Buy Coumadin Online

What is Coumadin?

Coumadin (warfarin) is an anticoagulant (blood thinner). Warfarin reduces the formation of blood clots.

Coumadin is used to prevent heart attacks, strokes, and blood clots in veins and arteries.

Coumadin may also be used for purposes not listed in this medication guide.

Important information about Coumadin

You should not take Coumadin if you have a bleeding or blood cell disorder, blood in your urine or stools, an infection of the lining of your heart, ulcer or stomach bleeding, coughing up blood, recent head injury or bleeding in the brain, recent or upcoming surgery, or if you need a spinal tap or spinal anesthesia (epidural). Do not take Coumadin if you cannot be reliable in taking it every day.

Do not use Coumadin if you are pregnant, unless your doctor tells you to. Coumadin can cause birth defects, but the benefits of preventing blood clots in certain women may outweigh any risks to the baby.

Coumadin increases your risk of bleeding, which can be severe or life-threatening. Avoid activities that may increase your risk of bleeding or injury.

Call your doctor or seek emergency medical attention if you have bleeding that will not stop. You may also have bleeding on the inside of your body, such as in your stomach or intestines. Call your doctor at once if you have black or bloody stools, or if you cough up blood or vomit that looks like coffee grounds. These could be signs of bleeding in your digestive tract.

Many drugs (including some over-the-counter medicines and herbal products) can cause serious medical problems if you take them with Coumadin. It is very important to tell your doctor about all medicines you have recently used.

While using Coumadin, you will need frequent blood tests.

Before taking Coumadin

You should not take Coumadin if you are allergic to warfarin, or if you have:

  • hemophilia or any bleeding disorder that is inherited or caused by disease;

  • a blood cell disorder such as anemia (lack of red blood cells) or a low level of platelets in your blood;

  • blood in your urine or stools, or if you have been coughing up blood;

  • an infection of the lining of your heart (also called bacterial endocarditis);

  • stomach or intestinal bleeding or ulcer;

  • recent head injury, aneurysm, or bleeding in the brain; or

  • if you undergo a spinal tap or receive spinal anesthesia (epidural).

You should not take Coumadin if you cannot be reliable in taking it because of alcoholism, psychiatric problems, dementia, or similar conditions.

Coumadin can make you bleed more easily, especially if you have:

  • a history of bleeding problems;

  • high blood pressure or severe heart disease;

  • kidney or liver disease;

  • cancer;

  • surgery or a medical emergency;

  • if you receive any type of injection (shot);

  • a disease affecting the blood vessels in your brain;

  • a history of stomach or intestinal bleeding;

  • if you are 65 or older; or

  • if you are severely ill or debilitated.

To make sure Coumadin is safe for you, tell your doctor if you have:

  • celiac sprue (an intestinal disorder);

  • diabetes;

  • congestive heart failure;

  • overactive thyroid;

  • recent or upcoming surgery on your brain, spine, or eye;

  • a connective tissue disorder such as Marfan Syndrome, Sjogren syndrome, scleroderma, rheumatoid arthritis, or lupus;

  • a hereditary clotting deficiency (warfarin may make your symptoms worse at first);

  • if you use a catheter; or

  • if you have ever had low blood platelets after receiving heparin.

Do not use Coumadin if you are pregnant, unless your doctor tells you to. Coumadin can cause birth defects. However, the benefits of preventing blood clots in certain women may outweigh any risks to the baby. Tell your doctor right away if you become pregnant during treatment. Use effective birth control while you are using this medication.

It is not known whether warfarin passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take Coumadin?

Take Coumadin exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than your doctor tells you to. Never take a double dose of this medication.

Take Coumadin at the same time every day. Coumadin can be taken with or without food.

Tell your doctor if you have any illness with diarrhea, fever, chills, body aches, or flu symptoms. Tell your doctor if your body weight changes for any reason.

While using Coumadin, you will need frequent "INR" or prothrombin time tests (to measure how long it takes your blood to clot). You may not notice any change in your symptoms, but your blood work will help your doctor determine how long to treat you with warfarin. You must remain under the care of a doctor while using Coumadin. Do not miss any follow-up appointments.

Wear a medical alert tag or carry an ID card stating that you take Coumadin. Any doctor, dentist, surgeon, or other medical care provider who treats you should know that you are taking this medication. You may need to stop taking the medicine for a short time if you need antibiotics, surgery, dental work, a spinal tap, or spinal anesthesia (epidural).

Store Coumadin at room temperature away from heat, moisture, and light.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose can cause excessive bleeding.

What should I avoid while taking Coumadin?

Ask your doctor before taking any medicine for pain, arthritis, fever, or swelling. This includes acetaminophen (Tylenol), aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), diclofenac, indomethacin, meloxicam, and others. These medicines may affect blood clotting and may also increase your risk of stomach bleeding.

Avoid making any changes in your diet without first talking to your doctor. Foods that are high in vitamin K (liver, leafy green vegetables, or vegetable oils) can make warfarin less effective. If these foods are part of your diet, eat a consistent amount on a weekly basis.

Grapefruit or cranberry juice may interact with Coumadin and lead to unwanted side effects. Avoid the use of grapefruit or cranberry products while taking Coumadin.

Coumadin side effects

Get emergency medical help if you have any of these signs of an allergic reaction to Coumadin: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Coumadin may cause you to bleed more easily, which can be severe or life-threatening. Call your doctor or seek emergency medical attention if you have any unusual bleeding, or bleeding that will not stop. You may also have bleeding on the inside of your body, such as in your stomach or intestines. Call your doctor at once if you have black or bloody stools, or if you cough up blood or vomit that looks like coffee grounds. These could be signs of bleeding in your digestive tract.

Call your doctor at once if you have:

  • pain, swelling, hot or cold feeling, skin changes, or discoloration anywhere on your body;

  • sudden and severe leg or foot pain, foot ulcer, purple toes or fingers;

  • sudden headache, dizziness, or weakness;

  • easy bruising, purple or red pinpoint spots under your skin, bleeding from wounds or needle injections;;

  • pale skin, feeling light-headed or short of breath, rapid heart rate, trouble concentrating;

  • dark urine, jaundice (yellowing of the skin or eyes);

  • little or no urinating;

  • numbness or muscle weakness; or

  • pain in your stomach, back, or sides.

Common Coumadin side effects may include:

  • nausea, vomiting, mild stomach pain;

  • bloating, gas; or

  • altered sense of taste.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Coumadin?

Many drugs (including some over-the-counter medicines and herbal products) can affect your INR and may increase the risk of bleeding if you take them with Coumadin. Not all possible drug interactions are listed in this medication guide. It is very important to ask your doctor before you start or stop using any other medicine, especially:

  • other medications to prevent blood clots;

  • an antibiotic, antifungal medication, sulfa drug, or medicine to treat tuberculosis;

  • supplements that contain vitamin K

  • seizure medication--carbamazepine, phenobarbital, phenytoin;

  • an antidepressant--citalopram, duloxetine, fluoxetine, fluvoxamine, paroxetine, sertraline, venlafaxine, vilazodone, and others; or

  • herbal (botanical) products including coenzyme Q10, cranberry, echinacea, garlic, ginkgo biloba, ginseng, goldenseal, or St. John's wort.

This list is not complete and many other drugs can interact with Coumadin. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start or stop using a new medicine without your doctor's advice. Give a list of all your medicines to any healthcare provider who treats you.

For the Consumer

Applies to warfarin: oral tablet

Along with its needed effects, warfarin (the active ingredient contained in Coumadin) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking warfarin:

Less common
  • Abdominal or stomach pain with cramping
  • bleeding gums
  • blood in the urine
  • bloody stools
  • blurred vision
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • chest pain or discomfort
  • confusion
  • coughing up blood
  • difficulty with breathing or swallowing
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • excessive bruising
  • headache
  • increased menstrual flow or vaginal bleeding
  • nosebleeds
  • paralysis
  • peeling of the skin
  • prolonged bleeding from cuts
  • red or black, tarry stools
  • red or dark brown urine
  • shortness of breath
  • sweating
  • unexplained swelling
  • unusual tiredness or weakness
Rare
  • Arm, back, or jaw pain
  • blue-green to black skin discoloration
  • blue or purple toes
  • change in consciousness
  • chest tightness or heaviness
  • chills
  • clay-colored stools
  • diarrhea
  • dizziness
  • fainting or loss of consciousness
  • fast or irregular breathing
  • fast or irregular heartbeat
  • fever
  • itching
  • light-colored stools
  • loss of appetite
  • nausea and vomiting
  • pain in the toes
  • pain, redness, or sloughing of the skin
  • pale skin
  • skin blisters
  • skin rash
  • small red or purple spots on the skin
  • stomach pain
  • swelling of the eyes or eyelids
  • tightness in the chest or wheezing
  • troubled breathing with exertion
  • unpleasant breath odor
  • unusual bleeding or bruising
  • upper right abdominal or stomach pain
  • vomiting of blood
  • yellow eyes and skin
Incidence not known
  • Painful or prolonged erection of the penis

Some side effects of warfarin may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common
  • Joint pain
  • muscle pain
Rare
  • Bloated
  • change in taste, or bad, unusual, or unpleasant (after) taste
  • cold intolerance
  • excess air or gas in the stomach or intestines
  • full feeling
  • general feeling of discomfort or illness
  • hair loss or thinning of the hair
  • hives or welts
  • lack or loss of strength
  • pain
  • passing gas
  • red, sore, or itching skin
  • sores, welting, or blisters
  • unusual drowsiness, dullness, or feeling of sluggishness

Tags: generic coumadin, purchase coumadin online, coumadin toxicity, order coumadin, viagra and coumadin, order warfarin, coumadin without a prescription, buy coumadin, purchase warfarin, cheap warfarin, order warfarin online, buy coumadin online, coumadin toxicity guidelines, generic warfarin, buy warfarin online, purchase coumadin, coumadin levels, buy warfarin, coumadin warfarin buy, purchase warfarin online, buy cheap coumadin, order coumadin online, coumadin toxicity icd 9 code, coumadin, cheap coumadin, buy cheap warfarin

Applies to warfarin: compounding powder, intravenous powder for injection, oral tablet

Hematologic

Hematologic side effects including occult and overt bleeding or hemorrhage at any site have been reported the most frequently. Bleeding complications may present as paralysis, paresthesia, headache, chest, abdominal, joint, muscle or other pain, dizziness, shortness of breath, difficulty breathing or swallowing, unexplained swelling, weakness, hypotension, or unexplained shock. Bleeding may result in hematomas, melena, hematuria, ecchymoses, epistaxis, and hematemesis. Spontaneous intraspinal hematomas, spinal cord hemorrhage, gastrointestinal hemorrhage, intracranial hemorrhage, ocular hemorrhage, intra-abdominal hemorrhage, hemopericardium, compartment syndrome following blunt trauma, and other serious bleeding events have been reported. Anemia has been reported infrequently.

Warfarin-induced intracranial hemorrhage is associated with a high rate of mortality and disability compared with extracranial hemorrhages.

Hematologic risk factors have included history of stroke, a serious comorbid condition, a history of gastrointestinal bleeding, atrial fibrillation, advanced age, and concomitant use of aspirin. In addition, patients with genetic variations in the CYP450 2C9 and VKORC1 enzymes are at a higher risk of bleeding than those without the variation.

A meta-analysis of five randomized controlled trials compared the efficacy and safety of combined oral anticoagulation and antiplatelet therapy versus oral anticoagulants alone after prosthetic heart valve replacement and found an increased risk of general hemorrhage (65%) and gastrointestinal hemorrhage (250%). Embolism and stroke were significantly decreased. The authors conclude that the benefits of decreased risk of thromboembolic events outweigh the toxic effects of combined anticoagulation and antiplatelet therapy.

The results of large observational cohort study (n=13,559) indicate that in patients with nonvalvular atrial fibrillation, the risk of major hemorrhage increases with age, particularly intracranial hemorrhage, whether or not they are receiving warfarin. In patients aged 80 and older the risk of intracranial hemorrhage increases sharply. Also, this study found that among anticoagulated patients with atrial fibrillation, intracranial hemorrhages were responsible for nearly 90% of the deaths from warfarin-associated hemorrhage and the majority of disability among survivors.

Dermatologic

Dermatologic side effects including necrosis of the skin and other tissues have been reported in 0.1% to 1.0% of patients. Dermatitis, urticaria, alopecia, rash, bullous eruptions, pruritus, and pallor have been reported infrequently.

Warfarin-induced skin necrosis predominantly affects obese women (4-fold greater occurrence in women) and typically occurs within 10 days of the initiation of therapy, but has occurred after several months or several years of therapy. The majority of lesions (80%) occur in areas with abundant adipose such as the thighs, breasts, abdomen, buttocks, and the extremities. The lesions are usually painful, abrupt in onset, erythematous, purpuric, and sharply demarcated. The proposed mechanism of warfarin-induced skin necrosis involves an imbalance between protein C or protein S and vitamin K-dependent clotting factors. The lesions may resolve spontaneously or progress to form hemorrhagic bullae with subsequent necrosis. Generally, warfarin is withheld; however, discontinuation does not affect lesion progression. Some patients have safely resumed warfarin therapy, but the recommended management in patients who require long-term anticoagulation is resumption of warfarin at a lower dose in conjunction with heparin bridge therapy. The dosage of warfarin should be slowly titrated until a therapeutic INR is reached.

One case of warfarin-induced skin necrosis of the eyelids has been reported. In this case, the patient developed bilateral periorbital ecchymoses with full-thickness necrotic lesions in the medial canthal region.

Other

Other side effects have been reported infrequently. These have included purple toe syndrome.

Cardiovascular

Cardiovascular side effects have included systemic atheroemboli and cholesterol microemboli, which present with a variety of signs and symptoms. These have included purple toe syndrome, livedo reticularis (blue tingeing of the skin), 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 due to embolic occlusion. Hemopericardium and cardiac tamponade have also been reported. Hypotension, edema, angina syndrome, and chest pain have been reported infrequently.

Hepatic

Hepatic side effects have been reported infrequently. These have included jaundice, intrahepatic cholestasis, hepatitis, and elevated liver enzymes.

Renal

Renal side effects have been reported infrequently. These have included hematuria, acute renal failure due to interstitial nephritis, and renal hematomas.

Gastrointestinal

A meta-analysis of five randomized controlled trials compared the efficacy and safety of combined oral anticoagulation and antiplatelet therapy versus oral anticoagulants alone after prosthetic heart valve replacement and found an increased risk of general hemorrhage (65%) and gastrointestinal hemorrhage (250%). Embolism and stroke were significantly decreased. The authors conclude that the benefits of decreased risk of thromboembolic events outweigh the toxic effects of combined anticoagulation and antiplatelet therapy.

Gastrointestinal side effects have been reported infrequently. Nausea, diarrhea, abdominal cramping, vomiting, and flatulence/bloating have been reported. Gastrointestinal bleed has occurred when warfarin was combined with aspirin for antithrombotic effects after placement of heart valves.

Genitourinary

Warfarin-induced priapism has been reported. In one case report, a 16 year old male patient had been treated with warfarin (the active ingredient contained in Coumadin) for a deep venous thrombosis in his leg. The patient experienced a hypercoagulable state upon initiation of warfarin therapy because he also had an undocumented protein C deficiency. This led to an increased risk of thromboembolism that manifested as priapism and skin necrosis.

Genitourinary side effects have included priapism.

Hypersensitivity

Hypersensitivity reactions including anaphylactic reactions have been reported infrequently. A case of leukocytoclastic cutaneous vasculitis has been reported.

Nervous system

Nervous system side effects have been reported rarely. These have included fever, fatigue, lethargy, malaise, asthenia, pain, headache, dizziness, taste perversion, cold intolerance, and paresthesia including feeling cold and chills, syncope, loss of consciousness, and coma.

Respiratory

Respiratory side effects have been reported rarely. These have included tracheal or tracheobronchial calcification.

Ocular

Ocular side effects have included subconjunctival hemorrhage and retinal hemorrhage.