Can you take warfarin in the morning

The drug is used to prevent blood clots that can cause strokes, heart attacks and blockages. It is also used to treat the abnormal heart rhythm called atrial fibrillation. Doctors have had a practical reason for telling patients to take warfarin in the evening, Garrison said.

Patients who use it must have blood tests every one to four weeks to determine if their dose is correct -- too much can lead to bleeding, too little won't prevent clots. Taking the drug at night meant less time between getting a test result and adjusting the dose. For the study, his team randomly assigned patients to take their warfarin either in the morning or the evening. Over seven months, the researchers tracked the amount of time patients' blood levels were outside the range where warfarin is most effective.

Your INR will be used to determine the dose of warfarin you need to take. Although there are now 3 new anticoagulants that don't require regular monitoring — rivaroxaban, apixaban and dabigatran — most people who need an anticoagulant will be prescribed warfarin. When you start taking warfarin, you may be given a yellow booklet about anticoagulants, which explains your treatment. How long you'll need to take warfarin for will depend on the condition for which it's been prescribed.

Ask the healthcare professional responsible for your care if you're not sure. If you usually take warfarin in the morning and forget to take it at your normal time, take it as soon as you remember and continue as normal. However, if it's time to take your next dose, don't take a double dose to catch up, unless your GP has specifically advised you to. If you forget to take your dose of warfarin in the evening but remember before midnight on the same day, take the missed dose.

If midnight has passed, leave that dose and take your normal dose the next day at the usual time. Ask your GP or staff at your local anticoagulant clinic if you're not sure what to do about a missed dose of warfarin. You can also call NHS 24 service for advice. Bleeding is the main side effect associated with warfarin, as it slows down the blood's normal clotting ability.

You're at greatest risk of bleeding in the first few weeks of starting treatment with warfarin and when you're unwell. Take extra care to avoid cutting yourself while taking anticoagulant medication because of the risk of excessive bleeding. Contact your GP or the healthcare specialist responsible for your care if you experience any persistent side effects while taking warfarin.

Warfarin can interact with many other medicines. The patient information leaflet that comes with a medicine should tell you if it's safe to take with warfarin. Herbal medicines and supplements can also interact with warfarin. You should therefore avoid taking them without first checking with your GP, pharmacist, or staff at your local anticoagulant clinic. Some food and drink can interfere with the effect of warfarin if consumed in large amounts, including foods that are rich in vitamin K.

When your first dose of warfarin is prescribed, it doesn't matter how much vitamin K you're eating because the dosage will be based on your current blood clotting levels.

Example of back of anticoagulant alert card. What if I forget to take it? It's important to try to remember to take your warfarin on time. If you miss a dose of warfarin, write it down in your yellow book.

Take the missed dose as soon as you remember. Never take more than 1 dose a day. If you often forget doses, it may help to set an alarm to remind you. If you're worried, contact your anticoagulant clinic or doctor. What if I take too much? You may need to change your next dose of warfarin or have a blood test. Less serious bleeding It's usual to bleed more easily than normal while you're taking warfarin.

The kind of bleeding you might have includes: periods that are heavier and last longer than normal bleeding for a little longer than usual if you cut yourself occasional nosebleeds that last for less than 10 minutes bleeding from your gums when you brush your teeth bruises that come up more easily and take longer to fade than usual This type of bleeding is not dangerous and should stop by itself. Things you can do to help yourself Cuts press on the cut for 10 minutes with a clean cloth.

Nosebleeds — find out how to stop a nosebleed or watch this video on nosebleeds. Bleeding gums — if your gums are bleeding, try using a soft toothbrush and waxed dental floss to clean your teeth. Bruises — these are harmless, but can be unsightly. It might help to make them fade more quickly if you put an ice pack wrapped in a towel over the bruise for 10 minutes at a time several times a day.

What you can do to prevent bleeding While you're taking warfarin, be careful when you do activities that might cause an injury or a cut or bruising. It can help to: stop playing contact sports or other activities than can cause a head injury, such as football, rugby, hockey and horse riding wear gloves when you use sharp objects like scissors, knives and gardening tools stop wet shaving or removing hair with wax - use an electric razor or hair-removing cream instead take false teeth dentures or retainers out for a few hours a day, if you wear them, to give your gums a rest — do not wear dentures or retainers that do not fit properly tell your doctor, dentist or nurse that you take warfarin ahead of having any medical or dental procedures or surgery - that includes vaccinations and routine appointments with the dental hygienist Serious bleeding Occasionally, you can have serious bleeding from taking warfarin.

This can be dangerous and needs urgent medical attention. You have red pee or black poo large bruises or bruises that happen for no reason nosebleeds that last longer than 10 minutes blood in your vomit or you're coughing up blood severe headaches, fits or seizures, changes to your eyesight, numbness or tingling in your arms or legs, or feel very tired, weak or sick — these can be signs of bleeding in your brain any bleeding from a cut or injury that will not stop or slow down These are symptoms of serious bleeding.

If you have serious bleeding, stop taking warfarin. Common side effects These side effects are usually mild, but talk to your doctor or pharmacist if these symptoms bother you or do not go away: a mild rash hair loss Serious side effects Call a doctor straight away if you develop any of these serious side effects: yellowing of your skin and dark urine - these can be signs of liver problems painful and swollen patches on your skin severe headaches, fits or seizures, changes to your eyesight, numbness or tingling in your arms or legs, or feeling very tired, weak or sick — these can be signs of bleeding in your brain Serious allergic reaction In rare cases, warfarin can cause a serious allergic reaction anaphylaxis.

Information: You can report any suspected side effect using the Yellow Card safety scheme. Visit Yellow Card for further information. What to do about: a mild rash — it may help to take an antihistamine, which you can buy from a pharmacy. Check with the pharmacist to see what type is suitable for you.

If the rash does not go away within a few days, speak to your doctor. These include: green leafy vegetables, including broccoli, spinach and lettuce chickpeas liver egg yolks wholegrain cereals mature cheese and blue cheese avocado olive oil It's important that you eat foods containing vitamin K, so rather than leaving them out of your diet, make sure you eat similar amounts of them regularly. Warfarin is not normally recommended during pregnancy.

Warfarin and breastfeeding Warfarin is generally safe to take while breastfeeding. Non-urgent advice: Tell your doctor if you're:. If you're taking warfarin, tell your doctor before starting to take these medicines: medicines for heart problems, such as amiodarone, quinidine and propafenone non-steroidal anti-inflammatory drugs NSAIDs like ibuprofen and aspirin cholesterol-lowering medicines, such as bezafibrate, gemfibrozil, clofibrate and cholestyramine antibiotics, such as erythromycin , co-trimoxazole or norfloxacin vitamin K supplements miconazole gel for fungal infections like thrush Taking warfarin with everyday painkillers It's safe to take paracetamol while you're on warfarin.

Mixing warfarin with herbal remedies and supplements Do not take St John's wort, the herbal remedy for depression, while you're taking warfarin. It can increase your risk of side effects. Important: Medicine safety Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements. How does warfarin work? How long does it take to work?

Warfarin takes about 3 days to build up its blood-thinning effect. But it can take weeks or even months before you settle on the right dose. You will not feel any different while you take warfarin. What will happen if I stop taking it? Do not stop taking warfarin without talking to your doctor.

Are there any other similar medicines? Warfarin is one of the oldest and most commonly used anticoagulants. Can I drink alcohol with it? Will I need to stop warfarin before surgery? Tell the doctor that you're taking warfarin. Can I have a tattoo or piercing?

Will I need to stop warfarin before dental treatment? This will be checked using the international normalised ratio INR test. Most people do not need to change their warfarin dose. Can I have vaccinations? Will it affect my contraception? Will it affect my fertility? Will it affect my sex life? There's no evidence that taking warfarin affects your sex life. Therapeutic changes did not significantly differ for patients who switched to morning administration.

Patients should take warfarin whenever regular compliance would be easiest. Above is the information needed to cite this article in your paper or presentation.

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