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Warfarin

Structure

Warfarin-1 Tablets
Each tablet contains Warfarin Sodium (crystalline) USP equivalent to Warfarin Sodium (anhydrous) 1

Warfarin-2 Tablets
Each tablet contains Warfarin Sodium (crystalline) USP equivalent to Warfarin Sodium (anhydrous) 2

Warfarin-5 Tablets
Each tablet contains Warfarin Sodium (crystalline) USP equivalent to Warfarin Sodium (anhydrous) 5

No Prescription

Warfarin is prescribed for:
- Pulmonary embolism;
- Prophylaxis and/or treatment of venous thrombosis and its extension;
- Prophylaxis and/or treatment of thromboembolic complications associated with atrial fibrillation and/or cardiac valve replacement and post myocardial infarction;

Dosage

The dosage and administration of warfarin must be individualized for each patient according to the particular patient’s PT/INR response to the drug.
Venous thromboembolism (including pulmonary embolism): An INR of 2.0-3.0 is sufficient for prophylaxis and treatment of venous thrombo-embolism and minimises the risk of hemorrhage associated with higher INRs.
Atrial fibrillation: An INR of 2.0-3.0 should be prescribed for long term warfarin therapy in appropriate patients.
Post myocardial infarction: In post myocardial infarction patients, warfarin therapy should be initiated early (2-4 weeks post-infarction) and dosage should be adjusted to maintain an INR of 2.5-3.5 long term.
In patients thought to be at an increased risk of bleeding complications or on aspirin therapy, maintenance of warfarin therapy at the lower end of this INR range is recommended.
Mechanical and Bioprosthetic heart valves: In patients with mechanical heart valve(s), long term prophylaxis with warfarin to an INR of 2.5-3.5 is recommended.
In patients with bioprosthetic heart valves, warfarin therapy to an INR of 2.0-3.0 for 12 weeks after insertion is recommended.
In patients with additional risk factors such as atrial fibrillation or prior thromboembolism, consideration should be given for long term therapy.
Recurrent systemic embolism: In cases where the risk of thromboembolism is great, such as in patients with recurrent systemic embolism, a higher INR may be required.
An INR of greater than 4.0 appears to provide no additional therapeutic benefit in most patients and is associated with a higher risk of bleeding.
Initial dose: It is recommended that warfarin therapy be initiated with a dose of 2 to 5 per day with dosage adjustments based on the results of PT/INR determinations.
Low initiation doses are recommended for elderly and/or debilitated patients and patients with potential to exhibit greater than expected PT/INR response to warfarin.
Maintenance: Most patients are satisfactorily maintained at a dose of 2 to 10 daily.
Duration of therapy: The duration of therapy in each patient should be individualized.
In general, anticoagulant therapy should be continued until the danger of thrombosis and embolism has passed.
Conversion from heparin therapy: Since the anticoagulant effect of warfarin is delayed, heparin is preferred initially for rapid anticoagulation.
Conversion to warfarin may begin concomitantly with heparin therapy or may be delayed by 3 to 6 days.
To ensure continuous anticoagulation, it is advisable to continue full dose heparin therapy and that warfarin therapy be overlapped with heparin for 4 to 5 days, until warfarin has produced the desired therapeutic response as determined by PT/INR.
Once this has been achieved, heparin may be discontinued.

Contraindications

Anticoagulation is contraindicated in any localised or general physical condition or personal circumstance in which the hazard of haemorrhage might be greater than the potential clinical benefits of anticoagulation such as:
pregnancy, hemorrhagic tendencies or blood dyscrasias
recent or contemplated surgery of:
1) central nervous system,
2) eye,
3) traumatic surgery resulting in large open surfaces
bleeding tendencies associated with active ulceration or overt bleeding of:
1) gastrointestinal, genitourinary or respiratory tracts,
2) cerebrovascular hemorrhage,
3) aneurysms – cerebral, dissecting aorta,
4) pericarditis and pericardial effusions,
5) bacterial endocarditis, threatened abortion, eclampsia and pre-eclampsia
inadequate laboratory facilities
unsupervised patients with senility, alcoholism, or psychosis or other lack of patient co-operation
spinal puncture and other diagnostic or therapeutic procedures with potential for uncontrollable bleeding
major regional, lumbar block anaesthesia and malignant hypertension.

Package

- Blister pack of 10 tablets;
(c) 2017