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#Antidote for warfarin professional#

Patient should have consistent limited intake of these foods, as vitamin K is the antidote for warfarin, and alternating intake of these foods will cause PT levels to fluctuate. Review foods high in vitamin K (see food sources for specific nutrients).Advise patient to read Medication Guide before starting therapy and with each Rx refill in case of changes. Inform patients that anticoagulant effect may persist for 2–5 days following discontinuation.

#Antidote for warfarin professional#

Inform health care professional of missed doses at time of checkup or lab tests. Take missed doses as soon as remembered that day do not double doses.

Instruct patient to take medication as directed.

Administration of whole blood or plasma also may be required in severe bleeding because of the delayed onset of vitamin K. If overdose occurs or anticoagulation needs to be immediately reversed, the antidote is vitamin K (phytonadione, Aquamephyton). Withholding 1 or more doses of warfarin is usually sufficient if INR is excessively elevated or if minor bleeding occurs.

Monitor stool and urine for occult blood before and periodically during therapy.

Monitor hepatic function and CBC before and periodically throughout therapy.

Pedi: Achieving and maintaining therapeutic PT/INR ranges may be more difficult in pediatric patients.

Monitor for side effects at lower therapeutic ranges

Geri: Patients over 60 yr exhibit greater than expected PT/INR response.

Asian patients and those who carry the CYP2C9*2 allele and/or the CYP2C9*3 allele, or those with VKORC1 AA genotype may require more frequent monitoring and lower doses. Heparin may affect the PT/INR draw blood for PT/INR in patients receiving both heparin and warfarin at least 5 hr after the IV bolus dose, 4 hr after cessation of IV infusion, or 24 hr after subcut heparin injection. Lower levels are acceptable when risk is lower. An INR of 2.5–3.5 is recommended for patients at very high risk of embolization (for example, patients with mitral valve replacement and ventricular hypertrophy).

Normal INR (not on anticoagulants) is 0.8–1.2. Therapeutic PT ranges 1.3–1.5 times greater than control however, the INR, a standardized system that provides a common basis for communicating and interpreting PT results, is usually referenced. Monitor PT, INR, and other clotting factors frequently during therapy monitor more frequently in patients with renal impairment. Assess for evidence of additional or increased thrombosis.Assess for signs of bleeding and hemorrhage (bleeding gums nosebleed unusual bruising tarry, black stools hematuria fall in hematocrit or BP guaiac-positive stools, urine, or nasogastric aspirate).Ingestion of large quantities of foods high in vitamin K content (see list in food sources for specific nutrients) may antagonize the anticoagulant effect of warfarin. ↑ bleeding risk with anise, arnica, chamomile, clove, dong quai, fenugreek, feverfew, garlic, ginger, ginkgo, Panax ginseng, licorice , and others.Many other drugs may affect the activity of warfarin.Barbiturates, carbamazepine, rifampin, and hormonal contraceptives containing estrogen may ↓ the anticoagulant response to warfarin.Acute alcohol ingestion may ↑ action of warfarin.Chronic alcohol ingestion may ↓ action of warfarin if chronic alcohol abuse results in significant liver damage, action of warfarin may be ↑ due to ↓ production of clotting factor.Chronic use of acetaminophen may ↑ the risk of bleeding.Androgens, capecitabine, cefotetan, chloramphenicol, clopidogrel, disulfiram, fluconazole, fluoroquinolones, itraconazole, metronidazole (including vaginal use), thrombolytics, eptifibatide, tirofiban, sulfonamides, quinidine, quinine, NSAIDs, valproates, and aspirin may ↑ the response to warfarin and ↑ the risk of bleeding.