Warfarin

According to Malaysian Drug Code Listing By Anatomical Group, warfarin is categorized under Antithrombotic Agents. The brand names available are : COUMADIN, APO-WARFARIN & ORFARIN

According to the Blue Book MOH Drug Formulary, warfarin is a Group B Category of Prescriber. It exists in form of :

• 1. Warfarin Sodium 1 mg Tablet
• 2. Warfarin Sodium 2 mg Tablet
• 3. Warfarin Sodium 3 mg Tablet
• 4. Warfarin Sodium 5 mg Tablet

According to British Pharmacopeia, warfarin is a vitamin K epoxide reductase inhibitor. There are 4 types of preparation :

• 1. Warfarin Sodium
• 2. Warfarin Sodium Clathrate
• 3. Warfarin Oral Suspension
• 4. Warfarin Tablets

According to ‘Terapi Warfarin’ by knowyourmedicine - http://www.knowyourmedicine.gov.my/aeimages//File/warfarin_3.pdf

TINDAK BALAS WARFARIN DENGAN UBAT-UBATAN LAIN / MAKANAN
Ubat-ubatan dan makanan yang bertindak balas dengan warfarin akan sama ada meningkatkan / mengurangkan kesan warfarin. Contohnya:

• 1. antibiotik (seperti cloxacillin, clarithromycin, dll)
• 2. ubat anti-epileptik
• 3. ubat tahan sakit jenis anti-inflammatori bukan steroid (seperti aspirin, diclofenac, mefenamic acid, dll)
• 4. herba (ginseng, gingko biloba, Dong Quai)
• 5. sayur-sayuran berdaun hijau (seperti bayam, brokoli, sawi, dll)

According to ‘Katemateegaroon, Dussanee, and Anusornsangiami, Wan Ar At, and Thomudtha, Adisak, and Nasurivong, Pornpimol, (2005) Pharmacist Monitoring Of Warfarin-Related Problems In Outpatient Anticoagulation Clinic. Malaysian Journal of Pharmaceutical Sciences, 3 (2). pp. 58-58. ISSN 16575-7319’, warfarin-related problems in the two groups included bleeding (10.0% vs. 3.1%), thrombo-embolism (0% vs. 0.5%), drug interactions (3.2% vs. 10.9%), and non-compliance (9.3% vs. 9.0%) in the study group versus the control group, respectively.

In HUKM, warfarin clinic is also known as INR clinic - http://pharmacy.hukm.ukm.my/services/inr.htm. The main aim of pharmacists' participation in INR clinic is therefore to provide integrated care to our warfarin patients. In return, this initiative is hoped to improve patient understanding and compliance to the therapy hence reducing complications, as well as to reduce our doctors' workload during the clinic.

Roles of Pharmacists in INR Clinic:

• • Warfarin therapy, compliance and adverse effects monitoring
• • INR interpretations
• • Dosage adjustment according to treatment protocols
• • Patient education

According to PSD website - http://www.pharmacy.gov.my/index.cfm?menuid=29&parentid=107, Ambulatory Care Pharmacy Service > Medication Therapy Adherence Clinic (MTAC) > MTAC Warfarin.