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Many drugs including some over-the-counter medicines and herbal products can affect your inr and may increase the risk of bleeding if you take them with coumadin.

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Prothrombin complex concentratePCCfresh frozen plasmaor activated Factor VII treatment may be considered if the requirement to reverse the effects of COUMADIN is urgentA risk of hepatitis and other viral diseases is associated with the use of blood productsPCC and activated Factor VII are also associated with an increased risk of thrombosisThereforethese preparations should be used only in exceptional or life-threatening bleeding episodes secondary to COUMADIN overdosage.

Individualize the duration of therapy for each patientIn generalanticoagulant therapy should be continued until the danger of thrombosis and embolism has passedsee Dosage and Administration2.2

Bleedinge.gappearance of blood in stools or urinehematuriaexcessive menstrual bleedingmelenapetechiaeexcessive bruising or persistent oozing from superficial injuriesunexplained fall in hemoglobinis a manifestation of excessive anticoagulation.

Examples of drugs known to increase the risk of bleeding are presented in Table 3Because bleeding risk is increased when these drugs are used concomitantly with warfarinclosely monitor patients receiving any such drug with warfarin.

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eating large amount of foods high in vitamin k such as liver, green leafy vegetables, or vegetable oils can make coumadin less effective, so you should consult with your doctor about any changes in your diet.

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