Warfarin Sodium
FULL PRESCRIBING INFORMATION: CONTENTS*
- BOXED WARNING
- WARFARIN SODIUM DESCRIPTION
- CLINICAL PHARMACOLOGY
- INDICATIONS & USAGE
- WARFARIN SODIUM CONTRAINDICATIONS
- WARNINGS
- PRECAUTIONS
- INFORMATION FOR PATIENTS
- CARCINOGENESIS & MUTAGENESIS & IMPAIRMENT OF FERTILITY
- PREGNANCY
- PEDIATRIC USE
- GERIATRIC USE
- WARFARIN SODIUM ADVERSE REACTIONS
- OVERDOSAGE
- DOSAGE & ADMINISTRATION
- HOW SUPPLIED
- STORAGE AND HANDLING
- REFERENCES
- SPL MEDGUIDE
- PACKAGE LABEL.PRINCIPAL DISPLAY PANEL SECTION
FULL PRESCRIBING INFORMATION
WARFARIN SODIUM DESCRIPTION
CLINICAL PHARMACOLOGY
Mechanism of Action
Pharmacokinetics
Absorption
Distribution
WARNINGS: Lactation
Metabolism
Table 1
Excretion
Pharmacogenomics
Elderly
Asians
Renal Dysfunction
Hepatic Dysfunction
Clinical Trials
Atrial Fibrillation (AF)
Table 2Table 2
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*
Myocardial Infarction
DOSAGE AND ADMINISTRATION
Mechanical and Bioprosthetic Heart Valves
INDICATIONS & USAGE
WARFARIN SODIUM CONTRAINDICATIONS
Pregnancy
Hemorrhagic tendencies or blood dyscrasias.
Recent or contemplated surgery of:
Bleeding tendencies associated with active ulceration or overt bleeding of:
Threatened abortion,
Inadequate laboratory facilities.
Unsupervised patients with senility,
Spinal puncture
Miscellaneous
WARNINGS
BLACK BOX WARNINGConversion From Heparin Therapy
Lactation:
Severe to moderate hepatic or renal insufficiency.
Infectious diseases or disturbances of intestinal flora:
Trauma
Surgery or trauma
Indwelling catheters.
Severe to moderate hypertension.
Known or suspected deficiency in protein C mediated anticoagulant response:
Miscellaneous:
PRECAUTIONS
Periodic determination of PT/INR is essentialDOSAGE AND ADMINISTRATION: Laboratory ControlCLINICAL PHARMACOLOGY, Pharmacogenomics
Drug/Drug and Drug/Disease Interactions
Drugs may interact with JantovenTablets (Warfarin Sodium Tablets, USP) through pharmacodynamic or pharmacokinetic mechanisms. Pharmacodynamic mechanisms for drug interactions with JantovenTablets are synergism (impaired hemostasis, reduced clotting factor synthesis), competitive antagonism (vitamin K), and altered physiologic control loop for vitamin K metabolism (hereditary resistance). Pharmacokinetic mechanisms for drug interactions with JantovenTablets are mainly enzyme induction, enzyme inhibition, and reduced plasma protein binding. It is important to note that some drugs may interact by more than one mechanism.
The following factors, alone or in combination, may be responsible for INCREASED PT/INR response:
CONTRAINDICATIONS
Potential drug interactions with JantovenTablets are listed below by drug class and by specific drugs.
Botanical (Herbal) Medicines
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● Bromelains, danshen, dong quai (Angelica sinensis), garlic, Ginkgo biloba, ginseng, and cranberry products are associated most often with an INCREASE in the effects of JantovenTablets.
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● Coenzyme Q10 (ubidecarenone) and St. John's wort are associated most often with a DECREASE in the effects of JantovenTablets.
Effect on Other Drugs
Considerations for Increased Bleeding Risk
PRECAUTIONSCLINICAL PHARMACOLOGY: Pharmacokinetics: MetabolismDOSAGE AND ADMINISTRATION
INFORMATION FOR PATIENTS
CONTRAINDICATIONSPatients should be informed that all warfarin sodium, USP, products represent the same medication, and should not be taken concomitantly, as overdosage may result.CARCINOGENESIS & MUTAGENESIS & IMPAIRMENT OF FERTILITY
CONTRAINDICATIONSPREGNANCY
CONTRAINDICATIONSPEDIATRIC USE
GERIATRIC USE
CLINICAL PHARMACOLOGYDOSAGE AND ADMINISTRATIONWARFARIN SODIUM ADVERSE REACTIONS
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● OVERDOSAGE: Treatment.)
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● Bleeding which occurs when the PT/INR is within the therapeutic range warrants diagnostic investigation since it may unmask a previously unsuspected lesion, e.g., tumor, ulcer, etc.
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● Necrosis of skin and other tissues. (SeeWARNINGS.)
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● Adverse reactions reported infrequently include: hypersensitivity/allergic reactions, including anaphylactic reactions, systemic cholesterol microembolization, purple toes syndrome, hepatitis, cholestatic hepatic injury, jaundice, elevated liver enzymes, hypotension, vasculitis, edema, anemia, pallor, fever, rash, dermatitis, including bullous eruptions, urticaria, angina syndrome, chest pain, abdominal pain including cramping, flatulence/bloating, fatigue, lethargy, malaise, asthenia, nausea, vomiting, diarrhea, pain, headache, dizziness, loss of consciousness, syncope, coma, taste perversion, pruritus, alopecia, cold intolerance, and paresthesia including feeling cold and chills.
OVERDOSAGE
Signs and SymptomsTreatment
DOSAGE & ADMINISTRATION
The best available information supports the following recommendations for dosing of JantovenTablets.Venous Thromboembolism (including deep venous thrombosis [DVT] and pulmonary embolism [PE])
Atrial Fibrillation
Post-Myocardial Infarction
Mechanical and Bioprosthetic Heart Valves
Recurrent Systemic Embolism and Other Indications
An INR of greater than 4.0 appears to provide no additional therapeutic benefit in most patients and is associated with a higher risk of bleeding.
Initial Dosage
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● Clinical factors including age, race, body weight, sex, concomitant medications, and comorbidities and
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● Genetic factors (CYP2C9 and VKORC1 genotypes).
VKORC1CYP2C9*1/*1*1/*2*1/*3*2/*2*2/*3*3/*3
Maintenance
PRECAUTIONS
Duration of Therapy
Missed Dose
Laboratory Control
The PT should be determined daily after the administration of the initial dose until PT/INR results stabilize in the therapeutic range. Intervals between subsequent PT/INR determinations should be based upon the physician's judgment of the patient's reliability and response to JantovenTablets in order to maintain the individual within the therapeutic range.To ensure adequate control, it is recommended that additional PT tests be done when other warfarin products are interchanged with warfarin sodium tablets, USP, as well as whenever other medications are initiated, discontinued, or taken irregularly (seePRECAUTIONS).
Treatment During Dentistry And Surgery
Conversion From Heparin Therapy
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● 5 hours after the last IV bolus dose of heparin, or
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● 4 hours after cessation of a continuous IV infusion of heparin, or
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● 24 hours after the last subcutaneous heparin injection.
HOW SUPPLIED
STORAGE AND HANDLING
REFERENCES
SPL MEDGUIDE
JantovenTablets (JAN-to-ven) Tablets(Warfarin Sodium Tablets, USP)
What is the most important information I should know about JantovenTablets?
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● Take your JantovenTablets exactly as prescribed to lower the chance of blood clots forming in your body. (SeeWhat are JantovenTablets?).
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● JantovenTablets are very important for your health, but they can cause serious and life-threatening bleeding problems. To benefit from JantovenTablets and also lower your chance for bleeding problems, you must:
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● Get your regular blood test to check for your response to JantovenTablets. 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 JantovenTablets will be adjusted to keep your PT/INR in a target range for you.
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● Call your healthcare provider right away if you get any of the following signs or symptoms of bleeding problems:
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● pain, swelling or discomfort
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● headaches, dizziness, or weakness
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● unusual bruising (bruises that develop without known cause or grow in size)
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● nose bleeds
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● bleeding gums
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● bleeding from cuts takes a long time to stop
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● menstrual bleeding or vaginal bleeding that is heavier than normal
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● pink or brown urine
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● red or black stools
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● coughing up blood
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● vomiting blood or material that looks like coffee grounds
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● Many other medicines, including prescription and non-prescription medicines, vitamins and herbal supplements can interact with JantovenTablets and:
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● affect the dose you need, or
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● increase JantovenTablets side effects.
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● Do not take other medicines that contain warfarin.Warfarin is the active ingredient in JantovenTablets.
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● Some foods can interact with JantovenTablets and affect your treatment and dose.
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● 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 JantovenTablets.
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● Avoid drinking cranberry juice or eating cranberry products.
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● Avoid drinking alcohol.
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● Always tell all of your healthcare providers that you take JantovenTablets.
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● Wear or carry information that you take JantovenTablets.
Who should not take JantovenTablets?
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● your chance of having bleeding problems is higher than the possible benefit of treatment. Your healthcare provider will decide if JantovenTablets are right for you. Talk to your healthcare provider about all of your health conditions.
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● you are pregnant or plan to become pregnant.JantovenTablets can cause death or birth defects to an unborn baby. Use effective birth control if you can get pregnant.
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● you are allergic to warfarin or to anything else in JantovenTablets.
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● have bleeding problems
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● fall often
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● have liver or kidney problems
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● have high blood pressure
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● have a heart problem called congestive heart failure
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● have diabetes
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● drink alcohol or have problems with alcohol abuse. Alcohol can affect your JantovenTablets dose and should be avoided.
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● are pregnant or planning to become pregnant.SeeWho should not take JantovenTablets?
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● are breastfeeding.JantovenTablets may increase bleeding in your baby. Talk to your doctor about the best way to feed your baby. If you choose to breastfeed while taking JantovenTablets, both you and your baby should be carefully monitored for bleeding problems.
How should I take JantovenTablets?
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● Take JantovenTablets exactly as prescribed. Your healthcare provider will adjust your dose from time to time depending on your response to JantovenTablets.
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● You must have regular blood tests and visits with your healthcare provider to monitor your condition.
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● Take JantovenTablets at the same time every day.You can take JantovenTablets either with food or on an empty stomach.
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● If you miss a dose of JantovenTablets, call your healthcare provider.Take the dose as soon as possible on the same day. Do not take a double dose of JantovenTablets the next day to make up for a missed dose.
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● Call your healthcare provider right away if you take too many JantovenTablets.
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● Call your healthcare provider if you are sick with diarrhea, an infection, or have a fever.
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● Tell your healthcare provider about any planned surgeries, medical or dental procedures. Your JantovenTablets may have to be stopped for a short time or you may need your dose adjusted.
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● Call your healthcare provider right away if you fall or injure yourself, especially if you hit your head.Your healthcare provider may need to check you.
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● Do not start, stop, or change any medicine without talking with your healthcare provider.
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● Do not make changes in your diet, such as eating large amounts of green, leafy vegetables.
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● Do not change your weight by dieting, without first checking with your healthcare provider.
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● Avoid drinking alcohol.
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● Do not do any activity or sport that may cause a serious injury.
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● JantovenTablets are very important for your health, but it can cause serious and life-threatening bleeding problems. SeeWhat is the most important information I should know about JantovenTablets?
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● Serious side effects of JantovenTablets also include:
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● death of skin tissue (skin necrosis or gangrene).This can happen soon after starting JantovenTablets. It happens because blood clots form and block blood flow to an area of your body. Call your healthcare provider right away if you have pain, color, or temperature change to any area of your body. You may need medical care right away to prevent death or loss (amputation) of your affected body part.
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● purple toes syndrome.Call your healthcare provider right away if you have pain in your toes and they look purple in color or dark in color.
How should I store JantovenTablets?
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● Store at 20-25(68-77Excursions permitted to 15-30(59-86[See USP Controlled Room Temperature.] Protect from light and moisture. Dispense in a tight, light-resistant container with a child-resistant closure.
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● Keep JantovenTablets and all medicines out of the reach of children.
PACKAGE LABEL.PRINCIPAL DISPLAY PANEL SECTION
Warfarin SodiumWarfarin Sodium TABLET
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PLEASE, BE CAREFUL!
Be sure to consult your doctor before taking any medication!