Acenocoumarol - Oral

Acenocoumarol is a blood-thinning medicine. It prevents special cells in the blood from sticking to each other. This reduces the risk of harmful blood clots forming in your body.

This medicine is used to treat or prevent blood clotting disorders, including deep vein thrombosis (blood clots in the leg veins) and pulmonary embolism (blood clots in a lung artery).

This medicine may also be used to manage other conditions as decided by your doctor.

Take Acenocoumarol exactly as directed by your doctor or according to the instructions on the label. Do not take more or less than instructed by your doctor.

Try to take it at the same time each day.

The dose of this medicine will be decided by your doctor. Your doctor will advise you on the treatment timeframe depending on your condition and your response to the medication.

Acenocoumarol must be taken regularly for it to be effective. Continue taking this medicine even when you feel better. Do not stop taking it unless instructed by the doctor.

If you miss a dose, take the missed dose as soon as you remember on the same day. If it is almost time for your next dose, skip the missed dose and return to your normal dosing schedule.

DO NOT double a dose under any circumstances.

If you often forget to take your medicine, let your doctor and pharmacist know.

Alert your doctor if you have the following conditions:

• bleeding problems e.g. bleeding in the lungs, stomach, bowel, or urinary tract
• blood disorders
• active stomach ulcer
• recent stroke caused by bleeding in the brain
• heart problems e.g. infection in the lining of the heart and heart valves, fluid build-up or inflammation around the heart
• severe high blood pressure
• mental illness
• alcoholism
• severe kidney disease
• severe liver disease
• recent or possible operation involving the spine, brain, or eyes
• have had a recent major surgery

as Acenocoumarol may not be suitable for you.

Do not take this medicine if you are pregnant or planning to have a baby soon. If you become pregnant while being treated with Acenocoumarol, alert your doctor immediately. This medicine may cause harm to your unborn child. You must use proven birth control methods while taking Acenocoumarol.

Inform your doctor if you have the following conditions:

• severe heart failure (weakness and inability of the heart to pump blood)
• conditions that may increase the risk of bleeding e.g. history of bleeding in the stomach, cancer, high blood pressure, disease of the blood vessels supplying the brain, recent injury
• protein C or protein S deficiency (rare disorders that may increase the risk of forming abnormal blood clots)
• TB (an infection known as tuberculosis)
• vitamin K deficiency
• thyroid problems
• mild to moderate kidney disease
• mild to moderate liver disease

Let your doctor know if you are breastfeeding.

Be sure to check with your doctor or pharmacist before giving Acenocoumarol to the elderly. Elderly people may be more sensitive to the side effects.

If you are going to have an operation, including minor surgery and dental work, inform your doctor or dentist that you are taking this medicine.

Some genetic traits (CYP2C9 and VKORC1) can affect an individual's response to this medicine or may increase the risk of serious side effects. Although not routinely done, your doctor may advise you to undergo genetic testing to check if Acenocoumarol is best suited for you. If you know you have this gene type, inform your doctor.

Why do I need to have blood tests done so often?

For as long as you are taking Acenocoumarol, you will need to have regular blood tests to check your body's response to the medicine. This blood test is called an INR (International Normalised Ratio). The INR measures how much time your blood takes to clot. Each person has his or her target INR result. Your doctor will discuss with you your target INR result.

You will need to have an INR blood test done more often in the first few days or weeks. Your doctor needs to monitor your response to this medicine so that a suitable dose can be customised for you.

Why is it important to keep my appointments with the doctor?

Keep your appointments with your doctor. Your doctor needs to monitor your condition and check your response to the medication regularly.

• Routine tests (e.g. liver function, complete blood count) may be done while you are being treated with this medicine. Your doctor will advise you about how often you need to have these tests.
• Regular monitoring for signs and symptoms of bleeding may also be needed.

What lifestyle changes can I make to improve my condition?

If you are a smoker, you should try to quit smoking. Smoking is harmful to your blood vessels and overall health. It has been shown that smoking will make your condition worse. Speak to your doctor or pharmacist about ways to stop your smoking habit.

Regular exercise will help to gradually improve your condition by improving your blood circulation. However, you should not over-exert yourself. Speak to your doctor about what type of exercise would be suitable for you.

You should also keep an eye on your cholesterol levels. Cholesterol build-up in the arteries can reduce blood flow and make the arteries stiff and narrow. Stick to a healthy, low-fat diet that includes lots of fresh fruits and vegetables.

Acenocoumarol may cause any of the following side effects: nausea, vomiting, decreased appetite, and hair loss.

Some side effects may need immediate medical help. Alert your doctor quickly if you experience any of the following:

• rashes, breathlessness, swelling of the face, eyes or mouth
• change in skin colour to purple or black
• blistering of the skin with or without scars, usually in the breasts, buttocks or thighs
• unusual bruising, excessive bleeding from cuts or wounds that takes a long time to stop, bleeding gums, nosebleeds
• pass out bloody or black as tar stools and vomiting blood or ground coffee-like material

Inform your doctor if any of these side effects do not go away or are severe, or if you experience other side effects.

Inform your doctor and pharmacist if you are taking any of these medicines:

• other blood-thinning medicines e.g. aspirin, clopidogrel, dipyridamole, ticlopidine
• medicines for irregular heartbeat e.g. amiodarone, quinidine
• medicines for epilepsy (fits or seizures) e.g. carbamazepine, phenobarbital, phenytoin
• medicines for depression e.g. citalopram, sertraline
• medicines for diabetes e.g. glibenclamide, glimepiride
• medicines to treat fungal infection e.g. ketoconazole, fluconazole
• certain antibiotics e.g. clarithromycin, clindamycin, ciprofloxacin
• NSAIDs (medicine for pain and inflammation) e.g. celecoxib, phenylbutazone, diflunisal
• cholesterol-lowering medicines e.g. atorvastatin, colestyramine
• azathioprine (medicine used in organ transplants or certain immune disorders)
• mercaptopurine (medicine for cancer)
• ritonavir (medicine for HIV infection)
• rifampicin (medicine to treat TB [an infection known as tuberculosis])
• St. John's wort (herbal medicine)

This list does not include all medicines that may interact with Acenocoumarol.

Always notify your doctor and pharmacist if you are taking any other medicines, including herbal tonics such as traditional Chinese medicines, supplements, and medicines that you buy without a prescription.

Avoid alcohol.

Avoid excessive consumption of cranberry juice or other products containing cranberry.

Avoid taking unusually large amounts of food that is high in vitamin K, such as dark green vegetables, beef or pork liver, and green tea.

Store in a cool, dry place away from the reach of children.

Medicines must not be used past the expiry date.