ANISINDIONE
(an-i-sin-dye'one)
Miradon
Classifications: blood formers, coagulators & anticoagulants; anticoagulant
Prototype: Warfarin Sodium
Pregnancy Category: X
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50 mg tablets
Anisindione inhibits precursor proteins of clotting factors II, VII, IX, and X. Anisindione inhibits formation of the active
form of vitamin K. Therefore, levels of the active form of vitamin K are depleted.
Reduction of active levels of vitamin K reduces levels of active clotting factors, and thus produces an anticoagulation effect.
The anticoagulant effect inhibits further formation of thrombi. Anisindione does not have a direct thrombolytic effect.
Prophylaxis and treatment of venous thrombosis (including in atrial fibrillation) and pulmonary embolism; adjunct in treatment
of coronary occlusion.
Pregnancy (category X); labor and delivery; lactation. Hemorrhagic tendencies or blood dyscrasias; recent cerebral hemorrhage;
GI ulcer or ulcerative colitis; open wounds.
Recent surgery of brain, eye, spinal cord, prostate; renal or hepatic disease; severe diabetes; bacterial endocarditis, pericarditis
or polyarthritis; diverticulitis or visceral carcinoma; aneurysm, severe or malignant hypertension, eclampsia, or preeclampsia;
possible abortion; malnutrition, emaciation, deficiencies of vitamin C or K; patient noncompliance; elderly females; patients
deficient in protein C; congestive heart failure.
Anticoagulation
Adult: PO 300 mg day 1, 200 mg day 2, then 100 mg q.d. Adjust dose to maintain desired PT level (dose range 25–250 mg)
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Oral
- Take at the same time each day.
- Store in a tightly closed container between 15°–30° C (59°–86° F).
Body as a Whole: Pyrexia. GI: Nausea, vomiting, diarrhea. Hematologic:
Hemorrhage. Skin: Dermatitis, urticaria, alopecia.
Anisindione may cause alkaline urine to be red-orange; may enhance uric acid excretion, cause elevation of serum transaminases, and may increase lactic dehydrogenase activity.
Drug: In addition to the drugs listed below, many other drugs have been reported to alter the expected response to anisindione;
however, clinical importance of these reports has not been substantiated. The addition or withdrawal of any drug to an established
drug regimen should be made cautiously, with more frequent INR determinations than usual and with careful observation of the patient and dose adjustment as indicated. The following may
enhance the anticoagulant effects of anisindione: Acetohexamide,
acetaminophen,
alkylating agents, allopurinol,
aminoglycosides, aminosalicylic acid,
amiodarone,
anabolic steroids, antibiotics (oral), antimetabolites, antiplatelet drugs, aspirin,
asparaginase,
capecitabine,
celecoxib,
chloramphenicol,
chlorpropamide,
chymotrypsin,
cimetidine,
clofibrate,
co-trimoxazole,
danazol,
dextran,
dextrothyroxine,
diazoxide,
disulfiram,
erythromycin,
ethacrynic acid,
fluconazole,
glucagons,
guanethidine, hepatotoxic drugs, influenza vaccine,
isoniazid,
itraconazole,
ketoconazole,
mao inhibitors, meclofenamate,
mefenamic acid,
methyldopa,
methylphenidate,
metronidazole,
miconazole,
mineral oil,
nalidixic acid,
neomycin (oral),
nonsteroidal anti-inflammatory drugs, plicamycin,
potassium products, propoxyphene,
propylthiouracil,
quinidine,
quinine,
rofecoxib,
salicylates,
streptokinase,
sulindac,
sulfonamides, sulfonylureas, tetracyclines, thiazides, thyroid drugs, tolbutamide,
tricyclic antidepressants, urokinase,
vitamin E,
zileuton. The following may increase or decrease the anticoagulant effects of anisindione: Alcohol (acute intoxication may increase, chronic alcoholism may decrease effects), chloral hydrate,
diuretic. The following may decrease the anticoagulant effects of anisindione: barbiturates,
carbamazepine,
cholestyramine,
corticosteroids, corticotropin,
ethchlorvynol,
glutethimide,
griseofulvin,
laxatives, mercaptopurine,
oral contraceptives, rifampin,
spironolactone,
vitamin C,
vitamin K.
Herbal:
Capsicum,
celery,
chamomile,
clove,
Devil's claw,
Dong quai,
Echinacea,
fenugreek,
feverfew,
garlic,
ginger,
ginkgo,
horse chestnut,
licorice root,
passionflower herb,
tumeric,
willow bark may increase risk of bleeding; ginseng,
green tea,
St. John's wort may decrease effectiveness of anisindione.
Absorption: Well absorbed. Peak: 2–3 d. Duration: 1–3 d. Metabolism: Metabolized in liver. Elimination: Excreted in urine. Half-Life: 3–5 d.
Assessment & Drug Effects
- 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 1.2–1.5 times the control or another parameter set by physician.
- Lab tests: For maintenance dosage, PT/INR determinations at 1–4-wk intervals, or more often, depending on patient's response;
periodic Hct, Hgb, platelet count, WBC with differential, urinalyses, stool guaiac, and liver and kidney function tests.
- Monitor closely whenever a new drug is added or removed from the regimen.
- Assess all systems carefully for S&S of hemorrhage.
Patient & Family Education
- Notify physician immediately if you experience any of the following: unusual bleeding or bruising, black or bloody stools,
blood in urine, unexplained tiredness or fever, chills or sore throat, or stomach pain.
- Avoid aspirin or other anti-inflammatory pain relievers while taking this drug.
- Do not increase your consumption of foods containing vitamin K, such as liver, green leafy vegetables, broccoli, or cauliflower,
without discussing your diet with your doctor.
- Do not breast feed while taking this drug.
1%)
Canadian drug name; 
Prototype drug