Warfarin Leaflet
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warfarin
What you need to know about: ● side effects ● interactions ● the warfarin booklet
What is warfarin and how does it work? Warfarin is one of a group of drugs called anticoagulants which work by affecting your body’s blood clotting mechanism. They extend the normal time it takes for blood to clot. You may have heard of it referred to as a “blood thinner”. Warfarin helps prevent your body from forming blood clots and helps stop any existing clots from getting bigger. It won’t however dissolve any clots which have already formed. Your body has it’s own system which will do this naturally over a few weeks. Warfarin may be given to treat an existing problem eg a clot in the leg (Deep Vein Thrombosis, DVT), or it may be given to help reduce the risk of a stroke in some people with a condition called atrial fibrillation or with damaged or replaced heart valves. Your doctor should have explained to you the reason for your treatment and it will be written in the front of your warfarin booklet. Warfarin comes in the form of tablets which are a different colour for every strength. The length of time that you need to take warfarin for will depend upon why you are taking it and will be decided by the doctor who first prescribed the warfarin. The expected duration of therapy will be written in the front of your warfarin booklet. If you are only to take warfarin for a specific time the clinic will advise you when you are due to stop.
How and why your blood is monitored Each person’s body responds differently to this medication and initially you will need to have quite frequent blood tests to find the best dose for you. This means that you may be taking different doses over the first few weeks. As your response to the drug stabilises, the length of time between your blood tests will increase. You may still need small alterations to your dose now and then to keep your blood just right. The blood test (either a finger prick or venous sample) used to monitor your warfarin treatment is called the INR. This is a measure of how long it takes your blood to clot compared with someone who is not taking warfarin. You will have been given a target range for your INR results. This target depends on the reason why you are taking warfarin. A common target range is 2-3. The target range set for you should be written in the front of your warfarin booklet. If, for example, your target range is 2-3 then the clinic staff will try to keep your INR results between these levels with
the perfect INR result being right in the middle (2.5). If your INR is too high you may begin to bleed easily and if it is low you can be at increased risk of developing a clot. If your result is a little outside the desired range it may correct itself without having to change your warfarin dose. Sometimes, however, you may find that your dose has to be changed to get your INR back within the target range - the clinic will advise you on this.
What are the possible side effects of warfarin? If you take your warfarin as recommended, it is unlikely that you will have any problems. However as warfarin affects blood clotting, the most important side effect is bleeding (haemorrhage). It is extremely important that you know the signs to look out for and what to do if you notice any signs of bleeding. You should seek medical advice immediately if you experience any of the following problems. This can be from your own family doctor, NHS Direct or your local Accident and Emergency Department. ● Suffer any injury, especially to your head, eyes or joints ● Bleed a lot from a cut or suffer excess nose bleeds or bleeding from your gums ● Notice any unexplained bruising, especially black or brown spots on your skin where you have not received an injury ● Vomit up any blood or material which looks like coffee grounds ● For women, increased bleeding during periods (or any other vaginal bleeding) ● Red or dark brown urine ● Red or black stools. It is also wise to seek immediate medical advice if you experience: ● Any major changes to your general state of health eg vomiting, diarrhoea or fever ● Suffer chest pains or shortness of breath ● Begin to suffer indigestion/heartburn. It is also wise to avoid activities that could cause you to bruise yourself or cut yourself, for example, contact sports. Take care while shaving, do not walk around bare foot and always wear strong gloves when gardening.
Other medicines and warfarin
Diet and warfarin
As you may know many medicines can have an effect on your warfarin. It is therefore important to tell the clinic staff if:
Warfarin can be taken either before, after or during a meal. No special diet is required when taking warfarin and usually it is fine to continue your normal diet. Some changes in your diet can affect your blood results. It is best therefore to adhere to the following advice:
● you are prescribed any new medicines ● any of your current medicines are stopped ● the dose of any of your medicines is changed. The information that the clinic will need to know about your medicines is: ● the name of the medicine (write it down or take the medicine with you) ● what dose you are or were taking ● when you started or stopped taking it, or when the dose changed. Always make sure that: ● your doctor or dentist knows you are on warfarin if they are prescribing something new for you. Show your warfarin booklet to the pharmacist if you wish to buy any medicine over the counter. This includes any cough/cold remedies or herbal remedies.
Aspirin Do not take aspirin (acetylsalicylic acid) unless a doctor (who knows you are or will be taking warfarin) has specifically prescribed it for you. Aspirin is also present in many painkillers and flu remedies. Always seek advice from a pharmacist before buying any over the counter medicine. Paracetamol 500mg (up to 4 tablets daily) can be taken without an effect on warfarin.
Other medications Many other types of medicines may also interfere with your warfarin. These include antibiotics, amiodarone, cholesterol lowering agents, Non-steroidal anti-inflammatory agents (either prescribed or ‘over the counter’) and some medicines for epilepsy to name just a few. They may either increase the effect of your warfarin making your blood take longer to clot and some can reduce the effect of your warfarin.
● Do not go on ‘crash’ diets or start binge eating ● Do not use dietary supplements without first checking with your doctor or pharmacist that it will not interfere with your warfarin ● Do not make large changes to the amounts of certain foods that you eat. It is perfectly alright to eat these foods but important not to make big changes to the amount of them you usually eat. Common ones are: ● avocado ● lettuce (dark green or red) ● broccoli ● soya bean products ● Brussel sprouts ● spinach ● cabbage (fresh boiled or raw green) ● watercress ● collards (white cabbage) ● endive (chicory)
Herbal remedies and other alternative medicines Many herbal and alternative medicines are known to affect warfarin therapy but for some we simply don’t know whether or not they are safe to take with your warfarin. The best advice is to avoid these products while you are taking warfarin. If, however, you are going to take these products then you must inform your anticoagulant clinic. It is advisable that you have your blood checked within a week of starting the drug. You will need regular (probably weekly) blood checks until it is established whether they may be affecting your blood results.
Always take advice from your doctor or pharmacist If your doctor wishes you to take a new drug (which may or may not affect your warfarin), then you must contact your anticoagulant clinic as soon as possible as they may advise you to have a blood test done within 4 - 7 days after starting the new medicine. Follow this advice if a medicine you normally take has been stopped.
Alcohol and warfarin Alcohol is known to affect the action of your warfarin if taken in larger quantities than recommended. It can cause your blood to become too thin if you drink more than recommended on a ‘one off’ basis and this increases your chance of bleeding. If you drink more than recommended
on a regular basis then this can cause your warfarin to be ineffective leading to a risk of clots forming. If your doctor has said that it is alright to continue to drink alcohol then we recommend a maximum of 2 units a day. Two units of alcohol
= 1 pint of normal strength beer or 2 pub measures of spirits or 2 small glasses of wine It is not safe to save up units and then have more on one day, for example at the weekend.
Your yellow book Take the time to read your warfarin booklet and follow the advice carefully. Always carry your warfarin booklet in case you are ever in an accident or need urgent medical treatment. Always show your warfarin booklet or state that you are on warfarin when you visit the doctor or dentist for treatment or medicines. It is a good idea to show them your warfarin booklet as they may wish to know what your results have been. Show it to the pharmacist before you purchase any medicines. Always try to take your warfarin tablets at the same time each day. It is generally recommended that 6 o’clock is the best time. However, choose a time you will remember and try to link it with an activity which you do each day e.g. 6 o’clock news, dinnertime. Some people use a calendar to remind them and also to record that they have taken the dose. If you still have problems speak to your local pharmacist about other alternatives such as using a compliance box for your tablets. If you do miss a dose, take a note of when this was and inform the clinic when you next visit. This allows the staff to respond appropriately to your blood result. If you are an hour or two late in taking your tablets it is OK to go ahead and take it. However do not take two doses on the same day to make up for a missed dose. If you are unsure whether or not you have taken your dose, do not take it. If you have missed more than one dose ask your doctor or anticoagulant clinic for advice. If for some reason you cannot attend your appointments for your blood tests please get in touch with your anticoagulant clinic to let them know and arrange a new appointment.
What you need to know about: ● side effects ● interactions ● the warfarin booklet
What is warfarin and how does it work? Warfarin is one of a group of drugs called anticoagulants which work by affecting your body’s blood clotting mechanism. They extend the normal time it takes for blood to clot. You may have heard of it referred to as a “blood thinner”. Warfarin helps prevent your body from forming blood clots and helps stop any existing clots from getting bigger. It won’t however dissolve any clots which have already formed. Your body has it’s own system which will do this naturally over a few weeks. Warfarin may be given to treat an existing problem eg a clot in the leg (Deep Vein Thrombosis, DVT), or it may be given to help reduce the risk of a stroke in some people with a condition called atrial fibrillation or with damaged or replaced heart valves. Your doctor should have explained to you the reason for your treatment and it will be written in the front of your warfarin booklet. Warfarin comes in the form of tablets which are a different colour for every strength. The length of time that you need to take warfarin for will depend upon why you are taking it and will be decided by the doctor who first prescribed the warfarin. The expected duration of therapy will be written in the front of your warfarin booklet. If you are only to take warfarin for a specific time the clinic will advise you when you are due to stop.
How and why your blood is monitored Each person’s body responds differently to this medication and initially you will need to have quite frequent blood tests to find the best dose for you. This means that you may be taking different doses over the first few weeks. As your response to the drug stabilises, the length of time between your blood tests will increase. You may still need small alterations to your dose now and then to keep your blood just right. The blood test (either a finger prick or venous sample) used to monitor your warfarin treatment is called the INR. This is a measure of how long it takes your blood to clot compared with someone who is not taking warfarin. You will have been given a target range for your INR results. This target depends on the reason why you are taking warfarin. A common target range is 2-3. The target range set for you should be written in the front of your warfarin booklet. If, for example, your target range is 2-3 then the clinic staff will try to keep your INR results between these levels with
the perfect INR result being right in the middle (2.5). If your INR is too high you may begin to bleed easily and if it is low you can be at increased risk of developing a clot. If your result is a little outside the desired range it may correct itself without having to change your warfarin dose. Sometimes, however, you may find that your dose has to be changed to get your INR back within the target range - the clinic will advise you on this.
What are the possible side effects of warfarin? If you take your warfarin as recommended, it is unlikely that you will have any problems. However as warfarin affects blood clotting, the most important side effect is bleeding (haemorrhage). It is extremely important that you know the signs to look out for and what to do if you notice any signs of bleeding. You should seek medical advice immediately if you experience any of the following problems. This can be from your own family doctor, NHS Direct or your local Accident and Emergency Department. ● Suffer any injury, especially to your head, eyes or joints ● Bleed a lot from a cut or suffer excess nose bleeds or bleeding from your gums ● Notice any unexplained bruising, especially black or brown spots on your skin where you have not received an injury ● Vomit up any blood or material which looks like coffee grounds ● For women, increased bleeding during periods (or any other vaginal bleeding) ● Red or dark brown urine ● Red or black stools. It is also wise to seek immediate medical advice if you experience: ● Any major changes to your general state of health eg vomiting, diarrhoea or fever ● Suffer chest pains or shortness of breath ● Begin to suffer indigestion/heartburn. It is also wise to avoid activities that could cause you to bruise yourself or cut yourself, for example, contact sports. Take care while shaving, do not walk around bare foot and always wear strong gloves when gardening.
Other medicines and warfarin
Diet and warfarin
As you may know many medicines can have an effect on your warfarin. It is therefore important to tell the clinic staff if:
Warfarin can be taken either before, after or during a meal. No special diet is required when taking warfarin and usually it is fine to continue your normal diet. Some changes in your diet can affect your blood results. It is best therefore to adhere to the following advice:
● you are prescribed any new medicines ● any of your current medicines are stopped ● the dose of any of your medicines is changed. The information that the clinic will need to know about your medicines is: ● the name of the medicine (write it down or take the medicine with you) ● what dose you are or were taking ● when you started or stopped taking it, or when the dose changed. Always make sure that: ● your doctor or dentist knows you are on warfarin if they are prescribing something new for you. Show your warfarin booklet to the pharmacist if you wish to buy any medicine over the counter. This includes any cough/cold remedies or herbal remedies.
Aspirin Do not take aspirin (acetylsalicylic acid) unless a doctor (who knows you are or will be taking warfarin) has specifically prescribed it for you. Aspirin is also present in many painkillers and flu remedies. Always seek advice from a pharmacist before buying any over the counter medicine. Paracetamol 500mg (up to 4 tablets daily) can be taken without an effect on warfarin.
Other medications Many other types of medicines may also interfere with your warfarin. These include antibiotics, amiodarone, cholesterol lowering agents, Non-steroidal anti-inflammatory agents (either prescribed or ‘over the counter’) and some medicines for epilepsy to name just a few. They may either increase the effect of your warfarin making your blood take longer to clot and some can reduce the effect of your warfarin.
● Do not go on ‘crash’ diets or start binge eating ● Do not use dietary supplements without first checking with your doctor or pharmacist that it will not interfere with your warfarin ● Do not make large changes to the amounts of certain foods that you eat. It is perfectly alright to eat these foods but important not to make big changes to the amount of them you usually eat. Common ones are: ● avocado ● lettuce (dark green or red) ● broccoli ● soya bean products ● Brussel sprouts ● spinach ● cabbage (fresh boiled or raw green) ● watercress ● collards (white cabbage) ● endive (chicory)
Herbal remedies and other alternative medicines Many herbal and alternative medicines are known to affect warfarin therapy but for some we simply don’t know whether or not they are safe to take with your warfarin. The best advice is to avoid these products while you are taking warfarin. If, however, you are going to take these products then you must inform your anticoagulant clinic. It is advisable that you have your blood checked within a week of starting the drug. You will need regular (probably weekly) blood checks until it is established whether they may be affecting your blood results.
Always take advice from your doctor or pharmacist If your doctor wishes you to take a new drug (which may or may not affect your warfarin), then you must contact your anticoagulant clinic as soon as possible as they may advise you to have a blood test done within 4 - 7 days after starting the new medicine. Follow this advice if a medicine you normally take has been stopped.
Alcohol and warfarin Alcohol is known to affect the action of your warfarin if taken in larger quantities than recommended. It can cause your blood to become too thin if you drink more than recommended on a ‘one off’ basis and this increases your chance of bleeding. If you drink more than recommended
on a regular basis then this can cause your warfarin to be ineffective leading to a risk of clots forming. If your doctor has said that it is alright to continue to drink alcohol then we recommend a maximum of 2 units a day. Two units of alcohol
= 1 pint of normal strength beer or 2 pub measures of spirits or 2 small glasses of wine It is not safe to save up units and then have more on one day, for example at the weekend.
Your yellow book Take the time to read your warfarin booklet and follow the advice carefully. Always carry your warfarin booklet in case you are ever in an accident or need urgent medical treatment. Always show your warfarin booklet or state that you are on warfarin when you visit the doctor or dentist for treatment or medicines. It is a good idea to show them your warfarin booklet as they may wish to know what your results have been. Show it to the pharmacist before you purchase any medicines. Always try to take your warfarin tablets at the same time each day. It is generally recommended that 6 o’clock is the best time. However, choose a time you will remember and try to link it with an activity which you do each day e.g. 6 o’clock news, dinnertime. Some people use a calendar to remind them and also to record that they have taken the dose. If you still have problems speak to your local pharmacist about other alternatives such as using a compliance box for your tablets. If you do miss a dose, take a note of when this was and inform the clinic when you next visit. This allows the staff to respond appropriately to your blood result. If you are an hour or two late in taking your tablets it is OK to go ahead and take it. However do not take two doses on the same day to make up for a missed dose. If you are unsure whether or not you have taken your dose, do not take it. If you have missed more than one dose ask your doctor or anticoagulant clinic for advice. If for some reason you cannot attend your appointments for your blood tests please get in touch with your anticoagulant clinic to let them know and arrange a new appointment.
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