TM Owner Upsher-Smith
Jantoven 5mg Tablet
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Indications & Clinical Uses
- Jantoven 5 mg tablets contain warfarin sodium, a vitamin K antagonist oral anticoagulant ("blood thinner") that works by reducing the liver's production of vitamin K-dependent clotting factors.
- Jantoven is a United States brand of warfarin marketed by Upsher-Smith Laboratories and contains the same active substance as Coumadin.
- It is approved for the prophylaxis and treatment of venous thrombosis and its extension and of pulmonary embolism; for the prophylaxis and treatment of thromboembolic complications associated with atrial fibrillation and/or cardiac valve replacement; and to reduce the risk of death, recurrent myocardial infarction and thromboembolic events such as stroke or systemic embolisation after a heart attack.
- It is taken by mouth once daily, usually starting at 2 to 5 mg daily, with the dose then set individually by INR blood testing.
- Jantoven does not dissolve clots that already exist; it stops them growing and prevents new ones forming.
Side Effects
- The most common adverse reactions to warfarin are fatal and non-fatal haemorrhage from any tissue or organ.
- Jantoven carries a BOXED WARNING: warfarin sodium can cause major or fatal bleeding, and regular monitoring of INR must be performed in all treated patients.
- Get urgent medical help for bleeding that will not stop, nosebleeds, bleeding gums, coughing or vomiting blood, red or black tarry stools, pink or brown urine, unusually heavy periods, unexplained large bruises, or a sudden severe headache, dizziness or weakness, which may signal bleeding into the brain.
- Less common but serious effects include skin necrosis or gangrene, usually within the first days of treatment, purple and painful toes, hypersensitivity reactions and calcification of blood vessels.
- Any fall, head injury or accident needs medical assessment even if you feel well, because internal bleeding may not be obvious.
Precautions & Warnings
- INR must be determined daily after the initial dose until results stabilise in the therapeutic range, then periodically for as long as treatment continues; the usual target is an INR of 2.5 (range 2.0 to 3.0) for venous thromboembolism, non-valvular atrial fibrillation and aortic mechanical valves.
- Jantoven is contraindicated in pregnancy except in women with mechanical heart valves, because it causes a recognised pattern of major congenital malformations (warfarin embryopathy), fatal fetal haemorrhage and fetal death; it is also contraindicated in threatened abortion, eclampsia and pre-eclampsia, in haemorrhagic tendencies or blood dyscrasias, after recent brain, spinal or eye surgery, and in warfarin hypersensitivity.
- Women able to become pregnant should use effective contraception.
- Tell every doctor, dentist and pharmacist that you take warfarin before any procedure, carry an anticoagulant alert card, and take care in liver disease, in older people and where falls are likely.
Avoid Interactions
- Drugs and substances that INCREASE the effect and raise the INR, and so raise bleeding risk: inhibitors of CYP2C9, CYP1A2 and CYP3A4, including amiodarone, fluconazole and other azole antifungals, metronidazole, co-trimoxazole, ciprofloxacin and many other antibiotics, and fluvoxamine; heparin, which increases the INR; aspirin, clopidogrel and NSAIDs, which add bleeding risk; and acute alcohol binges.
- Substances that REDUCE the effect and lower the INR, allowing clots to form, include CYP inducers such as rifampicin, carbamazepine, phenobarbital and St John's wort, and a sudden increase in dietary vitamin K.
- Eat a normal, balanced diet with a consistent amount of vitamin K rather than avoiding it: do not suddenly start or stop eating large amounts of spinach, kale, broccoli, cabbage or green salads.
- Do not start, stop or change any medicine, herbal product or supplement, including over-the-counter painkillers, without telling the prescriber who manages your INR.
References
Frequently Asked Questions
Jantoven (warfarin sodium) is an oral anticoagulant used to prevent and treat deep vein thrombosis and pulmonary embolism, to prevent clots in atrial fibrillation and after heart valve replacement, and to lower the risk of stroke or another heart attack after a myocardial infarction. It does not dissolve clots that already exist.
Take Jantoven (warfarin) by mouth once daily at the same time each day, with or without food. The usual starting dose is 2 to 5 mg, but your exact dose is set by your INR blood test result and may change often. Never change the dose yourself.
Bleeding is the main side effect of Jantoven (warfarin), and its boxed warning states that it can cause major or fatal bleeding. Seek urgent care for bleeding that will not stop, red or black stools, pink or brown urine, coughing up blood, or a sudden severe headache or weakness.
Avoid binge drinking, aspirin and NSAIDs such as ibuprofen while taking Jantoven (warfarin). Keep vitamin K intake steady rather than avoiding greens, because sudden changes in spinach, kale or broccoli alter your INR. Tell your prescriber before starting any antibiotic, antifungal or herbal product.
INR is checked daily after your first Jantoven (warfarin) dose until results settle in the therapeutic range, then periodically for as long as you take it. The usual target is 2.5, with a range of 2.0 to 3.0 for clots and atrial fibrillation. Never skip a test.
No. Jantoven (warfarin) is contraindicated in pregnancy except in women with mechanical heart valves, because it causes a recognised pattern of birth defects, fatal fetal bleeding and fetal death. Use effective contraception while taking it and tell your healthcare provider at once if you think you are pregnant.
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