Purple toes syndrome can occur when taking Coumadin, usually 3 to 10 weeks after the start of anticoagulation therapy. Symptoms include dark purplish or mottled color of the toes that turns white when pressure is applied and fades when you elevate your legs; pain and tenderness of the toes; and change in intensity of the color over a period of time. If any of these symptoms develop, notify your doctor immediately.

If you are taking Coumadin, your doctor should periodically check the time it takes for your blood to start the clotting process (prothrombin time). Numerous factors such as travel and changes in diet, environment, physical state, and medication may alter your response to treatment with an anticoagulant. Clotting time should also be monitored after your release from the hospital and whenever other medications are started, discontinued, or taken sporadically.

While taking Coumadin, avoid activities and sports that could cause an injury. Remain cautious after you stop taking Coumadin. It will continue to work for 2 to 5 days.

If you have congestive heart failure, you may become more sensitive to Coumadin and may need to have your dosage reduced. Your doctor will have you tested regularly.

Notify your doctor if any illness, such as diarrhea, infection, or fever develops; if any unusual symptoms, such as pain, swelling, or discomfort, appear; or if you see prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or dark brown urine, red or tarry black stool, headache, dizziness, or weakness.

Possible food and drug interactions when taking Coumadin

Coumadin can interact with a very wide variety of drugs, both prescription and over-the-counter. Check with your doctor before taking ANY other medication or vitamin product.

Be extremely cautious, too, about taking any herbal remedies and supplements. A wide assortment of herbal products—including St. John's wort, coenzyme Q10, bromelains, dan-shen, dong quai, garlic, cranberry products, and ginkgo biloba—are known to interact with Coumadin or otherwise affect coagulation.

Special information if you are pregnant or breastfeeding

Coumadin should not be taken by women who are or may become pregnant since the drug may cause fatal hemorrhage in the developing baby. There have also been reports of birth malformations, low birth weight, and retarded growth in children born to mothers treated with Coumadin during pregnancy. Spontaneous abortions and stillbirths are also known to occur. If you become pregnant while taking this drug, inform your doctor immediately.

Coumadin has not been found in the breast milk of mothers taking the drug. Nevertheless, the doctor may test the baby for coagulation abnormalities before recommending that you breastfeed while on Coumadin therapy.

Recommended dosage for Coumadin

ADULTS

The administration and dosage of Coumadin must be individualized by your doctor according to your sensitivity to the drug.

A common starting dosage of Coumadin tablets for adults is 2 to 5 milligrams per day. Individualized daily dosage adjustments are based on the results of tests that determine the amount of time it takes for the blood clotting process to begin.

A maintenance dose of 2 to 10 milligrams per day is satisfactory for most people. The duration of treatment will be determined by your physician.

CHILDREN

Although Coumadin has been widely used in children below the age of 18, its safety and effectiveness for this purpose have not been formally established.

OLDER ADULTS

Low starting and maintenance doses are recommended for older people, as the drug tends to have a greater effect.

Overdosage

Signs and symptoms of Coumadin overdose reflect abnormal bleeding.

• Symptoms of abnormal bleeding include:
  Blood in stools or urine, excessive menstrual bleeding, black stools, reddish or purplish spots on skin, excessive bruising, persistent bleeding from superficial injuries

If you suspect an overdose, seek emergency medical treatment immediately.