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Determine PT/INP prior to initiation of therapy and then daily until maintenance dosage is established.

Obtain a CAREFUL medication history prior to start of therapy and whenever altered responses to therapy require interpretation; extremely IMPORTANT since many drugs interfere with the activity of anticoagulant drugs (see INTERACTIONS).

Adjust dose to maintain PT at 1½–2½ times the control (12–15 sec), or 15–35% of normal prothrombin activity, or an INR of 2–4 depending on diagnosis.

Lab tests: For maintenance dosage, PT/INR determinations at 1–4-wk intervals depending on patient's response; periodic urinalyses, stool guaiac, and liver function tests. Blood samples should be drawn at 12–18 h after last dose (optimum).

Monitor closely older adult, psychotic, or alcoholic patients because they present serious noncompliance problems.

Note: Patients at greatest risk of hemorrhage include those whose PT/INR are difficult to regulate, who have an aortic valve prosthesis, who are receiving long-term anticoagulant therapy, and older adult and debilitated patients.

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- CNS: Fatigue, muscle weakness, headache, facial neuralgia, mental depression, paresthesias, hallucinations, confusion, drowsiness, agitation, dizziness.
- CV: Arrhythmias, hypotension, AV block.
- Special Senses: Visual disturbances.
- GI: Anorexia, nausea, vomiting, diarrhea.
- Other: Diaphoresis, recurrent malaise, dysphagia.

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Hemorrhagic tendencies, vitamin C or K deficiency, hemophilia, coagulation factor
deficiencies, dyscrasias; active bleeding; open wounds, active peptic ulcer, visceral
carcinoma, esophageal varices, malabsorption syndrome; hypertension (diastolic BP >110
mm Hg), cerebral vascular disease; heparin-induced thrombocytopenia (HIT); pericarditis
with acute MI; severe hepatic or renal disease; continuous tube drainage of any orifice;
subacute bacterial endocarditis; recent surgery of brain, spinal cord, or eye; regional or
lumbar block anesthesia; threatened abortion; unreliable patients; pregnancy (category X).

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- Prophylaxis and treatment of venous thrombosis and its extension, pulmonary embolism(PE).
- Prophylaxis and treatment of thromboembolic complications associated with atrialfibrillation (AF) and/or cardiac valve replacement.
- Reduction in the risk of death, recurrent myocardial infarction (MI), and thromboembolicevents such as stroke or systemic embolization after myocardial infarction.

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1 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg, 10 mg tablets; 2 mg injection

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Indirectly interferes with blood clotting by depressing hepatic synthesis of vitamin Kdependent coagulation factors: II, VII, IX, and X.

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Blood Formers, Coagulators, And Anticoagulants; Oral Anticoagulant (Pregnancy
Category: X)

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Coumadin Sodium, Panwarfin, Warfilone

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- Take apical pulse for 1 full min, noting rate, rhythm, and quality before administering drug.
- Withhold medication and notify physician if apical pulse falls below ordered parameters
(e.g., <50 or 60/min in adults and <60 or 70/min in children).
- Be familiar with patient's baseline data (e.g., quality of peripheral pulses, blood pressure,
clinical symptoms, serum electrolytes, creatinine clearance) as a foundation for making
assessments.
- Lab tests: Baseline and periodic serum digoxin, potassium, magnesium, and calcium. Draw
blood samples for determining plasma digoxin levels at least 6 h after daily dose and
preferably just before next scheduled daily dose.
- Monitor for S&S of drug toxicity: In children, cardiac arrhythmias are usually reliable signs
of early toxicity. Early indicators in adults (anorexia, nausea, vomiting, diarrhea, visual
disturbances) are rarely initial signs in children.
- Monitor I&O ratio during digitalization, particularly in patients with impaired renal
function. Also monitor for edema daily and auscultate chest for rales. Monitor serum
digoxin levels closely during concurrent antibiotic–digoxin therapy, which can precipitate
toxicity because of altered intestinal flora.
- Observe patients closely when being transferred from one preparation (tablet, elixir, or
parenteral) to another; when tablet is replaced by elixir potential for toxicity increases since
30% of drug is absorbed.

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CNS: Fatigue, muscle weakness, headache, facial neuralgia, mental depression, paresthesia, hallucinations, confusion, drowsiness, agitation, dizziness.
CV: Arrhythmias, hypotension, AV block.
Special Senses: Visual disturbances.
GI: Anorexia, nausea, vomiting, diarrhea.
Other: Diaphoresis, recurrent malaise, dysphagia.

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Digitalis hypersensitivity, ventricular fibrillation, ventricular tachycardia unless due to
CHF. Full digitalizing dose not given if patient has received digoxin during previous week
or if slowly excreted cardiotonic glycoside has been given during previous 2 wk

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To treat mild to moderate heart failure with rapid digitalization / Treatment of mild to moderate HF. Control ventricular response rate in patients with chronic atrial fibrillation.

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Oral Solution: (Lanoxin): 50 mcg/mL Injection Solution: (Lanoxin): 100 mcg/mL, 250
mcg/ml. Tablets: (Lanoxin): 62.5 mcg, 125 mcg, 187.5 mcg, 250 mcg

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Widely used cardiac glycoside of Digitalis lanata. Acts by increasing the force and velocity
of myocardial systolic contraction (positive inotropic effect). It also decreases conduction
velocity through the atrioventricular node. Action is more prompt and less prolonged than
that of digitalis and digitoxin.

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Cardiovascular Agent; Cardiac Glycosi de; Antiarrhythmic

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Lanoxin, Digitec, Toloxin