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Warfarin is a medication that requires careful monitoring due to its potential to cause significant bleeding, which can be life-threatening. Below are important safety considerations and precautions to review:

• Risk of Severe Bleeding: Warfarin can increase the risk of bleeding, especially when first starting the medication or if taken in excessive amounts. Regular INR tests will be conducted by your healthcare provider to ensure safe levels. It's crucial to maintain all medical and lab appointments and report any signs of serious bleeding immediately.

• Interactions with Other Substances: Be aware that other medications and foods can interact with warfarin, affecting its efficacy. Inform your healthcare provider about any new medications or dietary changes so they can adjust your INR monitoring accordingly. Alcohol consumption should also be discussed with your provider due to its potential impact on bleeding risk.

• Risk of Blood Clots from Premature Discontinuation: Do not skip doses or halt the use of warfarin without consulting your healthcare provider, as this may lead to blood clots. If discontinuation is necessary, your provider will guide you through a safe plan. Seek immediate medical attention if you experience symptoms of a stroke or blood clots, such as sudden weakness, confusion, or difficulty breathing.

• Risk of Fat-Containing Clots: Warfarin may cause fat-derived clots to obstruct blood flow, potentially affecting vital organs or causing "purple toe syndrome." Report any skin color changes promptly to your provider.

• Calciphylaxis Risk: Although rare, warfarin can cause calciphylaxis, a serious condition where calcium builds up in blood vessels, leading to skin changes or painful lumps. Seek medical advice immediately if you notice such symptoms.

• Skin or Tissue Necrosis and Gangrene: Warfarin may cause rare cases of skin tissue death or necrosis. This risk is heightened in individuals with certain clotting disorders. Early symptoms should be reported to your provider without delay.

• Pregnancy Considerations: Warfarin poses significant risks during pregnancy, potentially causing birth defects. It's generally contraindicated unless the benefits outweigh the risks, such as in individuals with artificial heart valves. Use effective contraception during treatment and for one month after cessation. Inform your provider if you are pregnant or planning to become pregnant.

• Contraindications: Warfarin should not be used in individuals with active bleeding, severe hypertension, or those undergoing certain surgeries. It is also contraindicated in pregnancy-related complications and specific medical procedures that could lead to uncontrolled bleeding.

In case of overdose, seek emergency medical assistance immediately. Always follow your healthcare provider's instructions and discuss any concerns or questions regarding the use of warfarin.

Common side effects:

• Nausea
• Loss of appetite
• Stomach or abdominal pain
• Bruising
• Rash
• Diarrhea
• Chills
• Itching
• Change in taste

Less common but important to monitor:

• Serious bleeding
• Frequent nosebleeds
• Unusual bruising
• Prolonged bleeding from cuts or gums
• Heavy menstrual flow
• Pink or dark urine
• Coughing up blood
• Vomit resembling coffee grounds
• Severe headaches
• Dizziness
• Unusual tiredness
• Bloody or tarry stools
• Chest pain
• Shortness of breath
• Difficulty swallowing

Serious side effects:

• Small blood clots leading to skin or tissue damage
• Painful, red, or purplish skin patches
• Signs of kidney problems
• Vision changes
• Confusion
• Difficulty speaking
• Weakness on one side of the body
• Symptoms of calciphylaxis
• Allergic reactions

Interactions with high risk of serious adverse effects and should be avoided:

• Defibrotide
• Tamoxifen

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Apixaban
• Dabigatran
• Aspirin
• Ibuprofen
• Naproxen
• Imatinib
• Marijuana
• Dronabinol
• Mifepristone