可密定Coumadin 
中文别名：华法林钠片
 
英文别名：Warfarin　Sodium　Tablets

药品类别：抗凝血药及溶栓药
 
化学成分
华法林钠
化学名称为：3-（3-氧代-1-苯基丁基）-4-羟基-2H-1-苯并吡喃二酮钠盐与异丙醇的包含物。
分子式：C19H15NaO4
分子量：330.31

药理药动
为香豆素类口服抗凝血药，竞争性拮抗维生素K的作用可阻断lit K环氧化物转变为氢醌形式。

适应症
预防和(/或)治疗静脉血栓的形成及扩展，肺栓塞；
预防和(/或)治疗房颤和(/或)心脏瓣膜置换后引起的血栓栓塞并发症；
减少心肌梗塞后死亡率、复发率和血栓栓塞并发症如卒中或体循环栓塞.

用法用量
可密定属治疗窗较小药物，其剂量和给药必须根据病人的PT或INR（国际标准化比值）而个体化给药。除置换有机械性瓣膜的病人INR应控制在2.5-3.5，其余情况INR应控制在2.0-3.0。
用药要从小剂量开始，一般为每天2-3mg（老年人应略低），然后根据PT或INR值调整剂量，疗程一般到血栓形成或血栓的危险消失。
 
不良反应
组织器官出血，根据出血的部位和程度不同的表现；皮肤或其它组织的坏死；其它少见的不良反应如：过敏反应、紫癜、皮疹、水肿、皮炎、腹痛、昏睡、不适、恶心、呕吐、头痛等。

禁忌症
用抗凝治疗后任何局部或全身的出血危险性大于治疗所得到的临床受益情况都视为禁忌症。
如：妊娠妇女服用时，可密定可通过胎盘屏障，引起宫内胎儿出血或畸形；出血倾向或血质不调；近期有手术情况，特别是中枢神经系统、眼和其他创伤性手术；活动性溃疡或其他组织隐性出血倾向；消化道、泌尿生殖道和呼吸道；脑血管；动脉瘤；心包炎心包积液和细菌性心内膜炎等；先兆流产、子痫或先兆子痫；无人照顾的老年病人，酗酒者，精神病和其他不合作病人；脊髓穿刺和其他可引起出血的诊断和治疗措施；其他大面积区域麻醉或腰部阻滞麻醉、恶性高血压和对香豆类药过敏者等。

注意事项
在长期应用最低维持量期间，如需手术，可先静脉注lit K，50mg，进行中枢神经系统或眼科手术前，应先停药。胃肠手术后，应检查大便隐血。

【原产地英文商品名】COUMADIN 5mg/tab 200tabs/box
【原产地英文药品名】WARFARIN SODIUM
【中文参考药品译名】
注：以下产品不同的规格和不同的价格，仅参考，购买时请以电话咨询为准！
·可密定 5毫克/片 200片/盒
·可密定 5毫克/片 150片/盒
·可密定 5毫克/片 100片/盒
·可密定 5毫克/片 50片/盒
【中文参考药品译名】华法林钠
【生产厂家中文参考译名】百时美施贵宝
【生产厂家英文名】BRISTOL MYERS SQUIBB

Brand Name(s): Coumadin

Coumadin Oral Warnings
Warfarin can cause very serious (possibly fatal) bleeding. This is more likely to occur when you first start taking this medication or if you take too much warfarin.

To decrease your risk for bleeding, your doctor or other health care provider will monitor you closely and check your lab results (INR test) to make sure you are not taking too much warfarin. Keep all medical and laboratory appointments. Tell your doctor right away if you notice any signs of serious bleeding. See also Side Effects section.

Coumadin Oral Uses
This medication is used to treat blood clots (such as in deep vein thrombosis-DVT or pulmonary embolus-PE) and/or to prevent new clots from forming in your body. Preventing harmful blood clots helps to reduce the risk of a stroke or heart attack. Conditions that increase your risk of developing blood clots include a certain type of irregular heart rhythm (atrial fibrillation), heart valve replacement, recent heart attack, and certain surgeries (such as hip/knee replacement).

Warfarin is commonly called a "blood thinner," but the more correct term is "anticoagulant." It helps to keep blood flowing smoothly in your body by decreasing the amount of certain substances (clotting proteins) in your blood.

How to use Coumadin Oral
Read the Medication Guide provided by your pharmacist before you start taking warfarin and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Take this medication by mouth with or without food as directed by your doctor or other health care professional, usually once a day. It is very important to take it exactly as directed. Do not increase the dose, take it more frequently, or stop using it unless directed by your doctor.

Dosage is based on your medical condition, laboratory tests (such as INR), and response to treatment. Your doctor or other health care provider will monitor you closely while you are taking this medication to determine the right dose for you.

Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day.

It is important to eat a balanced, consistent diet while taking warfarin. Some foods can affect how warfarin works in your body and may affect your treatment and dose. Avoid sudden large increases or decreases in your intake of foods high in vitamin K (such as broccoli, cauliflower, cabbage, brussels sprouts, kale, spinach, and other green leafy vegetables, liver, green tea, certain vitamin supplements). If you are trying to lose weight, check with your doctor before you try to go on a diet.

Cranberry products may also affect how your warfarin works. Limit the amount of cranberry juice (16 ounces/480 milliliters a day) or other cranberry products you may drink or eat.

Coumadin Oral Side Effects
Nausea, loss of appetite, or stomach/abdominal pain may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

This medication can cause serious bleeding if it affects your blood clotting proteins too much (shown by unusually high INR lab results). Even if your doctor stops your medication, this risk of bleeding can continue for up to a week. Tell your doctor right away if you have any signs of serious bleeding, including: unusual pain/swelling/discomfort, unusual/easy bruising, prolonged bleeding from cuts or gums, persistent/frequent nosebleeds, unusually heavy/prolonged menstrual flow, pink/dark urine, coughing up blood, vomit that is bloody or looks like coffee grounds, severe headache, dizziness/fainting, unusual or persistent tiredness/weakness, bloody/black/tarry stools, chest pain, shortness of breath, difficulty swallowing.

Tell your doctor right away if any of these unlikely but serious side effects occur: persistent nausea/vomiting, severe stomach/abdominal pain, yellowing eyes/skin.

This drug rarely has caused very serious (possibly fatal) problems if its effects lead to small blood clots (usually at the beginning of treatment). This can lead to severe skin/tissue damage that may require surgery or amputation if left untreated. Patients with certain blood conditions (protein C or S deficiency) may be at greater risk. Get medical help right away if any of these rare but serious side effects occur: painful/red/purplish patches on the skin (such as on the toe, breast, abdomen), change in the amount of urine, vision changes, confusion, slurred speech, weakness on one side of the body.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US -
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Coumadin Oral Precautions
Before taking warfarin, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: blood disorders (such as anemia, hemophilia), bleeding problems (such as bleeding of the stomach/intestines, bleeding in the brain), blood vessel disorders (such as aneurysms), recent major injury/surgery, liver disease, alcohol use, mental/mood disorders (including memory problems), frequent falls/injuries.

It is important that all your doctors and dentists know that you take warfarin. Before having surgery or any medical/dental procedures, tell your doctor or dentist that you are taking this medication and about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Avoid getting injections into the muscles. If you must have an injection into a muscle (for example, a flu shot), it should be given in the arm. This way, it will be easier to check for bleeding and/or apply pressure bandages.

This medication may cause stomach bleeding. Daily use of alcohol while using this medicine will increase your risk for stomach bleeding and may also affect how this medication works. Limit or avoid alcoholic beverages.

If you have not been eating well, if you have an illness or infection that causes fever, vomiting, or diarrhea for more than 2 days, or if you start using any antibiotic medications, contact your doctor or pharmacist immediately because these conditions can affect how warfarin works.

This medication can cause heavy bleeding. To lower the chance of getting cut, bruised, or injured, use great caution with sharp objects like safety razors and nail cutters. Use an electric razor when shaving and a soft toothbrush when brushing your teeth. Avoid activities such as contact sports. If you fall or injure yourself, especially if you hit your head, call your doctor immediately. Your doctor may need to check you.

The Food & Drug Administration has stated that generic warfarin products are interchangeable. However, consult your doctor or pharmacist before switching warfarin products. Be careful not to take more than one medication that contains warfarin unless specifically directed by the doctor or health care provider who is monitoring your warfarin treatment.

Older adults may be at greater risk for bleeding while using this drug.

This medication is not recommended for use during pregnancy because of serious (possibly fatal) harm to an unborn baby. Discuss the use of reliable forms of birth control with your doctor. If you become pregnant or think you may be pregnant, tell your doctor immediately. If you are planning pregnancy, discuss a plan for managing your condition with your doctor before you become pregnant. Your doctor may switch the type of medication you use during pregnancy.

Very small amounts of this medication may pass into breast milk but is unlikely to harm a nursing infant. Consult your doctor before breast-feeding.

Coumadin Oral Interactions
Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

Warfarin interacts with many prescription, nonprescription, vitamin, and herbal products. This includes medications that are applied to the skin or inside the vagina or rectum. The interactions with warfarin usually result in an increase or decrease in the "blood-thinning" (anticoagulant) effect. Your doctor or other health care professional should closely monitor you to prevent serious bleeding or clotting problems. While taking warfarin, it is very important to tell your doctor or pharmacist of any changes in medications, vitamins, or herbal products that you are taking.

Some products that may interact with this drug include: capecitabine, imatinib, mifepristone.

Aspirin, aspirin-like drugs (salicylates), and nonsteroidal anti-inflammatory drugs (NSAIDs such as ibuprofen, naproxen, celecoxib) may have effects similar to warfarin. These drugs may increase the risk of bleeding problems if taken during treatment with warfarin. Carefully check all prescription/nonprescription product labels (including drugs applied to the skin such as pain-relieving creams) since the products may contain NSAIDs or salicylates. Talk to your doctor about using a different medication (such as acetaminophen) to treat pain/fever. Low-dose aspirin and related drugs (such as clopidogrel, ticlopidine) should be continued if prescribed by your doctor for specific medical reasons such as heart attack or stroke prevention. Consult your doctor or pharmacist for more details.

Many herbal products interact with warfarin. Tell your doctor before taking any herbal products, especially bromelains, coenzyme Q10, cranberry, danshen, dong quai, fenugreek, garlic, ginkgo biloba, ginseng, and St. John's wort, among others.

This medication may interfere with a certain laboratory test to measure theophylline levels, possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

Coumadin Oral Overdose
If overdose is suspected, contact a poison control center or emergency room immediately. US residents can call the US National Poison Hotline at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: bloody/black/tarry stools, pink/dark urine, unusual/prolonged bleeding.

NOTES:
Do not share this medication with others.

Laboratory and/or medical tests (such as INR, complete blood count) must be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

MISSED DOSE:
For the best possible benefit, do not miss any doses. If you do miss a dose and remember on the same day, take it as soon as you remember. If you remember on the next day, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up because this could increase your risk for bleeding. Keep a record of missed doses to give to your doctor or pharmacist. Contact your doctor or pharmacist if you miss 2 or more doses in a row.

STORAGE:
Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

MEDICAL ALERT: Your condition and medication can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-800-854-1166 (US) or 1-800-668-1507 (Canada).