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The appropriate dose of warfarin is difficult to establish because it can vary by a factor of 10 among patients, and the consequences of receiving an incorrect dose can be catastrophic. Clinical factors, demographic variables, and variations in two genes — CYP2C9 (full name: cytochrome P450, subfamily 2, subfamily C, polypeptide 9) and VKORC1 (full name: vitamin K epoxide reductase complex, subunit 1) — contribute significantly to the variability among patients in dose requirements for warfarin. 

From Ralph Nader’s Public Citizen, Worst Pill

There are an estimated annual 33,000 emergency hospitalizations per year from the taking of Warfarin. 


Warfarin is a very important an d widely-used drug in preventing the
formation of life-threatening blood clots. In 2005, there were 22
million prescriptions filled for
                           the drug.  However, it interacts with 
a number of other drugs, dietary supplements, and vitamins. When used
improperly, warfarin can lead to
                           potentially life-threatening bleeding
episodes. The medications with which warfarin interacts are 
inexplicably not listed in the Medication
                           Guide. In our book, Worst Pills, Best 
Pills and on our website,, we have warned about these serious
interaction problems, list the interacting
                           drugs, and have continually
updated the information.
The FDA has the regulatory authority to require the
                           distribution of
Medication Guides by pharmacists for drugs that pose a serious and
significant public health concern. However, at this time, there are
only approximately 75 drugs that require Medication Guides out of the
thousands of drugs on the market. A list of these drugs with links
their respective Medication Guides can be found on the FDA's Web site
The new warfarin Medication Guide is reproduced below.
COUMADIN(COU-ma-din) Tablets
(Warfarin Sodium Tablets, USP) Crystallin
Read this Medication Guide before you start taking COUMADIN
Sodium) and each time you get a refill. There may be new information.
This Medication Guide does not take the place of talking to your
healthcare provider about your medical
                           condition or treatment. You and
your healthcare provider should talk about COUMADIN when you start
taking it and at regular checkups.
What is the most important information I should know
                           about COUMADIN?
Take your COUMADIN exactly as prescribed to lower the
                           chance of blood
clots forming in your body. (See "What is COUMADIN?").
COUMADIN is very important for your health, but it can
                           cause serious
and life-threatening bleeding problems. To benefit from COUMADIN and
also lower your chance for bleeding problems, you must:
        Get your
                           regular blood test to check for your response to
COUMADIN. This blood test is called a PT/INR test. The PT/INR test
checks to see how fast your blood
                           clots. Your healthcare provider will
decide what PT/INR numbers are best for you. Your dose of COUMADIN will
be adjusted to keep your PT/INR in
                           a target range for you.
        Call your
                           healthcare provider right away if you get any of the
        following signs or symptoms of bleeding problems:
        pain, swelling
                           or discomfort
        headaches, dizziness, or weakness
        unusual bruising (bruises
                           that develop without known cause or
grow in size)
        nose bleeds
        bleeding gums
                           bleeding from cuts takes a long time to stop
        menstrual bleeding or vaginal bleeding that is heavier
        pink or brown
        red or black stools
        coughing up blood
                           blood or material that looks like coffee grounds
Many other medicines, including prescription and non-prescription
medicines, vitamins and herbal supplements
                           can interact with COUMADIN
        affect the dose you need,
                           COUMADIN side effects.
Tell your healthcare provider about all the medicines
                           you take. Do not
Stop medicines or take anything new unless you have talked to your healthcare
provider. Keep a list of your medicines with you at all times to show
your healthcare provider and pharmacist. 
                           Do not take other medicines that contain warfarin. Warfarin is the active ingredient in COUMADIN.  Some foods can interact
                           with COUMADIN and affect your treatment and dose.
        Eat a normal,
                           balanced diet. Talk to your doctor before you 
Make any diet changes. Do not eat large amounts of leafy green vegetables.
Leafy green vegetables contain Vitamin
                           K. Certain vegetable oils also
contain large amounts of Vitamin K. Too much Vitamin K can lower the
effect of COUMADIN.
        Avoid drinking
                           cranberry juice or eating cranberry products.
        Avoid drinking alcohol.
Always tell all of your healthcare providers that you
                           take COUMADIN.
Wear or carry information that you take COUMADIN.
COUMADIN is an anticoagulant medicine. It is used to
                           lower the chance
of blood clots forming in your body. Blood clots can cause a stroke,
heart attack, or other serious conditions such as blood clots in the
legs or lungs.


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Disclaimer:  The information, facts, and opinions provided here is not a substitute for professional advice.  It only indicates what JK believes, does, or would do.  Always consult your primary care physician for any medical advice, diagnosis, and treatment.