Details
Stereochemistry | RACEMIC |
Molecular Formula | C19H16O4 |
Molecular Weight | 308.3279 |
Optical Activity | ( + / - ) |
Defined Stereocenters | 0 / 1 |
E/Z Centers | 0 |
Charge | 0 |
SHOW SMILES / InChI
SMILES
CC(=O)CC(C1=CC=CC=C1)C2=C(O)C3=C(OC2=O)C=CC=C3
InChI
InChIKey=PJVWKTKQMONHTI-UHFFFAOYSA-N
InChI=1S/C19H16O4/c1-12(20)11-15(13-7-3-2-4-8-13)17-18(21)14-9-5-6-10-16(14)23-19(17)22/h2-10,15,21H,11H2,1H3
Warfarin is an anticoagulant drug normally used to prevent blood clot formation as well as migration. Warfarin is marketed under the brand name Coumadin among others. Coumadin (crystalline warfarin sodium) is an anticoagulant which acts by inhibiting vitamin
K-dependent coagulation factors. Chemically, it is 3-(α-acetonylbenzyl)-4-hydroxycoumarin and is a racemic mixture of the R- and S-enantiomers. Coumadin is indicated for the prophylaxis and/or treatment of venous thrombosis and its extension, and pulmonary embolism. It is also indicated for the prophylaxis and/or treatment of the thromboembolic
complications associated with atrial fibrillation and/or cardiac valve replacement. Warfarin is thought to interfere with clotting factor synthesis by inhibition of the C1 subunit of the vitamin K epoxide reductase (VKORC1) enzyme complex, thereby reducing the regeneration of vitamin K1 epoxide. The degree of depression is dependent upon the dosage
administered and, in part, by the patient’s VKORC1 genotype. Therapeutic doses of warfarin decrease the total amount of the active form of each vitamin K dependent clotting factor made by the liver by approximately 30% to 50%.
CNS Activity
Originator
Approval Year
Targets
Primary Target | Pharmacology | Condition | Potency |
---|---|---|---|
24.7 nM [IC50] |
Conditions
Condition | Modality | Targets | Highest Phase | Product |
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Primary | COUMADIN Approved UseWarfarin sodium tablets are indicated for the prophylaxis and/or treatment of venous thrombosis and its extension, and pulmonary embolism. Warfarin sodium tablets are indicated for the prophylaxis and/or treatment of the thromboembolic complications associated with atrial fibrillation and/or cardiac valve replacement. Warfarin sodium tablets are indicated to reduce the risk of death, recurrent myocardial infarction, and thromboembolic events such as stroke or systemic embolization after myocardial infarction. Launch Date-4.91270406E11 |
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Preventing | COUMADIN Approved UseWarfarin sodium tablets are indicated for the prophylaxis and/or treatment of venous thrombosis and its extension, and pulmonary embolism. Warfarin sodium tablets are indicated for the prophylaxis and/or treatment of the thromboembolic complications associated with atrial fibrillation and/or cardiac valve replacement. Warfarin sodium tablets are indicated to reduce the risk of death, recurrent myocardial infarction, and thromboembolic events such as stroke or systemic embolization after myocardial infarction. Launch Date-4.91270406E11 |
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Preventing | COUMADIN Approved UseWarfarin sodium tablets are indicated for the prophylaxis and/or treatment of venous thrombosis and its extension, and pulmonary embolism. Warfarin sodium tablets are indicated for the prophylaxis and/or treatment of the thromboembolic complications associated with atrial fibrillation and/or cardiac valve replacement. Warfarin sodium tablets are indicated to reduce the risk of death, recurrent myocardial infarction, and thromboembolic events such as stroke or systemic embolization after myocardial infarction. Launch Date-4.91270406E11 |
Cmax
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
2186 ng/mL EXPERIMENT https://www.ncbi.nlm.nih.gov/pubmed/19552747 |
25 mg single, oral dose: 25 mg route of administration: Oral experiment type: SINGLE co-administered: |
WARFARIN plasma | Homo sapiens population: HEALTHY age: ADULT sex: FEMALE / MALE food status: FASTED |
AUC
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
52278 ng × h/mL EXPERIMENT https://www.ncbi.nlm.nih.gov/pubmed/19552747 |
25 mg single, oral dose: 25 mg route of administration: Oral experiment type: SINGLE co-administered: |
WARFARIN plasma | Homo sapiens population: HEALTHY age: ADULT sex: FEMALE / MALE food status: FASTED |
T1/2
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
32.4 h EXPERIMENT https://www.ncbi.nlm.nih.gov/pubmed/19552747 |
25 mg single, oral dose: 25 mg route of administration: Oral experiment type: SINGLE co-administered: |
WARFARIN plasma | Homo sapiens population: HEALTHY age: ADULT sex: FEMALE / MALE food status: FASTED |
|
7 day |
single, oral |
WARFARIN unknown | Homo sapiens population: UNHEALTHY age: UNKNOWN sex: UNKNOWN food status: UNKNOWN |
Funbound
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
1% |
single, oral |
WARFARIN unknown | Homo sapiens population: UNHEALTHY age: UNKNOWN sex: UNKNOWN food status: UNKNOWN |
Doses
Dose | Population | Adverse events |
---|---|---|
125 mg single, oral Overdose Dose: 125 mg Route: oral Route: single Dose: 125 mg Co-administed with:: oxycodone, p.o(200 mg, single) Sources: Page: p.718 |
unhealthy, 43 n = 1 Health Status: unhealthy Condition: Deep venous thromboses Age Group: 43 Sex: M Population Size: 1 Sources: Page: p.718 |
Disc. AE: Vomiting, Loss of consciousness... AEs leading to discontinuation/dose reduction: Vomiting Sources: Page: p.718Loss of consciousness |
150 mg single, oral Overdose Dose: 150 mg Route: oral Route: single Dose: 150 mg Co-administed with:: chlorpromazine, p.o(3 g, single) Sources: Page: p.718 |
unhealthy, 44 n = 1 Health Status: unhealthy Condition: Aortic valve replacement Age Group: 44 Sex: M Population Size: 1 Sources: Page: p.718 |
Disc. AE: Drowsiness... AEs leading to discontinuation/dose reduction: Drowsiness Sources: Page: p.718 |
540 mg single, oral Overdose Dose: 540 mg Route: oral Route: single Dose: 540 mg Co-administed with:: clonazepam, p.o(4 mg, single) Sources: Page: p.1 |
healthy, 59 n = 1 Health Status: healthy Age Group: 59 Sex: F Population Size: 1 Sources: Page: p.1 |
|
5 mg 1 times / day multiple, oral Recommended Dose: 5 mg, 1 times / day Route: oral Route: multiple Dose: 5 mg, 1 times / day Sources: Page: p.1 |
unhealthy, 64 n = 1 Health Status: unhealthy Condition: Cardiomyopathy |Atrial fibrillation Age Group: 64 Sex: M Population Size: 1 Sources: Page: p.1 |
Disc. AE: Hemoptysis, Hematuria... AEs leading to discontinuation/dose reduction: Hemoptysis Sources: Page: p.1Hematuria Dyspnea Cough |
10 mg 1 times / day multiple, oral (max) Recommended Dose: 10 mg, 1 times / day Route: oral Route: multiple Dose: 10 mg, 1 times / day Sources: Page: p.1 |
unhealthy Health Status: unhealthy Condition: Venous thrombosis|Atrial fibrillation|Myocardial infarction Sources: Page: p.1 |
Disc. AE: Bleeding... AEs leading to discontinuation/dose reduction: Bleeding (grade 5) Sources: Page: p.1 |
AEs
AE | Significance | Dose | Population |
---|---|---|---|
Loss of consciousness | Disc. AE | 125 mg single, oral Overdose Dose: 125 mg Route: oral Route: single Dose: 125 mg Co-administed with:: oxycodone, p.o(200 mg, single) Sources: Page: p.718 |
unhealthy, 43 n = 1 Health Status: unhealthy Condition: Deep venous thromboses Age Group: 43 Sex: M Population Size: 1 Sources: Page: p.718 |
Vomiting | Disc. AE | 125 mg single, oral Overdose Dose: 125 mg Route: oral Route: single Dose: 125 mg Co-administed with:: oxycodone, p.o(200 mg, single) Sources: Page: p.718 |
unhealthy, 43 n = 1 Health Status: unhealthy Condition: Deep venous thromboses Age Group: 43 Sex: M Population Size: 1 Sources: Page: p.718 |
Drowsiness | Disc. AE | 150 mg single, oral Overdose Dose: 150 mg Route: oral Route: single Dose: 150 mg Co-administed with:: chlorpromazine, p.o(3 g, single) Sources: Page: p.718 |
unhealthy, 44 n = 1 Health Status: unhealthy Condition: Aortic valve replacement Age Group: 44 Sex: M Population Size: 1 Sources: Page: p.718 |
Cough | Disc. AE | 5 mg 1 times / day multiple, oral Recommended Dose: 5 mg, 1 times / day Route: oral Route: multiple Dose: 5 mg, 1 times / day Sources: Page: p.1 |
unhealthy, 64 n = 1 Health Status: unhealthy Condition: Cardiomyopathy |Atrial fibrillation Age Group: 64 Sex: M Population Size: 1 Sources: Page: p.1 |
Dyspnea | Disc. AE | 5 mg 1 times / day multiple, oral Recommended Dose: 5 mg, 1 times / day Route: oral Route: multiple Dose: 5 mg, 1 times / day Sources: Page: p.1 |
unhealthy, 64 n = 1 Health Status: unhealthy Condition: Cardiomyopathy |Atrial fibrillation Age Group: 64 Sex: M Population Size: 1 Sources: Page: p.1 |
Hematuria | Disc. AE | 5 mg 1 times / day multiple, oral Recommended Dose: 5 mg, 1 times / day Route: oral Route: multiple Dose: 5 mg, 1 times / day Sources: Page: p.1 |
unhealthy, 64 n = 1 Health Status: unhealthy Condition: Cardiomyopathy |Atrial fibrillation Age Group: 64 Sex: M Population Size: 1 Sources: Page: p.1 |
Hemoptysis | Disc. AE | 5 mg 1 times / day multiple, oral Recommended Dose: 5 mg, 1 times / day Route: oral Route: multiple Dose: 5 mg, 1 times / day Sources: Page: p.1 |
unhealthy, 64 n = 1 Health Status: unhealthy Condition: Cardiomyopathy |Atrial fibrillation Age Group: 64 Sex: M Population Size: 1 Sources: Page: p.1 |
Bleeding | grade 5 Disc. AE |
10 mg 1 times / day multiple, oral (max) Recommended Dose: 10 mg, 1 times / day Route: oral Route: multiple Dose: 10 mg, 1 times / day Sources: Page: p.1 |
unhealthy Health Status: unhealthy Condition: Venous thrombosis|Atrial fibrillation|Myocardial infarction Sources: Page: p.1 |
Overview
CYP3A4 | CYP2C9 | CYP2D6 | hERG |
---|---|---|---|
OverviewOther
Other Inhibitor | Other Substrate | Other Inducer |
---|---|---|
Drug as perpetrator
Target | Modality | Activity | Metabolite | Clinical evidence |
---|---|---|---|---|
yes [Ki 8 uM] |
Drug as victim
Target | Modality | Activity | Metabolite | Clinical evidence |
---|---|---|---|---|
Page: 14.0 |
yes | |||
Page: 14.0 |
yes | |||
Page: 14.0 |
yes | |||
Page: 14.0 |
yes | likely (co-administration study) Comment: Inhibitors of CYP2C9, 1A2, and/or 3A4 have the potential to increase the effect (increase INR) of warfarin by increasing the exposure of warfarin; Inducers of CYP2C9, 1A2, and/or 3A4 have the potential to decrease the effect (decrease INR) of warfarin by decreasing the exposure of warfarin Page: 14.0 |
||
Page: 14.0 |
yes | likely (co-administration study) Comment: Inhibitors of CYP2C9, 1A2, and/or 3A4 have the potential to increase the effect (increase INR) of warfarin by increasing the exposure of warfarin; Inducers of CYP2C9, 1A2, and/or 3A4 have the potential to decrease the effect (decrease INR) of warfarin by decreasing the exposure of warfarin Page: 14.0 |
||
Page: 14.0 |
yes | yes (pharmacogenomic study) Comment: If the patient’s CYP2C9 and/or VKORC1 genotype are known, consider these ranges in choosing the initial dose. Patients with CYP2C9 *1/*3, *2/*2, *2/*3, and *3/*3 may require more prolonged time (>2 to 4 weeks) to achieve maximum INR effect for a given dosage regimen than patients without these CYP variants; Inhibitors of CYP2C9, 1A2, and/or 3A4 have the potential to increase the effect (increase INR) of warfarin by increasing the exposure of warfarin; Inducers of CYP2C9, 1A2, and/or 3A4 have the potential to decrease the effect (decrease INR) of warfarin by decreasing the exposure of warfarin Page: 14.0 |
PubMed
Title | Date | PubMed |
---|---|---|
Unexplained thrombosis in HIV-infected patients receiving protease inhibitors: report of seven cases. | 1999 Dec |
|
Multicentric warfarin-induced skin necrosis complicating heparin-induced thrombocytopenia. | 1999 Sep |
|
Warfarin-induced artery calcification is accelerated by growth and vitamin D. | 2000 Feb |
|
Anticoagulant induced submucosal hemorrhage mimicking a renal pelvic tumor. | 2000 Jan |
|
Intraspinal hemorrhage complicating oral anticoagulant therapy: an unusual case of cervical hematomyelia and a review of the literature. | 2000 Jan 24 |
|
Coumarin derivatives and breast-feeding. | 2000 Jun |
|
[Marked creatine-phosphokinase elevation in myopathy after treatment with bezafibrate]. | 2000 Sep |
|
Management of intracranial bleeding associated with anticoagulation: balancing the risk of further bleeding against thromboembolism from prosthetic heart valves. | 2000 Sep |
|
Abdominal wall hematoma as a complication of warfarinization. | 2001 Apr |
|
Spontaneous subcapsular renal hematoma secondary to anticoagulant therapy. | 2001 Apr |
|
Behçet's disease with a large intracardiac thrombus: a case report. | 2001 Apr |
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Thrombolysis and antithrombotic therapy for coronary artery disease. | 2001 Feb |
|
Antithrombotic therapy in valvular heart disease. | 2001 Feb |
|
Oral anticoagulants. Pharmacologic issues for use in the elderly. | 2001 Feb |
|
Implications of cytochrome P450 2C9 polymorphism on warfarin metabolism and dosing. | 2001 Feb |
|
Stroke prophylaxis in nonvalvular atrial fibrillation. | 2001 Feb |
|
Endovascular caval interruption in pregnant patients with deep vein thrombosis of the lower extremity. | 2001 Feb |
|
Heparin and coumadin: delayed postpolypectomy bleeding. | 2001 Feb |
|
Asymptomatic atrial fibrillation: problems of management. | 2001 Feb |
|
How safely and for how long can warfarin therapy be withheld in prosthetic heart valve patients hospitalized with a major hemorrhage? | 2001 Feb |
|
Anticoagulant pharmacodynamics of tinzaparin following 175 iu/kg subcutaneous administration to healthy volunteers. | 2001 Feb 15 |
|
Central venous device-related infection and thrombosis in patients treated with moderate dose continuous-infusion interleukin-2. | 2001 Feb 15 |
|
What is the best emergency treatment for children who ingest warfarin rodenticide? | 2001 Feb 5 |
|
Thrombus formation on atherosclerotic plaques: pathogenesis and clinical consequences. | 2001 Feb 6 |
|
[Old adrenal hematoma: a case report]. | 2001 Jan |
|
Catastrophic antiphospholipid antibody syndrome. | 2001 Jan |
|
Generic substitution: issues for problematic drugs. | 2001 Jan |
|
Regarding clinical practice guidelines on the use of warfarin. | 2001 Jan |
|
The sin of omission: a systematic review of antithrombotic therapy to prevent stroke in atrial fibrillation. | 2001 Jan |
|
Hypertension due to renal artery occlusion in a patient with antiphospholipid syndrome. | 2001 Jan |
|
Cardiac and great vessel thrombosis in Behçet's disease. | 2001 Jan |
|
Effect of regimen complexity on patient satisfaction and compliance with warfarin therapy. | 2001 Jan |
|
HIV and thrombosis: a review. | 2001 Jan |
|
Congenital heart disease: current indications for antithrombotic therapy in pediatric patients. | 2001 Jan |
|
Need for increased dose of warfarin in HIV patients taking nevirapine. | 2001 Jan 26 |
|
Sneddon's syndrome: a case report. | 2001 Mar |
|
Perception of teratogenic risk of common medicines. | 2001 Mar |
|
Prevention, diagnosis, and treatment of venous thromboembolic complications of gynecologic surgery. | 2001 Mar |
|
Increase in international normalized ratio associated with smoking cessation. | 2001 Mar |
|
A case report of warfarin resistance due to azathioprine and review of the literature. | 2001 Mar |
|
Palliative care for the elderly. | 2001 Mar |
|
Treatment of the patient with deep vein thrombosis. | 2001 Mar |
|
Efficacy and safety of intravenous phytonadione (vitamin K1) in patients on long-term oral anticoagulant therapy. | 2001 Mar |
|
Improving medication safety across a multihospital system. | 2001 Mar |
|
Low-dose warfarin fails to prolong survival of dual lumen venous dialysis catheters. | 2001 Mar |
|
Adverse reactions to fluoroquinolones. an overview on mechanistic aspects. | 2001 Mar |
|
Mild head injury, anticoagulants, and risk of intracranial injury. | 2001 Mar 10 |
|
Warfarin therapy for an octogenarian who has atrial fibrillation. | 2001 Mar 20 |
|
Vitamin K for warfarin-associated coagulopathy. | 2001 Mar 3 |
|
Clinical trials that have influenced the treatment of venous thromboembolism: a historical perspective. | 2001 Mar 6 |
Patents
Sample Use Guides
In Vivo Use Guide
Sources: https://www.drugs.com/dosage/warfarin.html
Usual Adult Dose for Prevention of Thromboembolism in Atrial Fibrillation Initial dose: 2 to 5 mg orally once a day
Maintenance dose: 2 to 10 mg orally once a day
Usual Adult Dose for Myocardial Infarction
Initial dose: 2 to 5 mg orally once a day
Maintenance dose: 2 to 10 mg orally once a day
Usual Adult Dose for Deep Vein Thrombosis - Prophylaxis
Initial dose: 2 to 5 mg orally once a day
Maintenance dose: 2 to 10 mg orally once a day
Route of Administration:
Oral
In Vitro Use Guide
Sources: https://www.ncbi.nlm.nih.gov/pubmed/6712738
Curator's Comment: One strain (TAS) is susceptible and two strains (HW and HS) resistant to the anticoagulant and lethal effects of warfarin.
Vitamin K-reductase activity was inhibited by approximately 13 and 8% respectively when microsomal preparations from TAS and HW animals were incubated with 50 uM vitamin K1 and 10 uM warfarin.
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Classification Tree | Code System | Code | ||
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NDF-RT |
N0000175964
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WHO-ATC |
B01AA03
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WHO-VATC |
QB01AA03
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NCI_THESAURUS |
C263
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LIVERTOX |
NBK548837
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NCI_THESAURUS |
C45597
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WHO-ESSENTIAL MEDICINES LIST |
10.2
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NDF-RT |
N0000175476
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EPA PESTICIDE CODE |
86002
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1719000
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C945
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6853
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341
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11289
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PRIMARY | RxNorm | ||
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WARFARIN
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81-81-2
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Warfarin
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DTXSID5023742
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SUB00090MIG
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warfarin
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59813
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10033
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54678486
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5Q7ZVV76EI
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87732
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5Q7ZVV76EI
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201-377-6
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CHEMBL1464
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100000079328
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DB00682
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1786
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M11506
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2847
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D014859
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ACTIVE MOIETY
METABOLITE INACTIVE (PARENT)
METABOLITE INACTIVE (PARENT)
METABOLITE INACTIVE (PARENT)
METABOLITE INACTIVE (PARENT)
METABOLITE LESS ACTIVE (PARENT)
SALT/SOLVATE (PARENT)
SALT/SOLVATE (PARENT)
SALT/SOLVATE (PARENT)