Marevan

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

- Bleeding
- Increased time taken to stop bleeding
- Bruising
- Diarrhoea
- Nausea and vomiting
- Rash
- Hair loss (alopecia)
- Liver disorders
- Yellowing of the skin and eyes (jaundice)
- Inflammation of the pancreas (pancreatitis)

The side effects listed above may not include all of the side effects reported by the drug's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

The anticoagulant effect of warfarin can be affected by many medicines. It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.

The following medicines may enhance the effect of warfarin (increased INR; warfarin dose may need reducing):

- allopurinol
- amiodarone
- antibiotic medicines (eg ampicillin, ciprofloxacin, co-trimoxazole, erythromycin, metronidazole)
- antifungal medicines (eg fluconazole, ketoconazole, miconazole)
- anabolic steroids (oxymetholone, stanozolol)
- aspirin (may also irritate the stomach lining, which can result in bleeding from the stomach or intestine in people taking warfarin)
- certain chemotherapy regimens
- cimetidine
- danazol
- dextropropoxyphene (found in co-proxamol/Distalgesic)
- diflunisal
- dipyridamole
- disulfiram
- fibrate medicines (eg bezafibrate, ciprofibrate, clofibrate)
- flutamide
- glucagon (large doses)
- glucosamine supplements
- non-steroidal anti-inflammatory drugs (NSAIDs, eg ibuprofen and particularly azapropazone, diclofenac, flurbiprofen, indometacin, phenylbutazone, piroxicam. NSAIDs may also irritate the stomach and intestinal lining, which can result in bleeding from the gut in people taking warfarin. The interaction does not generally apply to NSAIDs applied to the skin.)
- omeprazole
- paracetamol (long-term regular use, occassional painkilling doses should not affect warfarin significantly)
- proguanil
- propafenone
- statins such as rosuvastatin, simvastatin
- sulfinpyrazone
- tamoxifen
- thyroxine (levothyroxine)
- zafirlukast.

The following medicines may reduce the effect of warfarin (decreased INR; warfarin dose may need increasing):

- aminoglutethimide
- azathioprine
- barbiturates, including phenobarbitone and primidone
- carbamazepine
- certain chemotherapy regimens
- colestyramine
- griseofulvin
- oestrogens
- progestogens
- raloxifene
- rifampicin
- sucralfate
- the herbal remeday St John's wort (Hypericum perforatum)
- vitamin K.

The following medicines may also alter the effect of warfarin and the dose of warfarin may need to be adjusted up or down (as prothombin time may be increased or reduced by the following medicines):

- corticosteroids
- phenytoin
- quinidine
- ritonavir.

This medicine may enhance the blood sugar lowering effect of antidiabetic tablets such as glibenclamide. Antidiabetic tablets may also enhance the anti-blood-clotting effect of this medicine. Combined use should be well monitored.

There may be an increased risk of bleeding if warfarin is taken in combination with any of the following medicines.

- antiplatelet or 'blood thinning' medicines such as aspirin, ticlopidine, dipyridamole
- SSRI antidepressants such as paroxetine or fluoxetine
- heparin
- low molecular weight heparins, eg dalteparin.

Other medicines containing the same active ingredient

Warfarin tablets are also available without a brand name, ie as the generic medicine.

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