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Discontinue therapy if warfarin-induced necrosis is suspected and administer vitamin K (phytonadione) or fresh frozen plasma.
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Treatment is to stop the warfarin replacing it with heparin, giving vitamin K supplements and intravenous protein C infusions.
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Because feverfew might slightly inhibit the activity of blood-clotting cells known as platelets, it should not be combined with strong anticoagulants, such as Coumadin (warfarin) or heparin, except on medical advice.
Drug-diet interactions result from drugs reacting with foods or drinks.
Your dose of Coumadin will be adjusted to keep your INR in a target range for you.
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Viracept), ritonavir (Norvir), saquinavir (Invirase), and tipranavir (Aptivus); certain medications for narcolepsy such as armodafinil (Nuvigil) and modafinil (Provigil); certain medications for seizures such as carbamazepine (Carbatrol, Equetro, Tegretol), phenobarbital, phenytoin (Dilantin, Phenytek), and rufinamide (Banzel); certain medications to treat tuberculosis such as isoniazid (in Rifamate, Rifater) and rifampin (Rifadin, in Rifamate, Rifater); certain selective serotonin reuptake inhibitors (SSRIs) or selective serotonin and norepinephrine reuptake inhibitors (SNRIs) such as citalopram (Celexa), desvenlafaxine (Pristiq), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, in Symbyax), fluvoxamine (Luvox), milnacipran (Savella), paroxetine (Paxil, Pexeva), sertraline (Zoloft), venlafaxine (Effexor) corticosteroids such as prednisone; cyclosporine (Neoral, Sandimmune); disulfiram (Antabuse); methoxsalen (Oxsoralen, Uvadex); metronidazole (Flagyl); nefazodone (Serzone), oral contraceptives (birth control pills); oxandrolone (Oxandrin); pioglitazone (Actos, in Actoplus Met, Duetact, Oseni); propranolol (Inderal) or vilazodone (Viibryd).
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As a NP, I often prescribe and manage patients on coumadin - and I do so independently - meaning there are no physicians involved.
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Don't your doctor's will get you there, there have been cases were patients had to be on 50mg in order to get your INR correct because everyone have a different tolerance or reaction to this drug.
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During both of the elevated INR episodes, no other factors were identified that would have resulted in an elevated INR, such as drug, herbal, disease, or other food interactions.
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