![]() ![]() The major complications associated with warfarin are clotting due to underdosing or bleeding due to excessive anticoagulation. If a dose is missed or forgotten, call your healthcare provider for advice. Never increase or decrease your dose unless instructed to do so by your healthcare provider. Warfarin must be taken exactly as prescribed. Patients who do fill prescriptions abroad should ensure the accuracy and quality of the medication dispensed. Warfarin has many foreign brand names (Table 1). Foreign drugs may use identical or potentially confusing brand names for products with active ingredients that differ from U.S. residents against purchasing drugs at foreign Internet pharmacies. prescriptions abroad, either when traveling or online, need to maintain caution and vigilance. Some FDA–approved products have the same brand names as drug products marketed outside the United States but contain completely different active ingredients. prescriptions filled abroad may give patients the wrong active ingredient for treating their health condition. In 2006, the Food and Drug Administration issued a public health advisory to healthcare professionals and consumers that U.S. Therefore, if the color or dose of the dispensed tablet appears different from the pill taken previously, the patient should immediately notify the dispensing pharmacist or healthcare provider. The goal is to allow the patient to identify the color-coded dose and prevent mix-ups or errors. In the case of Coumadin (a brand-name product) and warfarin (a generic product), the manufacturers attempted to keep the colors consistent with the strength of the pills. In the United States, trademark laws do not allow generic drugs to look exactly like the brand-name drug however, the generic drug must have the same active ingredients. Generic drugs are often less expensive than their brand-name counterparts, because the generic manufacturers have not incurred the expenses of developing and marketing a new drug. Food and Drug Administration requires that all generic drugs be as safe and effective as brand-name drugs. Generic drugs are supposed to have the same dosage, therapeutic effects, route of administration, side effects, and strength as the original drug. Difference Between Brand-Name and Generic Medications Coumadin/ warfarin pills come in different colors, and each color corresponds to a different dose (see graphic below). Unlike most medications that are administered as a fixed dose, warfarin dosing is adjusted according to the INR blood test results therefore, the dose usually changes over time. ![]() This is why those who take warfarin must have their blood tested so frequently. If the INR is too low, blood clots will not be prevented, but if the INR is too high, there is an increased risk of bleeding. It is important to monitor the INR (at least once a month and sometimes as often as twice weekly) to make sure that the level of warfarin remains in the effective range. The INR ensures that PT results obtained by different laboratories can be compared. The INR is a standardized way of expressing the PT value. The PT is reported as the International Normalized Ratio (INR). The blood test used to measure the time it takes for blood to clot is referred to as a prothrombin time test, or protime (PT). On the basis of the results of the blood test, your daily dose of warfarin will be adjusted to keep your clotting time within a target range. Therefore, the effect of warfarin must be monitored carefully with blood testing. The goal of warfarin therapy is to decrease the clotting tendency of blood, not to prevent clotting completely. Therefore, by giving a medication that blocks the clotting factors, your body can stop harmful clots from forming and prevent clots from getting larger. ![]() Vitamin K is needed to make clotting factors and prevent bleeding. Warfarin decreases the body’s ability to form blood clots by blocking the formation of vitamin K–dependent clotting factors. The formation of a clot in the body is a complex process that involves multiple substances called clotting factors. Many people refer to anticoagulants as *blood thinners however, warfarin does not thin the blood but instead causes the blood to take longer to form a clot. Because warfarin interferes with the formation of blood clots, it is called an anticoagulant (PDF). Beneficial blood clots prevent or stop bleeding, but harmful blood clots can cause a heart attack, stroke, deep vein thrombosis or pulmonary embolism. Warfarin (brand names Coumadin and Jantoven) is a prescription medication used to prevent harmful blood clots from forming or growing larger. ![]()
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