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Drug Information For:


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Common Uses:

This medicine is an anticoagulant used to treat or prevent harmful blood clots that may occur in the veins (venous thrombosis) or lungs (pulmonary embolism), or with a type of abnormal heartbeat (such as atrial fibrillation), or following a heart valve replacement. This medicine is also used to reduce the risk of stroke and other problems in patients who have had a heart attack. It may also be used to treat or prevent other conditions as determined by your doctor.

Before Using This Medicine:

WARNING: THIS MEDICINE CAN CAUSE SEVERE AND SOMETIMES FATAL BLEEDING. Bleeding is more likely to occur at the start of treatment or with high doses. Patients who have a history of stomach or bowel bleeding, high blood pressure, stroke or "mini-stroke" (transient ischemic attack / TIA), serious heart disease, anemia, cancer, certain genetic factors, or kidney problems may be at greater risk. Patients who have inconsistent INRs (a blood test); have taken this medicine for a long time; have a recent injury or surgery; or are 65 years of age or older are also at greater risk. Certain blood clotting tests will be performed regularly while you take this medicine. Certain medicines, dietary changes, and other factors may affect INR levels while taking this medicine. Discuss any questions or concerns with your doctor. CONTACT YOUR DOCTOR RIGHT AWAY if you notice any unusual bleeding or bruising. Symptoms of bleeding problems include unusual bruising; bleeding gums; bloody or coffee ground-like vomit; coughing up blood; dizziness; increased bleeding from cuts; increased menstrual or vaginal bleeding; nosebleeds; pain, swelling, or discomfort; pink or brown urine; red or black stools; unusual headaches or weakness. Some medicines or medical conditions may interact with this medicine. INFORM YOUR DOCTOR OR PHARMACIST of all prescription and over-the-counter medicine that you are taking. DO NOT TAKE THIS MEDICINE if you are also taking mifepristone, streptokinase, or urokinase. ADDITIONAL MONITORING OF YOUR DOSE OR CONDITION may be needed if you are taking heparin; other anticoagulants; antiplatelet medicines (eg, clopidogrel); nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, ibuprofen); salicylates (eg, aspirin); topical pain medicine; or other prescription and nonprescription medicines (eg, used for infections, inflammation, aches and pains, high blood pressure, high cholesterol, seizures, mental or mood problems, diabetes, stomach or bowel problems, irregular heartbeat, birth control, hormone replacement, cancer, and other conditions), multivitamin products, and herbal or dietary products (eg, herbal teas, coenzyme Q10, garlic, ginseng, gingko, St. John's wort, and others). DO NOT START OR STOP any medicine without doctor or pharmacist approval. Inform your doctor of any other medical conditions including fever, diarrhea, fluid buildup, very poor health, poor nutrition, nutrient or fat absorption problems, celiac disease, low levels of vitamin K or vitamin C in the blood, excessive fat in the stools, recent or current infection, tuberculosis, or if you have recently been injured, fallen, given birth, or had surgery. Tell your doctor if you have a history of liver, kidney, or thyroid problems; yellowing of the skin or eyes; stomach or bowel problems (eg, ulcer, bleeding, inflammation); heart problems (eg,infection, heart failure); blood clots; blood problems (eg, anemia, protein C deficiency, high red blood cell levels); blood vessel problems; high blood pressure; mental or mood problems; high cholesterol; arthritis; diabetes; cancer; allergies; pregnancy; or breast-feeding. Inform your doctor if you smoke or drink alcohol, you fall often, or you have a heart valve replacement, a catheter, or intrauterine device (IUD). DO NOT USE THIS MEDICINE if you are planning or have recently had certain types of surgery or other medical procedures, or if you have certain types of active bleeding; severe, uncontrolled high blood pressure; certain heart conditions (eg, inflammation, infection); certain blood vessel problems (eg, aneurysm); certain blood or bleeding problems; or an active ulcer. DO NOT USE THIS MEDICINE if you are unable to have routine blood clotting tests, you are pregnant and do not have a mechanical heart valve, or you are unable to follow your doctor's instructions properly and do not have someone to help you take your medicine. Contact your doctor or pharmacist if you have any questions or concerns about taking this medicine.

How to Use This Medicine:

Follow the directions for using this medicine provided by your doctor. This medicine comes with a MEDICATION GUIDE approved by the U.S. Food and Drug Administration. Read it carefully each time you refill this medicine. Ask your doctor, nurse, or pharmacist any questions that you may have about this medicine. This medicine may be taken by mouth on an empty stomach or with food. STORE THIS MEDICINE at room temperature in a tightly-closed container, away from heat and light. KEEP THIS MEDICINE out of the reach of children and away from pets. It is very important to take this medicine on a regular schedule as prescribed by your doctor. Take this medicine at the same time each day. CONTINUE TO TAKE THIS MEDICINE as directed by your doctor even if you feel well. Do not miss any doses unless directed to do so by your doctor. IF YOU MISS A DOSE OF THIS MEDICINE, contact your doctor right away. Take the missed dose as soon as possible if you remember on the same day. If you do not remember until the next day, skip the missed dose and go back to your regular dosing schedule. DO NOT take 2 doses at once.


DO NOT USE THIS MEDICINE if you have had an allergic reaction to it or are allergic to any ingredient in this product. DO NOT EXCEED THE RECOMMENDED DOSE or use for longer than prescribed without checking with your doctor. DO NOT STOP USING THIS MEDICINE without first checking with your doctor. Certain blood clotting tests will be performed regularly while you take this medicine. Keep all doctor and lab appointments. BEFORE YOU HAVE ANY MEDICAL OR DENTAL TREATMENTS, EMERGENCY CARE, OR SURGERY, tell the doctor or dentist that you are using this medicine. THIS MEDICINE REDUCES BLOOD CLOTTING. To prevent bleeding, avoid any sports or other activities that may expose you to a risk of bruising or serious injury. Brush your teeth carefully with a soft toothbrush, floss your teeth gently, and use caution when shaving. DO NOT DRINK ALCOHOL while you are taking this medicine. DO NOT CHANGE YOUR EATING HABITS, activity level, or weight without checking with your doctor. Doing so may lead to a change in the amount of this medicine in your blood. This could increase your risk of side effects. Foods that are high in vitamin K (eg, green leafy vegetables, broccoli, liver, certain vegetable oils) may change the effects of this medicine. Ask your doctor for a list of foods that may affect this medicine. DO NOT participate in any activity that may cause a serious injury while taking this medicine. CHECK WITH YOUR DOCTOR before you eat cranberries or grapefruit, or before you eat or drink products that contain cranberry or grapefruit. Tell your doctor if cranberry or grapefruit products or any foods high in vitamin K are already a part of your diet. TELL YOUR DOCTOR if you develop a fever, infection, or severe diarrhea. IF TREATMENT IS STOPPED, the blood thinning effects may last for 2 to 5 days after you stop taking it. Discuss any questions or concerns with your doctor. BEFORE YOU BEGIN TAKING ANY MEDICINE, either prescription or over-the-counter, check with your doctor or pharmacist. This includes vitamins, herbal or dietary supplements, or medicines such as aspirin, ibuprofen, acetaminophen, or cold medicines. IF YOU ARE ALREADY TAKING ASPIRIN for a heart or other condition, talk with your doctor about whether or not you should continue taking it with this medicine. IF YOU WILL BE TRAVELING OR if you will be confined to a bed or chair for a long period of time (eg, car or airplane ride), tell your doctor. Elevated body temperature may increase the effect of this medicine. BE CAREFUL TO AVOID BECOMING OVERHEATED, especially during hot weather. USE THIS MEDICINE WITH CAUTION IN THE ELDERLY and in ASIAN patients because they may be more sensitive to the effects of the medicine. FOR WOMEN: DO NOT USE THIS MEDICINE if you are pregnant. IT HAS BEEN SHOWN TO CAUSE HARM to the fetus. Avoid becoming pregnant while you are taking this medicine. If you may become pregnant, use an effective form of birth control. If yoususpect that you could be pregnant, contact your doctor immediately. IT IS UNKNOWN IF THIS MEDICINE IS EXCRETED in breast milk. IF YOU ARE OR WILL BE BREAST-FEEDING while you are using this medicine, check with your doctor or pharmacist to discuss the risks to your baby.

Possible Side Effects:

NO COMMON SIDE EFFECTS HAVE BEEN REPORTED with the proper use of this medicine. If you notice any unusual effects, contact your doctor, nurse, or pharmacist. CONTACT YOUR DOCTOR IMMEDIATELY if you experience any back, side, muscle, joint, or stomach pain; black tarry or bloody stools; blood in the urine (pink or brown urine); bloody or coffee ground-like vomit; chest pain; decreased urination; dizziness; fainting; fever; numbness or tingling; pain, unusual color, or temperature change in any area of the body; pale skin; purple, dark, or painful toes; shortness of breath; skin sores or ulcers; stroke symptoms (such as confusion, slurred speech, vision problems, one-sided weakness); sudden severe pain in your legs, feet, or toes; trouble swallowing; unusual bruising or bleeding (such as nosebleed, unusual bleeding from gums, increased bleeding from cuts, increased menstrual or vaginal bleeding, coughing up blood); unexplained swelling; unusual pain, swelling, or discomfort; unusual headache or weakness; wounds or sores that do not heal properly; or yellowing of the skin or eyes. An allergic reaction to this medicine is unlikely, but seek immediate medical attention if it occurs. Symptoms of an allergic reaction include rash; hives; itching; difficulty breathing; tightness in the chest; or swelling of the mouth, face, lips, or tongue. If you notice other effects not listed above, contact your doctor, nurse, or pharmacist. This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your healthcare provider. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.


IF OVERDOSE IS SUSPECTED, contact your local poison control center or emergency room immediately. Symptoms of overdose may include abnormal or excessive bleeding or bruising; blood in your vomit, urine, or stools; black tarry stools; or increased menstrual bleeding.

Additional Information:

Carry an identification card at all times that says you are taking this medicine. DO NOT SHARE THIS MEDICINE with others for whom it was not prescribed. DO NOT USE THIS MEDICINE for other health conditions. IF YOU WILL BE USING THIS MEDICINE FOR AN EXTENDED PERIOD OF TIME, obtain refills before your supply runs out. CHECK WITH YOUR PHARMACIST about how to dispose of unused medicine.

Copyright 2015 Wolters Kluwer Health, Inc.


- This information is not intended to substitute for professional medical advice. Be sure to contact your physician, pharmacist or other health care provider for more information about this medication. By searching these web site pages, you agree to our terms and conditions of use.