$30.70

SINTROM

(Also Known As: NICOUMALONE)

Take this medicine only as directed by your doctor. Do not take more or less of it, do not take it more often, and do not take it for a longer time than your doctor ordered. This is especially important for elderly patients, who are especially sensitive to the effects of anticoagulants. Also, it is best if you take this medicine at the same time each day.

Your doctor or health care professional should check your progress at regular visits. A blood test must be taken regularly to see how fast your blood is clotting. This will help your doctor decide on the proper amount of anticoagulant you should be taking each day. Some patients may be able to test their blood at home; discuss with your doctor whether or not this is possible for you.

Dosing

The dose of these medicines will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

For acenocoumarol
• For oral dosage form (tablets):
  • For preventing or treating harmful blood clots:
    • Adults The usual dose is 1 to 10 milligrams (mg) per day, adjusted according to blood tests.
    • Children Dose must be determined by your doctor.

For anisindione
• For oral dosage form (tablets):
  • For preventing or treating harmful blood clots:
    • Adults The usual dose is 25 to 250 milligrams (mg) per day, adjusted according to blood tests.
    • Children Dose must be determined by your doctor.

For dicumarol
• For oral dosage form (tablets):
  • For preventing or treating harmful blood clots:
    • Adults The usual dose is 25 to 200 milligrams (mg) per day, adjusted according to blood tests.
    • Children Dose must be determined by your doctor.

For warfarin
• For oral dosage form (tablets):
  • For preventing or treating harmful blood clots:
    • Adults The starting dose is usually 2 to 5 milligrams (mg) per day for two to four days. Then, your dose may be adjusted, depending on your condition and results of routine blood tests.
    • Children Dose must be determined by your doctor.
• For injection dosage form:
  • For preventing or treating harmful blood clots:
    • Adults The starting dose is usually 2 to 5 milligrams (mg) per day for two to four days. Then, your dose may be adjusted, depending on your condition and results of routine blood tests.
    • Children Dose must be determined by your doctor.

Missed dose

If you miss a dose of this medicine, take it as soon as possible. Then go back to your regular dosing schedule. If you do not remember until the next day, do not take the missed dose at all and do not double the next one. Doubling the dose may cause bleeding. Instead, go back to your regular dosing schedule. It is recommended that you keep a record of each dose as you take it to avoid mistakes. Also, be sure to give your doctor a record of any doses you miss. If you have any questions about this, check with your doctor.

Storage

To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store this medicine in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For anticoagulants, the following should be considered:

Allergies Tell your doctor if you have ever had any unusual or allergic reaction to an anticoagulant. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy Anticoagulants may cause birth defects. They may also cause other problems affecting the physical or mental growth of the fetus or newborn baby. In addition, use of this medicine during the last 6 months of pregnancy may increase the chance of severe, possibly fatal, bleeding in the fetus. If taken during the last few weeks of pregnancy, anticoagulants may cause severe bleeding in both the fetus and the mother before or during delivery and in the newborn infant.

Do not begin taking this medicine during pregnancy, and do not become pregnant while taking it, unless you have first discussed the possible effects of this medicine with your doctor. Also, if you suspect that you may be pregnant and you are already taking an anticoagulant, check with your doctor at once. Your doctor may suggest that you take a different anticoagulant that is less likely to harm the fetus or the newborn infant during all or part of your pregnancy. Anticoagulants may also cause severe bleeding in the mother if taken soon after the baby is born.

Breast-feeding Warfarin is not likely to cause problems in nursing babies. Other anticoagulants may pass into the breast milk. A blood test can be done to see if unwanted effects are occurring in the nursing baby. If necessary, another medicine that will overcome any unwanted effects of the anticoagulant can be given to the baby.

Children Very young babies may be especially sensitive to the effects of anticoagulants. This may increase the chance of bleeding during treatment.

Older adults Elderly people are especially sensitive to the effects of anticoagulants. This may increase the chance of bleeding during treatment.

Other medicines Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Many different medicines can affect the way anticoagulants work in your body . Therefore, it is very important that your health care professional knows if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine, especially:

• Amiodarone (e.g., Cordarone) or
• Cimetidine (e.g., Tagamet) or
• Metronidazole (e.g., Flagyl) or
• Omeprazole (e.g., Prilosec) or
• Zafirlukast (e.g., Accolate) Effects of anticoagulants may be increased because of slower removal from the body

• Anabolic steroids (nandrolone [e.g., Anabolin], oxandrolone [e.g., Anavar], oxymetholone [e.g., Anadrol], stanozolol [e.g., Winstrol]) or
• Androgens (male hormones) or
• Antifungals, azole (e.g., Diflucan) or
• Antithyroid agents (medicine for overactive thyroid) or
• Aspirin or other salicylates, including bismuth subsalicylate (e.g., Pepto-Bismol) or
• Cephalosporins (medicine for infection) or
• Cinchophen or
• Clofibrate (e.g., Abitrate, Atromid-S) or
• Danazol (e.g., Danocrine) or
• Dextrothyroxine or
• Diflunisal or
• Disulfiram (e.g., Antabuse) or
• Fluvoxamine (e.g., Luvox) or
• Inflammation or pain medicine (except narcotics) or
• Lepirudin (e.g., Refludan) or
• Medications causing low platelet count or
• Paroxetine (e.g., Paxil) or
• Propafenone (e.g., Rythmol) or
• Quinidine (e.g., Quinidex) or
• Sertraline (e.g., Zoloft) or
• Sulfapyridine or
• Sulfasalazine (e.g., Azulfidine) or
• Thyroid hormones or
• Ticlopidine (e.g., Ticlid) or
• Zileuton (e.g., Zyflo) These medications may increase the effects of anticoagulants and may increase the chance of bleeding

• Carbenicillin by injection (e.g., Geopen) or
• Dipyridamole (e.g., Persantine) or
• Divalproex (e.g., Depakote) or
• Moxalactam (e.g., Moxam) or
• Pentoxifylline (e.g., Trantal) or
• Plicamycin (e.g., Mithracin) or
• Sulfinpyrazone (e.g., Anturane) or
• Thrombolytic agents (medicine for blood clots) or
• Ticarcillin (e.g., Ticar) or
• Valproic acid (e.g., Depakene) Using any of these medicines together with anticoagulants may increase the chance of bleeding

• Alcohol (with chronic use) or
• Barbiturates or
• Carbamazepine (e.g., Tegretol) or
• Corticosteroids (cortisone-like medicine) or
• Glutethimide (e.g., Doriden) or
• Griseofulvin (e.g., Fulvicin) or
• Phenylbutazone (e.g., Butazolidin) or
• Phenytoin (e.g., Dilantin) or
• Primidone (e.g., Mysoline) or
• Rifampin (e.g., Rifadin) Effects of anticoagulants may be decreased because of faster removal from the body

• Vitamin K (e.g., AquaMEPHYTON) Vitamin K helps produce some important blood clotting factors and may decrease the effects of anticoagulants if used at the same time

• Aneurysm (swelling in a blood vessel) especially in the head or chest or
• Bleeding in the brain or
• Blood disorders or diseases, especially thrombocytopenia (low platelet count), polycythemia (high red blood cell count), or leukemia or
• Bruising, excessive or
• Cancer of the internal organs, especially of the abdomen or
• Childbirth, recent or
• Diabetes mellitus (sugar diabetes) or
• Diverticulitis or
• Falls or blows to the body or head or
• Heart infection or
• Hemophilia or other bleeding problems or
• Hypertension (high blood pressure) or
• Inflammation of blood vessels or
• Intestinal problems, especially conditions that may affect the absorption of food or vitamins or
• Liver disease or
• Pregnancy, terminated or
• Spinal anesthetics or spinal puncture or
• Surgery, major, especially of the head or eye, or dental surgery or
• Toxemia of pregnancy or
• Ulcers, active, of the stomach, lung, or urinary tract or
• Vitamin K deficiency or
• Wounds, open, surgical or from an ulcer These conditions may increase the chance of bleeding

In addition, it is important that you tell your doctor if you are now being treated by any other medical doctor or dentist.