Warfarin Nycomed: instructions for use
- Warfarin Nycomed: instructions for use
- Form of preparation, its composition and packaging
- Mechanism of action
- When and whom should I take?
- Who and when is it not recommended to take?
- How to use?
- Symptoms of overdose and their treatment
- Interaction of warfarin with other drugs
- The use of Warfarin Nycomed in pregnancy and lactation
- Side effects
- How and where to store?
- Terms of leave from pharmacies
- Warfarin Nycomed price
Farm Group: The drug refers to anticoagulants of an indirect type of action
Form of preparation, its composition and packaging
The drug Warfarin Nycomed is available in the form of round tablets of blue color with a cross-shaped division line.
1 tablet Warfarin Nycomed contains sodium warfarin 2.5 mg, as well as additional substances: corn starch, lactose, calcium hydrogenphosphate, indigocarmine as a dye, povidone and magnesium stearate.
Tablets are packed in plastic containers in the amount of 50 or 100 pieces.
Mechanism of action
Warfarin Nycomed is an anticoagulant with an indirect type of action. It inhibits the formation of specific coagulation factors in the liver, namely, 2,7,9 and 10 (vitamin K-dependent). The content of these substances in the blood plasma decreases, and the process of blood clotting is inhibited.
The start of anticoagulant action takes place 1.5-3 days after the first dose and reaches a maximum of about 5-7 days. Warfarin Nycomed effect continues for 4-5 days after withdrawal.
Warfarin Nycomed, getting into the body, quickly absorbed from the intestine into the blood. In this case, a high degree of binding to plasma albumins is observed.
Then the metabolism in the liver goes. Warfarin is a mixture of optical isomers of R- and S-. Each of them passes its path of exchange, forming two different products. The left-handed isomer exhibits a more pronounced (2-5 times) efficacy than the dextrorotatory one, but the half-life of the second is less, that is, the dextrorotatory isomer lasts longer in the body. Catalysts for the metabolism of warfarin isomers are the enzymes CYP2C9, CYP1A2 and CYP3A4. Patients who have a polymorphism of these substances show increased sensitivity to the drug and bleeding may occur.
In the future, warfarin is converted into inactive products, which together with bile are excreted into the intestines, from there absorbed into the blood and excreted in the urine. The half-life is on average 20 to 60 hours. The dextrorotatory isomer lingers longer and is withdrawn within 37-89 hours by 50%, and the left-handed isomer is already in 21-43 hours.
When and whom should I take?
Warfarin Nycomed uses:
- For therapeutic and prophylactic measures for thrombosis of veins and embolism of arteries
- Prevention of myocardial infarction and prevention of complications in the post-infarction period
- Prevention of vascular occlusion in atrial fibrillation, valve defects and prosthetics
- Therapy and prevention of obstruction in the postoperative period
Who and when is it not recommended to take?
- Sudden acute bleeding
- Severe liver damage
- Reduced blood platelet count
- Insufficiency of proteins C and S
- Period of gestation
- Hypersensitivity to the components of the drug
- At an increased risk of hemorrhage
How to use?
The drug Warfarin Nycomed is taken once a day, at the same time. The course of treatment depends on the course of the disease and is determined individually by the doctor.
Before starting the treatment, an INR is performed, the repeated analysis is performed at a frequency of once every -1-2 months. The clinical condition of the patient determines the need for further therapy. You can cancel treatment immediately as needed.
If the patient has not previously taken Warfarin Nycomed, his starting dose is 2 tablets per day (5 mg) for 4 days. Next, the definition of MNO is carried out and, depending on the numbers obtained, a maintenance dose is administered. As a rule, it ranges from 1 to 3 tablets per day.
If the patient has previously received Warfarin Nycomed, he is given a double maintenance dose (established earlier) in the first two days, and then continues treatment with the usual maintenance dosage. After 4 days from the start of therapy, INR is monitored and a dose is administered in accordance with the data obtained.
With venous clogging, arterial embolism, heart valve diseases, atrial fibrillation, valve prosthesis with bioprostheses, it is necessary to keep the INR value in the range from 2 to 3. If valve prosthesis is performed by mechanical prostheses or acute myocardial infarction is observed, it is recommended to control INRs on higher figures 2.5 to 3.5.
Information on the use of the drug in childhood is not very much. Standard start of treatment is carried out with a dose of 0.2 mg per kg of body weight per day. If there is a dysfunction of the liver, the dose is halved and 0.1 mg per kg of body weight is prescribed. The maintenance dose, as well as in the case of adult patients, is selected based on the indices of the INR. Therapy is carried out under the supervision of an experienced specialist.
Treatment of elderly patients does not require dose changes or multiple reception, but is conducted under close supervision, since this category of patients increases the risk of side effects.
If the liver is broken, careful monitoring of the INR is necessary, since the liver participates, both in the metabolism of the drug, and in the development of coagulation factors.
With renal failure, there is no need to change the dose. Conducting peritoneal dialysis is not an occasion for increasing the dose.
The anticoagulation therapy before, after and during the surgery is performed as follows. It is necessary to determine the INR 7 days before the surgery. Then, depending on the INR indicators, it is necessary to stop receiving a few days before the operation. If the INR is more than 4 - the reception is stopped in 5 days. If the INR is in the range of 3 to 4 - already in 3 days, if the INR varies between 2 and 3 - reception is stopped in 2 days. If there is a risk of thrombosis, heparin must be injected subcutaneously. If in the evening before the operation INR is more than 1.8, the patient is administered intravenously or orally with vitamin K at a dosage of 0.5-1 mg.
It is necessary to conduct a regular injection of low molecular weight heparin within a week after the operation and to restore the intake of Warfarin Nycomed. If surgical intervention of a small amount of warfarin in an individually selected maintenance dose is taken on the same day. If a major operation was performed, the treatment with Warfarin is restored on the same day as the patient returns to enteral feeding.
Symptoms of overdose and their treatment
Signs of an overdose of the drug is the location of the INR on the hemorrhage development border. The patient may have bleeding gums, a slight discharge of blood in the urine.
Treatment: with minor symptoms of an overdose, treatment consists in the temporary discontinuation of taking Warfarin Nycomed or even lowering the dosage. The effectiveness of therapy is determined by the achievement of MNO of the required indicators. With the development of severe bleeding, vitamin K, freshly frozen plasma is injected intravenously, and activated charcoal or other sorbents are orally taken.
If the patient needs to return to receiving anticoagulants again, high doses of vitamin K should not be used, since the resistance to Warfarin Nycomed begins to develop.
Interaction of warfarin with other drugs
To start or stop taking other medications while using Warfarin is only after consulting with the treating specialist. Mutual inhibition or induc- tion must always be considered.
When used with warfarin drugs that affect the number of platelets, the risk of bleeding increases. These include: aspirin and most NSAIDs (except selective inhibitors of COX-2), clopidogrel, dipyridamole, penicillins in large dosages.
It is not necessary to use cytochrome P450 inhibitors together with Warfarin, since in this case bleeding may develop.
Many medicines and even medicinal herbs are capable of both strengthening and reducing the effect of Warfarin Nycomed, so it's worth to consult with your doctor before you start taking a new medicine against the background of using Warfarin.
It is not necessary to take warfarin with preparations of St. John's wort, which is the inducer of this medicine. At the same time, potentiation can last up to 14 days. All actions regarding the withdrawal of drugs or the continuation of their admission should be carried out against a background of careful monitoring by the INR.
It should be borne in mind that food rich in vitamin K is also capable of altering the effect of Warfarin, namely, inhibiting it. If, on the contrary, vitamin K does not go enough against a background of diarrhea or a laxative, an increase in Warfarin effects is observed.
The use of Warfarin Nycomed in pregnancy and lactation
Warfarin Nycomed is contraindicated throughout the period of bearing of the child. It is proved that the drug penetrates through the placental barrier and has a detrimental effect on the development of the fetus with subsequent disturbances in the work of organs and systems. Taking warfarin can lead to bleeding, both during the gestation of the child, and during the birth process.
Warfarin Nycomed is ingested in breast milk, but in such meager quantities that it is unable to influence the child's coagulation system. Therefore, the drug can be used during breastfeeding.
Most often among the side effects characteristic of admission Warfarin develops bleeding. Their frequency among people taking the drug is 8%. At the same time heavy bleeding is not more than 1%, and fatal 0.25%. Most often, the development of bleeding hypertension, which was not under control and not subjected to appropriate therapy. A high level of INR also contributes to the development of hemorrhages. If the INR is within normal limits, and bleeding does begin, additional studies should be conducted to establish the factors that affect this side effect.
The risk of bleeding also increases in the following cases: old age, intensive concomitant antiplatelet therapy, bleeding in the digestive tract in anamnesis.
On the part of the digestive tract: dyspepsia, nausea and vomiting, frustration.
From the skin: palmar-plantar syndrome and coumarin necrosis. The first occurs more often in men with atherosclerotic occlusions of blood vessels. In this case, plaques break away from the walls of the vessels under the influence of the drug and clog their lumen. Symmetrical painful hemorrhages on the fingers and feet are observed. Coumarin necrosis is more typical of women. It has the appearance of dark, swollen skin on the legs and buttocks, which later dies.
All adverse events are reversible and gradually disappear after discontinuation of the drug.
How and where to store?
Warfarin Nycomed is stored at a temperature of no higher than 25 ° C, for 5 years from the date of manufacture. Keep away from children
Terms of leave from pharmacies
Warfarin Nycomed belongs to the list of prescription drugs.
Warfarin Nycomed price
Warfarin Nycomed tablets 2,5mg - 100-121 rub.