Maintenance dose: 2 to 10 mg orally once a day -BLEEDING RISK: This drug can cause major or fatal bleeding. ���d8�l�9�N��}�>���$ ���d8��m�q�Y,EK���?��0��~������WO�!�\H$��2>�}�/���`ˮ���0S��Cѱ�C���=�,*;�C�H&]3յ3&Iq2)j�ZS����OK�m�Au����b��ұY۪d%��Fs�ޓK�&F�\�>r�Ӿ=��-��X��Z���[�(_^,E���ﲡp0�KQs�?�~�4+Ě�@�θq8K��2��S��s����2l;��0�2�iY�0��,Z����f_�~Y����W���i��Qh��hك��_J�E�+��T�m�T���e*W(i%p��2��S�8����a.j�]�0,�[�( Some days you may need to take ½ a tablet. The American College of Chest Physicians (ACCP) provides the following dosage guidelines for antithrombotic therapy in neonates and children: Duration of therapy: Medical information abstracted from chart review was … You will need frequent "INR" or prothrombin time tests (to measure your blood-clotting time and determine your warfarin dose). A: Baseline CBC, PT/INR required prior to continuation of warfarin therapy. Warfarin is a narrow therapeutic index drug (NTI). Typical maintenance dose ranges between 2 and 10 mg/day. Dosing should not be increased by more than 5-20% weekly dose. Note: In addition to genetic variation, initial dose is influenced by age, race, body weight, gender, concomitant medications, comorbidities, and possibly other factors. Check INR after 2 days and adjust dose according to results. -Consult the manufacturer product information of other anticoagulants to determine appropriate conversion to this drug. Administration advice: Maintenance warfarin dose adjustments should be based on current INR results and trends and patient assessment of any missed doses, drug interactions, dietary intake or supplements, documentation of bleeding, or other changes that may affect the INR. The maintenance dose of warfarin is calculated by taking the INR on day 4 after three loading doses by using the chart below. Maintenance dose: 2 to 10 mg orally once a day Daily warfarin dose adjustments should be based on current INR measurements and prior to making a dose adjustment assess for any missed doses, drug interactions, dietary intake or supplements, documentation of bleeding, or other changes that may affect the INR. Armed with the above information, let's talk about what NOT to do. Srivastava A, Hudson M, Hamoud I, et al. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Do not heavily load the patient's dose towards one part of the week. The following general recommendations for warfarin use are made. Information in this guideline is current at time of publication. -VKORC1 AA and CYP450 2C9 *1/*2: 3 to 4 mg 5. Outpatient Warfarin Dosing. ; B: Assess patient compliance and determine if any changes have been made that may impact therapy: 1) addition of interacting drugs or herbal products; 2) changes in diet (eating/not eating) 3) changes in health status. Patients requiring warfarin should have INR tests performed according to the management plan communicated to them by the Clinical Haematology department. Seek emergency help if you have any bleeding that will not stop. Elderly or debilitated patients often require low daily doses of warfarin (2-4 mg.). Initial dose: 2 to 5 mg orally once a day -VKORC1 GG and CYP450 2C9 *1/*3: 3 to 4 mg Warfarin and Dosage Adjustments Initially increases in warfarin dose may result in small changes in INR, however with higher doses, small adjustments may lead to much bigger changes in INR (as the production of different coagulation factors are reduced). Adults and the elderly (over 65 years): The recommended dose is 10 mg daily for 2 days. Conversion from Heparin and Other Anticoagulants: for surgery) • Hold warfarin. Warfarin is taken by mouth to inhibit vitamin K. This vitamin is essential for effective production of clotting factors II, VII, IX, X, and anticoagulant proteins C&S. Warfarin. Authorized prescriber order is required for holding of warfarin dosing or administration of phytonadione. Coumadin tablets come in multiple strengths. -Advise patients to eat a balanced diet with a consistent amount of vitamin K and to avoid drastic changes in dietary habits, such as eating large amounts of green leafy vegetables. Monitoring: -Dosage and administration must be individualized according to the patient's INR and condition being treated. People are started on about 5 mg of warfarin a day for the first few days. Warfarin is given once daily. Maintenance dose: 2 to 10 mg orally once a day Warfarin (Coumadin) Dosing Guide FOR 2.5 mg TABL ETS Warfarin (brand name Coumadin) is prescribed in a weekly dose. Pre-admission warfarin dose (if applicable): mg. Last pre-admission INR level: Date measured: INR target ... Warfarin 6pm Warfarin 6pm Chart continues overleaf On discharge, please ensure this chart is faxed to the GP on the day of discharge or first thing on Monday if discharge occurs at the weekend. Comments: Instruct patients about prevention measures to minimize risk of bleeding and to report signs and symptoms of bleeding. • If INR remains high, give an additional dose of Vitamin K 1 mg -2 mg orally. US BOXED WARNING: -Prophylaxis and treatment of thromboembolic complications in patients with a bioprosthetic valve in the mitral position (target INR: 2.5; range: 2 to 3) for the first 3 months after valve insertion is recommended. Example: Your patient has been taking warfarin 5mg daily for more than 2 weeks and INR is 1.8. 3/4/4/3/4/4. Detailed Warfarin dosage information for adults and children.
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