Warfarin is
                           a very important an d widely-used drug in preventing the

formation of life-threatening blood clots. In 2005, there were 22

million prescriptions filled for the drug.  However, it interacts with 

a number of other drugs, dietary supplements,
                           and vitamins. When used

improperly, warfarin can lead to potentially life-threatening bleeding

episodes. The medications
                           with which warfarin interacts are 

inexplicably not listed in the Medication Guide. In our book, Worst Pills, Best 

Pills and on our website,
                           Worstpills.org, we have warned about these serious

interaction problems, list the interacting drugs, and have 

continually updated the information.

The FDA has the regulatory
                           authority to require the distribution of

Medication Guides by pharmacists for drugs that pose a serious and

significant public health
                           concern. However, at this time, there are 

only approximately 75 drugs that require Medication Guides out of the

thousands of drugs on
                           the market. A list of these drugs with links to

their respective Medication Guides can be found on the FDA's Web site

at: http://www.fda.gov/cder/Offices/ODS/medication_guides.htm.

The new warfarin Medication Guide is reproduced below.

MEDICATION GUIDE

COUMADIN(COU-ma-din) Tablets

(Warfarin Sodium Tablets,
                           USP) Crystallin

Read this Medication Guide before you start taking COUMADIN (Warfarin

Sodium) and each time
                           you get a refill. There may be new information.

This Medication Guide does not take the place of talking to your

healthcare provider about
                           your medical condition or treatment. You and

your healthcare provider should talk about COUMADIN when you start

taking it and at regular
                           checkups.

What is the most important information I should know about COUMADIN?

Take your COUMADIN exactly
                           as prescribed to lower the chance of blood

clots forming in your body. (See "What is COUMADIN?").

COUMADIN is very important
                           for your health, but it can cause serious

and life-threatening bleeding problems. To benefit from COUMADIN and

also lower your chance
                           for bleeding problems, you must:

        Get
                           your regular blood test to check for your response to

COUMADIN. This blood test is called a PT/INR test. The PT/INR
                           test

checks to see how fast your blood clots. Your healthcare provider will

decide what PT/INR numbers are best for you.
                           Your dose of COUMADIN will

be adjusted to keep your PT/INR in a target range for you.

        Call your healthcare provider right away if you get any of the

        following signs or symptoms of bleeding problems:

        pain, swelling or discomfort

       
                           headaches, dizziness, or weakness

        unusual
                           bruising (bruises that develop without known cause or

grow in size)

       
                           nose bleeds

        bleeding gums

        bleeding from cuts takes a long time to stop

        menstrual bleeding or vaginal bleeding that is heavier than

normal

        pink or brown urine

       
                           red or black stools

        coughing
                           up blood

        vomiting blood or material
                           that looks like coffee grounds

Many other medicines, including prescription and non-prescription

medicines, vitamins and
                           herbal supplements can interact with COUMADIN

and:

        affect
                           the dose you need, or

        increase
                           COUMADIN side effects.

Tell your healthcare provider about all the medicines you take. Do not

Stop medicines or take
                           anything new unless you have talked to your healthcare

provider. Keep a list of your medicines with you at all
                           times to show

your healthcare provider and pharmacist.  Do not take other
                           medicines that contain warfarin. Warfarin is the active ingredient in COUMADIN.  Some
                           foods can interact with COUMADIN and affect your treatment and dose.

        Eat a normal, balanced diet. Talk to your doctor before you 

Make any diet changes.
                           Do not eat large amounts of leafy green vegetables.

Leafy green vegetables contain Vitamin K. Certain vegetable oils also

contain large amounts
                           of Vitamin K. Too much Vitamin K can lower the

effect of COUMADIN.

       
                           Avoid drinking cranberry juice or eating cranberry products.

       
                           Avoid drinking alcohol.

Always tell all of your healthcare providers that you take COUMADIN.

Wear or carry information
                           that you take COUMADIN.

What is COUMADIN?

COUMADIN is an anticoagulant medicine. It
                           is used to lower the chance

of blood clots forming in your body. Blood clots can cause a stroke,

heart attack, or other
                           serious conditions such as blood clots in the

legs or lungs.