Nurses Compass
Drug Guide
Dicumarol
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/ANursing 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.