LEBANON INTERNAL MEDICINE ASSOCIATES
PATIENT INFORMATION SHEET
WHEN SHOULD I COME IN FOR MY BLOOD TEST?
Each time you have your INR test done, you will be told the next date to have your blood
tested again. If you are having your blood test done by the finger stick method, you will
be given a specific appointment time to return. If you are having blood drawn from your
arm at the laboratory, you can have your test done (without an appointment) during
normal business hours, but mornings are preferred so that I can contact you with your
If you are unable to have your blood tested on the date specified, please call my office
immediately (273-6706 extension 112).
WHY DOES MY COUMADIN/WARFARIN DOSAGE CHANGE?
The effect you get from the amount of Coumadin/warfarin you take depends on several
things, including changes in your other medications, illness, your diet, and your general
lifestyle. To ensure that you continue to take the correct amount of medication, you
1. Take your medication each day, according to the directed schedule that is given to you.
2. Have you blood test done regularly as it is scheduled.
3. Always report all changes in your medications, health, and lifestyle.
WHY IS IT IMPORTANT TO FOLLOW YOUR COUMADIN/WARFARIN
Because your dosage can change from one day to the next, I strongly encourage you to
keep track of your dose with the schedule provided to you. Check the schedule each day
to see how much medication to take – don’t guess.
If you get confused, just give me a call.
WHEN IS THE BEST TIME TO TAKE MY COUMADIN/WARFARIN
Coumadin/warfarin is taken just once a day. As a general rule, I advise all patients to take
their medication at approximately the same time each day, usually about 6 pm, or with
your evening meal. Taking your medication at the same time each day will help you get
into a daily habit, making it easier to remember to do so. You can take your medication
with or without food (it won’t upset your stomach).
WHAT ABOUT MY OTHER MEDICATIONS?
Any medication (prescription or over-the-counter) can potentially affect your body’s
ALWAYS let me know whenever you begin a new medication or stop taking an old
In most cases, I am able to predict how other medications will affect your
Coumadin/warfarin, and I will adjust your dosage accordingly. You may take your
medication at the same time as most other medications.
Other important points to remember
Never take aspirin (along with Coumadin/warfarin) without my knowledge. If
your physician has recommended that you take one coated aspirin/Ecotrin daily,
do not take more than this while you are taking Coumadin/warfarin. Your daily
coated aspirin/Ecotrin dose should never exceed 325 mg.
Do not take ibuprofen (Advil, Motrin, Nuprin, Medipren, Excedrin IB, Haltran,
Midol 200, Pamprin-IB, Trendar, or others), naproxen (Aleve, Naprosyn,
Anaprox), ketoprofen (Orudis, Actron), cimetidine (Tagamet HB), or famotidine
(Pepcid AC) while taking Coumadin/warfarin.
Do not take Vitamin E or vitamin C supplement without my knowledge.
WHAT CAN I SAFELY TAKE ALONG WITH COUMADIN/WARFARIN?
For headache or pain relief: acetaminophen (Tylenol). For constipation: Metamucil or Milk of Magnesia For cold symptoms: Sudafed (to decongest), Chlor-Trimeton or Benadryl (for
runny nose/sneezing/watery eyes), and Robitussin (for cough).
WHAT IF I’M SCHEDULED TO SEE ANOTHER DOCTOR OR MY DENTIST?
health care providers that you are taking Coumadin/warfarin. Contact me
if and when you will be seeing another physician, particularly if surgery or dental
procedures are involved; I might need to adjust your medication dosage before
your appointment. Some people (with artificial heart valves) will also need
antibiotics beforehand, even for such a minor procedure as teeth cleaning.
Call and let me know about any new medication that anyone prescribes for you
WHAT ARE COUMADIN/WARFARIN’S SIDE EFFECTS?
Coumadin/warfarin is relatively free of side effects; it will not make you drowsy, change
your blood pressure, make your mouth dry, or increase your heart rate. If something feels
different from normal that you think might be caused by the medication, please call so
MUST I CHANGE MY DIET WHILE TAKING COUMADIN/WARFARIN?
Some foods are high in vitamin K, which can counteract the effect of Coumadin/warfarin.
You may continue to include these foods in your diet in moderation, that is, one normal
Green leafy vegetables (broccoli, brussel sprouts, cauliflower, spinach, other
Chick peas Beef and pork liver Green tea (served in Oriental restaurants)
, be consistent with what you normally eat, and notify me if you wish to
go on any special diet. Likewise, you should also call me if you are ill vomiting/diarrhea)
or not eating at all, as this will affect your medication.
MAY I DRINK ALCOHOL WHILE TAKING COUMADIN/WARFARIN?
Alcohol beverages, in moderation, are safe while taking Coumadin/warfarin; this means a
maximum of two drinks per day (1 beer – 1 glass of wine – 1 cocktail/shot). Excessive
alcohol intake puts you at significant risk for injury and potential bleeding complications
while taking Coumadin. Use common sense, and be careful.
WHAT IF I FORGET TO TAKE A DOSE OF COUMADIN/WARFARIN?
Take it as soon as you remember, even up until noon the following day (you will also
take that day’s dose at the normally scheduled time). If you forget altogether, or aren’t
sure what to do, please call me before taking the next dose.
WHAT IF I EXPERIENCE SOME UNUSUAL BLEEDING?
Signs of bleeding include prolonged bleeding from cuts, nosebleeds, gum bleeding,
increased vaginal bleeding, blood in the urine, red/black stools. If bleeding from the nose
or skin, apply firm, direct pressure to the area until the bleeding stops. If you notice blood
in your urine or with a bowel movement, call me immediately. You might note a few
more bruises on your skin while taking Coumadin/warfarin; this is not worrisome unless
they become large or painful or don’t go away in a reasonable time. When in doubt,
please call. Bleeding may be a sign that your INR is too high, indicating you may be
WHAT IF I GET SICK?
Acute illness will change your body’s response to your medication. An episode of
congestive heart failure, fever (over 101 degrees), flu, viral/bacterial infection, nausea, or
vomiting (for more than 24 hours) can cause your medication to accumulate in your body
and cause your INR to go up dramatically. If you experience any of the above, please call
so that we can discuss how you are feeling. Remember also to call me before you begin
taking antibiotics for any reason.
Your medication dosage may need to be adjusted. If
you are given a flu vaccination, plan to have your blood tested 7-10 days later, as it also
can affect your Coumadin/warfarin response. Coumadin/warfarin is a complex medicine
that is helpful for many people with your medical history. You are the most important
person ensuring that your therapy is successful.
Let all health care providers know that you are taking Coumadin/warfarin. Have your INR tested regularly as scheduled.
Food, drink, illness, and other medications may affect your body’s response to
Call with any questions you might have. I am here to help you.
DECRETO DEL PRESIDENTE DELLA GIUNTA REGIONALE 16 novembre 2001, n. 16/R Regolamento regionale recante: “Disposizioni in materia di procedimento di valutazione d’incidenza” Visto l’articolo 121 della Costituzione come modificato dalla legge costituzionale 22 novembre 1999, n. 1; Viste le direttive CE 43/92 e 42/2001 Visto il decreto del Presidente della Repubblica 8 settembre 19
International Task Force for Prevention of Coronary Heart Disease Last update: Scientific News Literature Up-date since 2002 Observational Studies Prediction of risk of coronary events in middle-aged men in the Prospective Cardiovascular Münster Study (PROCAM), using neural networks. Int J Epidemiol 2002;31:1253-1262 Intervention trials indicate that abou