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The use of vitamin K 1 reduces response to subsequent COUMADIN therapy and patients may return to a pretreatment thrombotic status following the rapid reversal of a prolonged INRResumption of COUMADIN administration reverses the effect of vitamin Kand a therapeutic INR can again be obtained by careful dosage adjustmentIf rapid re-anticoagulation is indicatedheparin may be preferable for initial therapy.

Your doctor may want to do a blood teststop the warfarinor prescribe medication to stop the bleeding.

COUMADIN has a narrow therapeutic rangeindexand its action may be affected by factors such as other drugs and dietary vitamin KThereforeanticoagulation must be carefully monitored during COUMADIN therapyDetermine the INR daily after the administration of the initial dose until INR results stabilize in the therapeutic rangeAfter stabilizationmaintain dosing within the therapeutic range by performing periodic INRsThe frequency of performing INR should be based on the clinical situation but generally acceptable intervals for INR determinations are 1 to 4 weeksPerform additional INR tests when other warfarin products are interchanged with COUMADINas well as whenever other medications are initiateddiscontinuedor taken irregularlyHeparina common concomitant drugincreases the INRsee Conversion From Other Anticoagulants and DRUG INTERACTIONS

Consult the labeling of all concurrently used drugs to obtain further information about interactions with COUMADIN or adverse reactions pertaining to bleeding.

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