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Thread: Marevan 1 mg tablet

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    Default Marevan 1 mg tablet

    Composition: WARFARIN SODIUM 1 MG

    Indications and Usage
    Prophylaxis and/or treatment of venous thrombosis and its extension, pulmonary embolism; prophylaxis and/or treatment of thromboembolic complications associated with atrial fibrillation and/or cardiac valve replacement; reduction of risk of death, recurrent MI, and thromboembolic events such as stroke or systemic embolism after MI.
    Marevan tablet attachment.php?attachmentid=316&stc=1&d=1435839914
    Contraindications
    Pregnancy, except in pregnant women with mechanical heart valves who are at high risk of thromboembolism; hemorrhagic tendencies or blood dyscrasias; recent or contemplated surgery of the CNS or eye, or traumatic surgery resulting in large open surfaces; bleeding tendencies associated with active ulceration or overt bleeding of GI, GU, or respiratory tracts; CNS hemorrhage; cerebral aneurysms; dissecting aorta; pericarditis and pericardial effusions; bacterial endocarditis; threatened abortion; eclampsia and preeclampsia; spinal puncture and other diagnostic or therapeutic procedures with potential for uncontrolled bleeding; major regional or lumbar block anesthesia; malignant hypertension; unsupervised patients with conditions associated with a potential high level of noncompliance; malignant hypertension; hypersensitivity to any component of the product.

    Precautions

    Warnings
    Bleeding risk
    Major or fatal bleeding can occur. Bleeding is more likely to occur within the first month. Risk factors include INR greater than 4, age 65 y and older, highly variable INRs, history of GI bleeding, hypertension, cerebrovascular disease, anemia, malignancy, trauma, renal impairment, certain genetic factors, concomitant drugs (see Interactions), and long duration of warfarin therapy. Perform regular monitoring of INR in all patients. Instruct patients about prevention measures to minimize the risk of bleeding.

    Monitor
    Determine INR daily after the initial dose until the INR results stabilize in the therapeutic range. Maintain dosing within the therapeutic range by performing periodic INRs. Base the frequency of INR monitoring on the clinical situation; generally acceptable intervals are 1 to 4 wk. Perform additional INR tests when other warfarin products are interchanged, as well as when other medications are initiated, discontinued, or taken regularly.

    Pregnancy
    Category D for women with mechanical valves; Category X for other pregnant populations. Warfarin exposure during pregnancy causes a pattern of major congenital malformations (warfarin embryopathy), fetal hemorrhage, and an increased risk of spontaneous abortion and fetal mortality.

    Lactation
    Undetermined. The American Academy of Pediatrics classifies warfarin as compatible with breast-feeding. Monitor breast-feeding infants for bruising or bleeding.

    Children
    Adequate and well-controlled studies with warfarin have not been conducted in any pediatric population, and the optimum dosing, safety, and efficacy in pediatric patients are not known.

    Elderly
    May be more sensitive to effects; use with caution.

    Hepatic Function
    Use cautiously.

    Special Risk Patients
    The risks of warfarin therapy may be increased in the following: severe to moderate hepatic impairment, infectious diseases or disturbances of intestinal flora (sprue, antibiotic therapy), use of an indwelling catheter, severe to moderate hypertension, polycythemia vera, vasculitis, diabetes mellitus.

    Atheroemboli/Microemboli
    Therapy may enhance the release of atheromatous plaque emboli. Can present with a variety of signs and symptoms and commonly involves the kidney, pancreas, spleen, and liver. Purple toe syndrome may result from microemboli to the feet. Discontinue therapy when such phenomena are observed.

    Eye surgery
    In cataract surgery, warfarin use was associated with a significant increase in minor complications of sharp needle and local anesthesia block, but not sight-threatening operative hemorrhagic complications. Because warfarin cessation or reduction may lead to serious thromboembolic complications, base the decision to discontinue warfarin for relatively less invasive and complex eye surgery on the risks weighed against the benefits.

    Heparin-induced thrombocytopenia
    Do not use warfarin as initial therapy in patients with heparin-induced thrombocytopenia or heparin-induced thrombocytopenia with thrombosis syndrome. Cases of limb ischemia, necrosis, and gangrene have occurred in patients with heparin-induced thrombocytopenia or heparin-induced thrombocytopenia with thrombosis syndrome. Warfarin treatment may be considered after the platelet count has normalized.

    Protein C deficiency
    Hereditary or acquired deficiencies of protein C or S have been associated with necrosis following warfarin therapy. If warfarin is the suspected cause of necrosis, discontinue administration.

    Surgical/Dental procedures
    Adjust dose to maintain INR at low end of therapeutic range for patients who must be anticoagulated during dental or surgical procedures.

    Tissue necrosis
    Necrosis and/or gangrene of skin and other tissues is an uncommon but serious risk (less than 0.1%). Necrosis may be associated with local thrombosis and usually appears within a few days of treatment initiation.











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