet of your diet, avoid a large number of foods with a high content of vitamin K, do not sit on mono-diets;
- at the time of taking the drug, give up traumatic sports;
- pay attention to any swelling, bruises that have arisen suddenly;
- do not forget to inform the doctor, to whom you got for the first time, about taking Warfarin.
Advantages and disadvantages of the drug
The advantage of taking the drug is:
- prolonging the full life of people with many serious diseases( deep vein thrombosis, prosthetic heart valves);
- one-time daily intake, preferably evening;
- is relatively small list of contraindications.
- moderate and safe motor activity;
- adherence to a strict regimen;
- possibility of bleeding.
The cost of the drug
Warfarin( Warfarin Nycomed) is usually prescribed for long-term use, so consider the cost of packs of 100 pieces of tablets. Price Warfarin( Russian manufacturer) from 115 to 163 rubles. for packing, Warfarin Nycomed( Denmark) - from 166 to 227 RUB .for packing.
Buy Warfarin in conventional and online pharmacies in the whole country.
Conditions and periods of storage, release of the preparation
Storage of the preparation - at room temperature( not above 25 ° С), in places not accessible to children.
Shelf life is indicated on the packaging.
The release of the drug is prescription.