ABSTRACT
Trade names: Aldocumar; Coumadin (Bristol-Myers Squibb); Coumadine; Marevan; Waran; Warfilone Indications: Thromboembolic disease, pulmonary embolism Category: Anticoagulant; Coumarin Half-life: 1.5-2.5 days (highly variable) Clinically important, potentially hazardous interactions with: amiodarone, amobarbital, antithyroid agents, aprepitant, aprobarbital, arnica, aspirin, azathioprine, azithromycin, barbiturates, beclomethasone, bismuth, bivalirudin, bosentan, butabarbital, capsicum, chamomile, chondroitin, cimetidine, clarithromycin, clofibrate, clopidogrel, clorazepate, cotrimoxazole, coenzyme Q-10, cyclosporine, dan-shen, danazol, daptomycin, delavirdine, desvenlafaxine, devil’s claw, dexamethasone, dexibuprofen, dicloxacillin, dirithromycin, disulfiram, dong quai, econazole, erythromycin, etoricoxib, evening primrose, exenatide, fenofibrate, feverfew, fluconazole, flunisolide, fluoxymesterone, fosamprenavir, garlic, gemfibrozil, ginger, ginkgo biloba, ginseng, glucagon, grapefruit juice, green tea, guarana, horse chestnut (bark, flower, leaf, seed), imatinib, influenza vaccines, itraconazole, ketoconazole, leflunomide, levothyroxine, liothyronine, lopinavir, melatonin, mephobarbital, methimazole, methylprednisolone, methyltestosterone, metronidazole, miconazole, moricizine, nafcillin, nalidixic acid, nilutamide, orlistat, PEG-interferon, penicillin G, penicillin V, penicillins, pentobarbital, phenobarbital, phenylbutazones, phytonadione, piperacillin, primidone, propoxyphene, propylthiouracil, quinidine, quinine, red clover, rifampin, rifapentine, rofecoxib, ropinirole, rosuvastatin, roxithromycin, salicylates, saw palmetto, secobarbital, simvastatin, sitaxentan, sorafenib, St John’s wort, stanozolol, sulfamethoxazole, sulfinpyrazone, sulfisoxazole, sulfonamides, sulindac, telithromycin, testosterone, thyroid, tibolone, tigecycline, tolterodine, troleandomycin, valdecoxib, vitamin A, vitamin E, zileuton
Note: Alternative remedies, including herbals, may potentially increase the risk of bleeding or potentiate the effects of warfarin therapy. Some of these include the following: angelica root, arnica flower, anise, asafetida, bogbean, borage seed oil, bromelain, dan shen, devil’s claw, fenugreek, feverfew, garlic, ginger, ginkgo biloba, ginseng, horse chestnut, lovage root, meadowsweet, onion, parsley, passionflower herb, poplar, quassia, red clover, rue, turmeric and willow bark
Skin Abscess
(1997): Clayton BD, J Geriatr Dermatology 5, 314 Acral purpura
(1986): Stone MS+, J Am Acad Dermatol 14, 796 Angioedema (<1%) Bullous dermatitis
(1993): Elis A+, J Intern Med 234, 615 (hemorrhagic) (1986): Stone MS+, J Am Acad Dermatol 14, 796 (passim)
Dermatitis (1992): Breathnach SM+, Adverse Drug Reactions and the Skin
Blackwell, Oxford, 248 (passim) (1991): Quintavalla R+, Int Angiol 10, 103
Ecchymoses (2000): Juaneza MA+, Am J Med Sci 320(6), 388 (1988): Cole MS+, Surgery 103, 271 (passim)
Exanthems (2003): Spyropoulos AC+, Pharmacotherapy 23(4), 533 (1993): Antony SJ+, South Med J 86, 1413
Gangrene Hematoma
(1997): Clayton BD, J Geriatr Dermatology 5, 314 Hypersensitivity
(2004): Konishi H+, J Clin Pharm Ther 29(5), 485 (2002): Kristensen SR, Blood 100(7), 2676
Livedo reticularis (1993): Park S+, Arch Dermatol 129, 775
Necrosis (>10%) (2004): Khalid K, J Postgrad Med 50(4), 268 (breast) (2003): Parsi K+, Australas J Dermatol 44(1), 57
Pruritus (<1%) (2003): Spyropoulos AC+, Pharmacotherapy 23(4), 533
Purple toe syndrome (2003): Talmadge DB+, Pharmacotherapy 23(5), 674
Purplish erythema (feet and toes) (<1%) (1998): Krahn MJ+, Can J Cardiol 14, 90 (purple toes) (1997): Sallah S+, Thromb Haemost 78, 785 (purple toes)
Purpura (2002): Scarff CE+, Australas J Dermatol 43(3), 202 (1988): Cole MS+, Surgery 103, 271 (passim)
Rash (<1%) (2003): Spyropoulos AC+, Pharmacotherapy 23(4), 533
Ulcerations (2002): Scarff CE+, Australas J Dermatol 43(3), 202
Urticaria (1988): Cole MS+, Surgery 103, 271 (passim) (1986): Stone MS+, J Am Acad Dermatol 14, 796 (passim)
Vasculitis (2005): Yaghoubian B+, Cutis 75(6), 329 (1998): Krahn MJ+, Can J Cardiol 14, 90
Vesiculation (1986): Stone MS+, J Am Acad Dermatol 14, 796 (passim)
Hair Alopecia (>10%)
(1995): Nagao T+, Lancet 346, 1004 (1989): Kruis-de Vries MH+, Dermatologica 178, 109 (passim)
Mucosal Oral ulceration (<1%) Tongue hemorrhage
(2000): Shojania KG, Am J Med 109, 77
Cardiovascular Arrhythmias
(2002): Zaidenstein R+, Pharmacoepidemiol Drug Saf 11(3), 235 Hypotension
(2002): Zaidenstein R+, Pharmacoepidemiol Drug Saf 11(3), 235
Neuromuscular/Skeletal Rhabdomyolysis
(1999): Mogyorosi A+, J Intern Med 246(6), 599 (with simvastatin)
Hematologic Hemorrhage
(1989): Geoghegan+, BMJ 298, 902 (1988): Cole MS, Surgery 103, 271
Genitourinary Priapism
(2000): Zimbelman J+, J Pediatr 137, 266 (1997): Daryanani S+, Clin Lab Haematol 19, 213
Ocular Ocular hemorrhage
(2002): Mootha VV+, Arch Ophthalmol 120(1), 94 (with fluconazole)
Retinal vein occlusion (2004): Browning DJ+, Ophthalmology 111(6), 1196
