Warfarin Nycomed: instructions for use
- Warfarin Nycomed: instructions for use
- The form of release of the drug, its composition and packaging
- Mechanism of action
- When and to whom to take?
- Who and when is not recommended to take?
- How to use?
- Symptoms of overdose and their treatment
- Interaction of warfarin with other drugs
- The use of warfarin Nycomed during pregnancy and lactation
- Side effects
- How and where to store?
- Pharmacy sales terms
- Warfarin Nycomed price
Farm group: The drug belongs to the anticoagulants of indirect type of action
The form of release of the drug, its composition and packaging
The drug Warfarin Nycomed is available in the form of round blue-colored tablets with a cross-shaped dividing line.
1 tablet Warfarin Nycomed contains 2.5 mg of warfarin sodium, as well as additional substances: corn starch, lacttose, calcium hydrogen phosphate, indigo carmine 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 blood plasma falls, and the process of blood coagulation is inhibited.
The start of the anticoagulant action occurs already 1.5-3 days after the first dose and reaches a maximum of about 5-7 days. The effect of Warfarin Nycomed continues for 4-5 days after discontinuation.
Warfarin Nikomed, getting inside the body, is rapidly absorbed from the intestine into the blood. At the same time, there is a high degree of binding to plasma albumin.
Next is the metabolism in the liver. Warfarin is a mixture of the optical isomers of R- and S-. Each of them passes its own path of exchange, forming two different products. The left-handed isomer exhibits a more pronounced (2-5 times) efficacy than the right-rotating, but the second half-life is less, that is, the right-rotating longer is in the body. The catalysts for the exchange of warfarin isomers are CYP2C9, CYP1A2 and CYP3A4 enzymes. Patients who have a polymorphism of these substances, there is increased sensitivity to the drug and bleeding may occur.
Further, warfarin is converted into inactive products, which, along with bile, are excreted into the intestine, from there they are absorbed into the blood and excreted in the urine. The elimination half-life averages from 20 to 60 hours. The right-rotating isomer is delayed longer and is displayed for 37-89 hours by 50%, and the left-rotating isomer is already 21-43 hours.
When and to whom to take?
Warfarin Nycomed use:
- for therapeutic and preventive measures for venous thrombosis and arterial emboli
- prevention of myocardial infarction and prevention of complications in the post-infarction period
- prevention of vascular occlusion during atrial fibrillation, valve defects and their prosthetics
- therapy and prevention of blockage in the postoperative period
Who and when is not recommended to take?
- Sudden bleeding acute character
- Severe liver damage
- Low blood platelet count
- Protein C and S deficiency
- Gestation period
- Hypersensitivity to drug components
- With an increased risk of hemorrhage
How to use?
The drug Warfarin Nicomed 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 a doctor.
Before starting the treatment, the INR determination is carried out, the repeated analysis is carried out at a frequency of -1-2 months. The clinical condition of the patient determines the need for further therapy. You can cancel the treatment immediately if necessary.
If the patient has not previously taken Warfarin Nicomed, his starting dose is 2 tablets per day (5 mg) for 4 days. Then they carry out the determination of INR and, depending on the numbers received, a maintenance dose is prescribed. As a rule, it ranges from 1 to 3 tablets per day.
If the patient has previously taken Warfarin Nycomed, then in the first two days he is prescribed a double maintenance dose (established previously), and then continue the treatment with the usual maintenance dosage. 4 days after the start of therapy, an INR control is performed and the dose is prescribed in accordance with the data obtained.
When clogged veins, arterial emboli, diseases of the heart valves, atrial fibrillation, valvular bioprosthetic prosthetics, it is necessary to keep the INR index from 2 to 3. 2.5 to 3.5.
Information about the use of the drug in childhood is not very much. Standardly, the start of treatment is carried out with a dose of 0.2 mg per 1 kg of weight per day. If there is a violation of the liver, reduce the dose by half and appoint 0.1 mg per 1 kg of weight. Maintenance dose, as well as in the case of adult patients, is selected based on the INR indicators. Therapy is carried out under the supervision of an experienced specialist.
Treatment of elderly patients does not require changes in doses or frequency of administration, but is carried out under close observation, since in this category of patients the risk of side effects increases.
In case of liver malfunction, it is necessary to conduct a thorough monitoring of the INR, since the liver takes part both in the metabolism of the drug and in the development of clotting factors.
In renal failure there is no need to change the dose. Peritoneal dialysis is not a reason for increasing the dose.
Conducting anticoagulation therapy before, after and during operations is as follows. It is necessary to determine the INR 7 days before the surgery. Then, depending on the performance of the INR, it is necessary to stop taking it several days before the operation. If the INR is greater than 4, the reception is stopped in 5 days. If the INR is in the range from 3 to 4 - already in 3 days, if the INR ranges between 2 and 3 - the reception is stopped in 2 days. If there is a risk of thrombosis, heparin should be injected subcutaneously. If in the evening before the operation, the INR is greater than 1.8, then vitamin K is administered intravenously or orally to the patient at a dosage of 0.5-1 mg.
It is necessary for a week after the operation to carry out the regular introduction of low molecular weight heparin and restore the reception of Warfarin Nycomed. If a small volume of surgical intervention warfarin in an individually selected maintenance dose is taken on the same day. If a major operation was performed, the reception of warfarin is restored on the same day when the patient returns to the enteral diet.
Symptoms of overdose and their treatment
Signs of overdose of the drug is the location of the INR at the border of the development of hemorrhages. The patient may experience bleeding gums, a slight discharge of blood in the urine.
Treatment: with minor symptoms of overdose, treatment consists in temporarily discontinuing warfarin Nycomed or even lowering the dosage. The effectiveness of therapy is determined by the achievement of the required indicators by the INR. With the development of severe bleeding, vitamin K, fresh frozen plasma is injected intravenously, and activated charcoal or other sorbents are taken orally.
If the patient will need to return to the reception of anticoagulants, you should not use high doses of vitamin K, as Nycomed begins to develop resistance to warfarin.
Interaction of warfarin with other drugs
To start or stop taking other drugs against the background of the use of warfarin is only after consulting with your doctor. In this case, mutual inhibition or induction should be taken into account.
When drugs with warfarin are used that affect platelet count, the risk of bleeding increases. These include: aspirin and most NSAIDs (other than selective COX-2 inhibitors), clopidogrel, dipyridamole, and penicillins in large dosages.
Together with warfarin, cytochrome P450 inhibitors should not be used, since in such a case bleeding may develop.
Many drugs and even medicinal herbs can both strengthen and reduce the effect of Warfarin Nycomed, so you should always consult a doctor before starting a new medicine while using Warfarin.
Do not take warfarin with Hypericum, which is an inducer of this medicine. In this case, the potentiation can last up to 14 days. All actions concerning the withdrawal of drugs or the continuation of their administration should be carried out against the background of careful monitoring of the INR.
It should be borne in mind that food rich in vitamin K is also able to change the effect of warfarin, namely, to inhibit it. If, on the contrary, vitamin K is not sufficiently supplied with diarrhea or laxative intake, the effects of warfarin are enhanced.
The use of warfarin Nycomed during pregnancy and lactation
Warfarin Nicomed is contraindicated throughout the entire period of childbearing. It is proved that the drug penetrates the placental barrier and has a detrimental effect on the development of the fetus with subsequent disruption of the organs and systems. Reception of warfarin can lead to bleeding, both during childbirth and during the labor process.
Warfarin Nycomed enters breast milk, but in such meager amounts that it is unable to affect the coagulation system of the child. Therefore, the drug can be used during breastfeeding.
Most often among the side effects characteristic of the reception of warfarin bleeding develops. Their frequency among people taking the drug is 8%. In this case, heavy bleeding is not more than 1%, and fatal 0.25%. Most often, hypertension contributes to the development of bleeding, which has not been controlled and has not been subjected to appropriate therapy. Also contributes to the development of hemorrhages high levels of INR. If the INR is within the normal range, and the bleeding has nonetheless begun, additional research should be conducted in order to establish the factors affecting this side effect.
The risk of bleeding increases also in the following cases: advanced age, intensive concomitant antiplatelet therapy, bleeding in the gastrointestinal tract in history.
On the part of the digestive tract: dyspepsia, nausea and vomiting, disorder.
On the part of the skin: palmar-plantar syndrome and coumarin necrosis. The first occurs more often in men with atherosclerotic vascular occlusions. In this case, the plaques detach from the vessel wall under the influence of the drug and clog their lumen. Symmetric painful hemorrhages on fingers and feet are observed. Coumarin necrosis is more common in women. It has the appearance of dark, swollen skin on the legs and buttocks, which then dies off.
All side effects are reversible and gradually disappear after drug withdrawal.
How and where to store?
Warfarin Nycomed stored at a temperature not higher than 25 ° C, for 5 years from the date of manufacture. Keep out of the reach of children
Pharmacy sales terms
Warfarin Nycomed belongs to the list of prescription drugs.
Warfarin Nycomed price
Warfarin Nicomed tablets 2.5 mg - 100-121 rubles.