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Acenocoumarol: Indications, Dosing, Side Effects and Interactions
Acenocoumarol clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Acenocoumarol: Indications, Dosing, Side Effects and Interactions
Acenocoumarol clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Prophylaxis of embolisation in rheumatic heart disease and atrial fibrillation,Prophylaxis after insertion of prosthetic heart valve,Prophylaxis and treatment of venous thrombosis and pulmonary embolism,Transient ischaemic attacks**
- **Adult** (By Mouth): Initially 2-4 mg once daily for 2 days, alternatively initially 6 mg on day 1, then 4 mg on day 2; maintenance 1-8 mg daily, adjusted according to response, dose to be taken at the same time each day, lower doses may be required in patients over 65 years, severe heart failure with hepatic congestion, and malnutrition.
Cautions
K antagonists Bacterial endocarditis (use only if warfarin otherwise indicated); conditions in which risk of bleeding is increased; history of gastro-intestinal bleeding; hyperthyroidism; hypothyroidism; peptic ulcer; recent ischaemic stroke; recent surgery; uncontrolled hypertension Cautions, further information Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: with concurrent significant bleeding risk, such as uncontrolled severe hypertension, bleeding diathesis, or recent non-trivial spontaneous bleeding (high risk of bleeding) as part of dual therapy with an antiplatelet agent in patients with stable coronary, cerebrovascular, or peripheral arterial disease, without a clear indication for anticoagulant therapy (no added benefit) for first deep venous thrombosis without continuing provoking risk factors (e.g. thrombophilia) for longer than 6 months (no proven added benefit) for first pulmonary embolus without continuing provoking risk factors for longer than 12 months (no proven added benefit) Cautions For acenocoumarol Patients over 65 years
Contraindications
K antagonists Avoid use within 48 hours postpartum; haemorrhagic stroke; significant bleeding
Side effects
K antagonists Common or very common Haemorrhage Rare or very rare Alopecia; nausea; vomiting Frequency not known Blue toe syndrome; CNS haemorrhage; diarrhoea; fever; haemothorax; jaundice; pancreatitis; skin necrosis (increased risk in patients with protein C or protein S deficiency); skin reactions Side-effects For acenocoumarol Rare or very rare Appetite decreased; liver injury; skin necrosis haemorrhagic (increased risk in patients with protein C or protein S deficiency); vasculitis
Interactions
**Other interactions (16):**
- Many of these are isolated reports only or have been reported with warfarin rather than acenocoumarol; for completeness, all have been included.
- Interactions resulting in concomitant use not being recommended The following drugs potentiate the anticoagulant activity of acenocoumarol and/or alter haemostasis and thereby increase the risk of...
- Consequently, Sinthrome should not be prescribed with such drugs, which include: heparin (including low-molecular-weight heparin) (except in situations which require rapid anticoagulation; see...
- Increased INR has been reported in patients taking glucosamine and oral vitamin K antagonists.
- Patients treated with oral vitamin K antagonists should therefore be closely monitored at the time of initiation or termination of glucosamine therapy.
- Interactions to be considered The anticoagulant effect may be potentiated by concomitant administration of the following drugs: allopurinol; anabolic steroids; androgens; anti-arrhythmic...
Pregnancy
K antagonists Should not be given in the first trimester of pregnancy. Warfarin, acenocoumarol, and phenindione cross the placenta with risk of congenital malformations, and placental, fetal, or neonatal haemorrhage, especially during the last few weeks of pregnancy and at delivery. Therefore, if at all possible, they should be avoided in pregnancy, especially in the first and third trimesters (difficult decisions may have to be made, particularly in women with prosthetic heart valves, atrial fibrillation, or with a history of recurrent venous thrombosis or pulmonary embolism). Stopping these drugs before the sixth week of gestation may largely avoid the risk of fetal abnormality.
Breast feeding
Risk of haemorrhage; increased by vitamin K deficiency-manufacturer recommends prophylactic vitamin K for the infant (consult product literature).
Hepatic impairment
K antagonists In general, manufacturers advise caution in mild to moderate impairment; avoid in severe impairment. Hepatic impairment For acenocoumarol Dose adjustments Manufacturer advises consider dose reduction in mild to moderate impairment.
Renal impairment
Caution in mild to moderate impairment; avoid in severe impairment. M
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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