Warfarin

Generic Name Warfarin

Brand Name Jantoven

Drug Anticoagulant
Class/Pharmacological
Class

Dosage form used in SI Warfarin(coumadin) Tablets, 1mg, 2mg, 5mg

EML
Warfarin (Marevan) Tablets, 1mg, 3mg, 5mg

MOA Inhibit synthesis of vitamin K-dependent clotting factors (II, VII, IX, X) and the
antithrombotic factors protein C and protein S.

Indication Prevention and treatment of VTE

Prevention of thromboembolism in patients with prosthetic heart valves

Prevention of stroke in patients with previous MI and increased embolic risk

Precaution Protein C or protein S deficiency—increases risk of skin necrosis.

Alcoholism—contraindicated.

Contraindicated in severe active bleeding or disease states with an increased

risk of severe bleeding, e.g. severe uncontrolled hypertension, severe hepatic
disease

Risk of bleeding during surgery increases with the INR.

Side Effects Common

bleeding

Rare

skin necrosis, purple discoloration of toes, alopecia, fever, rash, nausea,

vomiting, diarrhea, hepatic dysfunction, allergic reactions, e.g.
hypersensitivity

Dosage 5 mg once daily for 2 days then adjust according to INR.

maintenance dose, 1–10 mg daily, taken at the same time each day

Duration of treatment varies with indication.

Storage Store at normal room temperature

Important counseling Take at the same time everyday

points
 Take same brand (no switching of brand)

Avoid green vegetables that have vitamin K

Avoid alcohol consumption

Let your doctor/pharmacist know that you take this drug

Do regular blood test to monitor INR

Drug Administration Take orally

Ancillary instruction Finish the course

Until advice by the doctor to stop, increase or reduce dose

44. HEPARIN

GENERIC NAME Heparin

Brand Name Monoject Flush Syr/Hep lock

DRUG CLASS Glycosaminoglycan- Anti-coagulants

Dosage Forms Used Injection 25,000 IU in 5ml

Mode of action Inactivate clotting factors IIa (thrombin) and Xa by binding to antithrombin III;
LMWHs and danaparoid have a much greater effect on factor Xa than on
thrombin. Danaparoid is a more selective inhibitor of factor Xa than LMWHs.

Indications Prevention of VTE in surgical and high-risk medical patients

Treatment of VTE

Treatment of acute coronary syndromes

Treatment of peripheral arterial occlusion (seek specialist advice)

Prevention of arterial thrombosis during coronary angioplasty (seek specialist

advice)

Prevention of extracorporeal thrombosis during hemodialysis (seek specialist

advice)

Prevention of extracorporeal thrombosis during cardiopulmonary bypass

(seek specialist advice)

Treatment of disseminated intravascular coagulation (seek specialist advice

Precautions Contraindicated in active bleeding or disease states with an increased risk of

 bleeding, e.g. bleeding disorders.

Contraindicated in severe hepatic impairment or disease, including

esophageal varices.

Hypersensitivity, past or present-induced thrombocytopenia.

Side effects Common

bleeding, bruising and pain at injection site, hyperkalemia, mild reversible

thrombocytopenia (does not necessarily indicate increased risk for severe
thrombocytopenia)

Dosage Prevention of VTE

General surgery, adult, SC 5000 units 2 hours before procedure, then

5000 units 2 or 3 times daily for 7–10 days or until mobilised.

High-risk medical patients, adult, SC 5000 units 2 or 3 times daily for 7–

10 days or until mobilised.

Treatment of VTE

Adjust doses according to APTT.

Adult

Either, IV bolus 5000 units, followed by either IV infusion 1300 units/hour

(often 30 000 units/24 hours) or SC 17 500 units every 12 hours or

IV bolus 80 units/kg followed by IV infusion 18 units/kg/hour.

Child

IV bolus 75 units/kg followed by IV infusion 15–25 units/kg/hour.

Storage Store injection at room temperature or below 300C. Store in a dry place
away from moisture and direct sunlight. Keep away from children.

How to take , when to Injection:

take (Drug
Return to your clinic every day for your dose.
administration)

Ancillary instruction Complete your dose. Can be taken with or without food