Health Watch by Steve Mullenix

The North Jefferson News



Many people take a drug called Coumadin (warfarin).

Often this drug gets a bad rap or reputation for some rather serious side effects and they are not without concern. But properly managed, this drug can be a life saver to many individuals.

Coumadin is an anticoagulant (blood thinner). It reduces or prohibits the formation of blood clots. It works by blocking the synthesis of certain clotting factors and subsequently blocks blood clot formation. There are over 27 different steps in the formation of a blood clot, which makes for a very complex process. Coumadin works on only one step in the complex process.

Taking Coumadin is a balancing act. You want to take enough Coumadin or warfarin to decrease the risk of a blood clot, but not so much as to stop the clotting process completely. If this happens, you are at a higher risk of bleeding problems.

That’s why it is essential that your physician monitor your blood while you are taking this medication. The return visits for blood tests are a necessity.

The test used most often to monitor the effect of Coumadin is called prothrombin time (PT). The result of this test determines how high or low your dose of Coumadin should be.

While taking Coumadin, there are precautions you should follow:

• Don’t smoke

• Use a soft toothbrush

• Use waxed dental floss

• Use an electric razor instead of a straight razor or blades

• Avoid use or be extremely cautious when using scissors or knives

• Wear gloves when working outside

• Avoid rough sports and wear protective clothing

Some foods are of a concern as well. Foods high in Vitamin K can make Coumadin less effective. Try to avoid large amounts of these foods; however, neither should you suddenly lower your current intake. Remember, taking Coumadin is an exercise in balance. The following foods are high in Vitamin K:

• Beef or Pork Liver

• Alfalfa

• Asparagus

• Broccoli

• Brussels Sprouts

• Cabbage

• Cauliflower

• Lettuce, spinach, kale or turnip greens

• Watercress

• Canola and soybean oil

Now let’s address that big drug interaction that everyone is aware of — the Coumadin and aspirin interaction.

As we have previously stated, there are over 27 steps in the process of forming a blood clot. Coumadin or warfarin works on only one of these 27 steps. Aspirin, on the other hand, works at an entirely different step in the process.

Potentially there is a chance for a very high if not total suppression of the clotting process. Other drugs of similar classes like Celebrex, Voltaren, Motrin, Ibuprofen and Aleve can also cause the potential for serious bleeding in the stomach or intestines.

Other over-the-counter products such as Vitamin E, Coenzyme Q-10, Dong Quai, Garlic, Ginkgo Bilova, Ginseng, and St. Johns Wort may bear discussion with your doctor as well.

What happens if you miss a dose? Take the missed dose as soon as you remember. Call your physician or pharmacist if you have any problems. Do not take two doses on the same day and Do not take two doses at the same time.

Make sure any other physician, dentist or pharmacist you may be seeing is aware you are on Coumadin therapy. It’s not a bad idea to invest in one of the medical alert bracelets or necklaces which alerts a medical professional of Coumadin therapy.

Call your physician right away if you experience any of the following:

• Red or dark brown urine

• Red, dark brown or black stool

• Menstrual periods that are heavier than usual

• Bleeding gums

• Nosebleeds

• Cuts that won’t stop bleeding

• Severe headache or stomach pain or upset

• Weakness, faintness or dizziness

• Frequent bruises or blood blisters

• Skin rash or irritation

• Unusual or unexplained fever

• Joint or back pain

• Swelling or pain at an injection site

• Skin changes or discoloration anywhere on your body

• Hair loss

What happens if you overdose? Seek emergency medical attention immediately if you think you have had too much medication. Overdose symptoms may include bruising, broken blood vessels under the skin, excessive bleeding from cuts or wounds or blood in the urine or stools.

Only your physician can determine if Coumadin is needed in your treatment regimen, as well as the appropriate dose.

Therapy with Coumadin should not be taken lightly but in some cases can be an absolute life-saving medication. As long as physicians’ directions are followed and appropriate precautions are taken, you should not experience any problems with your Coumadin therapy.

Steve Mullenix (R.Ph) co-owns The Pharmacy in Mount Olive with his wife, Sherry Mullenix (J.D., R.N.). They can be reached at 631-1201.