Warfarin

Sounds like 'war-far-in'

Easy-to-read medicine information about warfarin – what it is, how to take it safely and possible side effects.

Type of medicine Also called
  • Blood-thinning medicine
  • Anticoagulant (stops blood clots)
  • Marevan®
  • Coumadin®
Do not change brand without checking with your pharmacist or doctor first.

What is warfarin?

Warfarin is an anticoagulant, which means it makes it less likely your blood will clot. It is used to treat clots that have formed in your legs (deep vein thrombosis) or in your lungs (pulmonary embolism).

Warfarin is also used to stop new clots forming if you are at risk of this happening from atrial fibrillation (irregular heart beat), heart valve replacement, heart attack and major surgery like a hip replacement or knee replacement. Warfarin decreases certain substances (clotting proteins) in your blood.

The following animation describes how warfarin works in your body: 


Source: British Heart Foundation, UK

Different brands of warfarin 

In New Zealand there are 2 different brands of warfarin tablets – Marevan® and Coumadin®. Most people take the Marevan® brand. Warfarin tablets come in different strengths. Each strength is a different colour. You may need to take more than one strength of tablet.

The tablets below are the Marevan® brand. If your tablets look different, ask your pharmacist which brand you have been given.

How is my dose of warfarin worked out?

The dose of warfarin will be different for different people depending on what you are using it for and your blood test results. You will need to have regular blood tests that measure how long your blood takes to clot.

The test is called an INR (international normalised ratio) test. INR tests help your doctor work out whether your dosage of warfarin is right for you. They will check whether your INR blood test results are within the best range for you (INR range). Read more about warfarin and INR.

The length of time you need to take warfarin depends on what you are using it for and your individual condition. Some people may need to take warfarin for the rest of their lives, while others only need to take it for a few months. Your doctor will talk to you about your situation.

How to take warfarin

  • Take your tablets (as one dose), once a day, at the same time each day.
  • It is best to take your warfarin in the evening, so you can have your blood test to check your INR in the morning.
  • You can take warfarin with or without food.
  • Limit alcohol while you are taking warfarin. Alcohol increases your risk of severe bleeding. Read more about warfarin and diet
  • Always take your warfarin dose exactly as your doctor or nurse has told you. 
  • Don't stop taking warfarin until your doctor or nurse tells you to. Stopping too early can put you at greater risk for getting blood clots or stroke.
Extra care is needed when taking warfarin because it can cause bleeding. Here are some of the things you need to know.

What should I do if I miss a dose of warfarin?

If you forget to take a dose, take the missed dose if you remember on the same day. If not, skip the dose and carry on as normal. Do not take 2 doses of warfarin on the same day. Record your missed dose in your anticoagulant booklet and tell your doctor on your next visit. 

Contact your doctor if you miss 2 or more doses in a row.

Does food and drink affect warfarin?

What you eat and drink can affect warfarin. As part of a healthy balanced diet, you can continue to eat foods that contain vitamin K in moderate amounts. The most important thing is to keep your regular diet stable. If you make any changes to your regular diet, tell your doctor. Read more about warfarin and diet.

What if I am ill while taking warfarin? 

If you are ill, especially if you are not eating regular meals as you would normally, this may change the effect of warfarin in your body and your INR. Contact your doctor if you experience vomiting (being sick) or runny poos (diarrhoea), fever or infection, loss of appetite and are not feeling well.

Take care when taking new medicines with warfarin

Warfarin should not be taken with some medications and herbal supplements, so always check with your doctor or pharmacist before starting any new medicines, including over-the-counter anti-inflammatories such as diclofenac (eg, Voltaren Rapid), ibuprofen (eg, Nurofen) and naproxen (eg, Naprogesic).

Some herbal or 'natural' products such as co-enzyme Q10, echinacea, fenugreek, fish oils, dong quai, ginkgo biloba, garlic, ginger, ginseng, glucosamine, kava kava, liquorice and St John’s Wort are known to have an effect on warfarin. Always check with your doctor or pharmacist before taking herbal preparations or dietary supplements.

Tell your health professionals you are taking warfarin

It is important to let health professionals who are treating you know that you are taking warfarin, such as your dentist, pharmacist, podiatrist and nurse. You may need to stop using this medicine for several days before having surgery or medical tests.

Travelling overseas while taking warfarin

If you are travelling overseas, speak to your doctor about how to manage your warfarin and INR testing. Take enough warfarin with you so you do not run out while you are away. Keep your activity and eating habits as close to your normal routine as you can. If you experience any unusual bleeding or bruising, get medical help.

Ask questions about warfarin

There is a lot to remember about warfarin. Ask your pharmacist or doctor if there is anything you are unsure of. Use one of the handouts or patient guides on this page (see Learn more below).

Side effects of warfarin

Like all medicines warfarin can cause side effects, although not everyone gets them. Common side effects include nausea (feeling sick) and diarrhoea (runny poos). These may go away with time. Tell your doctor if troublesome.

Warfarin increases your risk of bleeding. You might bleed or bruise more easily while you are taking warfarin.

  • Be careful when shaving, clipping fingernails, brushing and flossing your teeth or playing sports.
  • Avoid new tattoos and piercings while taking warfarin as these may cause bruising and bleeding. Minor bleeding should usually stop on its own.
  • If you have a fall or hurt your head or body, get medical help immediately, even if you feel okay.
Signs of severe bleeding

Contact your healthcare provider urgently if you have any of the following signs of bleeding

  • become pale, very weak and tired, or short of breath
  • any bleeding from your gums
  • cuts or nosebleeds that won’t stop
  • blood in your stools (poo) – black, tarry stools
  • blood in your urine (wee) – pink, red or brown-coloured urine
  • heavy periods (menstrual bleeding)
  • coughing up blood or vomit that looks like coffee grounds.

Learn more

The following links have more information on warfarin:

Warfarin (Māori) New Zealand Formulary, NZ, 2017
Starting on warfarin Pharmac, NZ
Reducing harm from high-risk medicines – warfarin Health Quality and Safety Commission, NZ, 2015
Taking your warfarin medication bestpractice, BPAC, NZ
Marevan® Medsafe, NZ
Anticoagulants Heart Foundation, NZ

Credits: Written by Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 06 Feb 2020