Home Drug Guide Dicumarol

Drug Guide

Generic Name

Dicumarol

Brand Names

Classification

Therapeutic: Anticoagulant

Pharmacological: Vitamin K antagonist

FDA Approved Indications

  • Prevention and treatment of thromboembolic disorders such as deep vein thrombosis, pulmonary embolism, and atrial fibrillation

Mechanism of Action

Dicumarol inhibits vitamin K epoxide reductase, leading to decreased synthesis of active vitamin K-dependent clotting factors II, VII, IX, and X, thereby exerting an anticoagulant effect.

Dosage and Administration

Adult: Typically 2-10 mg daily, adjusted based on INR monitoring.

Pediatric: Not commonly used in children; consult specialist.

Geriatric: Use with caution, start with lower doses due to increased bleeding risk.

Renal Impairment: Adjust dose cautiously; monitor INR closely.

Hepatic Impairment: Use with caution; hepatic function impacts coagulation factors.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed, crosses placenta; appears in breast milk.

Metabolism: Hepatic metabolism, primarily via conjugation.

Excretion: Excreted in urine and feces; half-life approximately 36-42 hours.

Half Life: Approximately 36-42 hours.

Contraindications

  • Active bleeding, severe bleeding disorders, pregnancy (category C/D), vitamin K deficiency

Precautions

  • Risk of bleeding, monitor INR regularly, use with caution in hepatic disease, stage pregnancy and lactation considerations.

Adverse Reactions - Common

  • Bleeding, including hemorrhage (Frequent)

Adverse Reactions - Serious

  • Severe bleeding, anemia, thrombocytopenia (Infrequent)

Drug-Drug Interactions

  • Other anticoagulants, antiplatelet agents, NSAIDs, aspirin, thrombolytics

Drug-Food Interactions

  • Foods high in vitamin K (e.g., leafy greens) can reduce efficacy.

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor INR regularly, assess for signs of bleeding, baseline coagulation profile.

Diagnoses:

  • Risk for bleeding
  • Ineffective tissue perfusion related to bleeding risk.

Implementation: Administer as prescribed, educate on bleeding precautions, monitor INR, adjust dose accordingly.

Evaluation: Therapeutic INR range maintained, no signs of bleeding or adverse effects.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Report any unusual bleeding or bruising.
  • Avoid sudden dietary changes in vitamin K intake.
  • Regular INR monitoring is essential.

Special Considerations

Black Box Warnings:

  • Major and fatal bleeding; use with caution.
  • Potential for severe bleeding; dosage adjustment critical.

Genetic Factors: Genetic variability can affect metabolism and response.

Lab Test Interference: Can interfere with certain coagulation tests.

Overdose Management

Signs/Symptoms: Excessive bleeding, hematuria, melena, hematomas.

Treatment: Discontinue drug; administer vitamin K1 IV; provide supportive care; in severe cases, consider blood product transfusions.

Storage and Handling

Storage: Store at room temperature, protected from moisture and light.

Stability: Stable when stored properly; check expiration date.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.