ALDOCUMAR 1 mg TABLETS

2. What you need to know before taking ALDOCUMAR

Do not takeALDOCUMAR

• If you are allergic to warfarin sodium or any of the excipients of the preparation.
• If you are pregnant.
• If you are not willing to take the medication correctly.
• In pathological conditions where the risk of bleeding is greater than the possible clinical benefit, such as bleeding diathesis and/or blood dyscrasia.
• In organic injuries that may bleed.
• In recent or planned surgical interventions in the central nervous system, ophthalmological operations, and traumatic interventions that expose large tissue surfaces.
• In gastroduodenal ulcer or manifest bleeding in the gastrointestinal, urogenital, or respiratory tracts, cerebrovascular bleeding, pericarditis, and pericardial effusions, endocarditis.
• In severe hypertension; severe liver and kidney parenchymal damage.
• In increased fibrinolytic activity (e.g., after lung, prostate, etc. operations).
• If you are taking high doses of NSAIDs, miconazole (systemic and oral gel), phenylbutazone (systemic), high doses of acetylsalicylic acid, and by extrapolation, other salicylates at high doses.

Warnings and precautionsConsult your doctor or pharmacist before starting to take ALDOCUMAR:

• If you have moderate to severe renal or hepatic insufficiency.
• If you have infectious diseases or alterations of the intestinal flora.
• If you have trauma that may result in internal bleeding.
• If you have surgery or trauma with large exposed surfaces.
• If you use catheters.
• If you have severe to moderate hypertension.
• If you have a known or suspected deficiency in protein C-mediated anticoagulant response, which may cause tissue necrosis.
• If you are a weakened or elderly patient.

ALDOCUMARhas been prescribed to you for the treatment of your current condition. Do not take this medication for other conditions without your doctor's indication.

• Periodic determination of prothrombin time (INR) is essential. Numerous factors, alone or in combination, physical condition, or concomitant medication may modify the patient's response to anticoagulants. It is generally good practice to monitor the patient's response with additional INR determinations in the immediate post-discharge period and when other medications are started, interrupted, or taken irregularly.
• It is necessary to follow the proposed dosing schedule exactly as indicated by your doctor.
• Avoid consuming alcohol.
• Do not take ALDOCUMARduring pregnancy.
• Avoid any activity or sport that may result in traumatic damage.
• Carry an identification that indicates the use of an anticoagulant.
• Contact your doctor if any disease appears, such as diarrhea, infection, or fever, or if unusual bleeding occurs.
• If therapy with ALDOCUMARis interrupted, it should be taken into account that the anticoagulant effects may persist for 2 to 5 days.

Taking ALDOCUMAR with other medications

It is recommended to monitor INR more closely in patients who replace 10 mg tablet fractions with 1, 3, and 5 mg tablets, as these allow for more precise dosing.

Whenever concomitant treatment with ALDOCUMARis started or stopped, repeated prothrombin time determinations should be performed until a stable value is obtained.

If you are going to take any other medication (even those purchased without a prescription), consult your doctor.

• Medications and products that may increase the response to ALDOCUMAR: allopurinol, analgesics (dextropropoxyphene, tramadol), antiarrhythmics (amiodarone), antibacterials (ciprofloxacin, clarithromycin, erythromycin, norfloxacin, chloramphenicol), antiulcer agents (cimetidine, omeprazole, ranitidine), cisapride, disulfiram, statins (fluvastatin, lovastatin, simvastatin), fluconazole, fluorouracil, fluvoxamine, interferon alpha and beta, itraconazole, metronidazole, tamoxifen, inactivated influenza virus, etacrynic acid, nalidixic acid, nonsteroidal anti-inflammatory drugs (diclofenac, phenylbutazone, ibuprofen, ketoprofen, mefenamic acid, sulindac), miconazole, carnitine, thyroid hormones, neomycin, paracetamol, quinidine, vitamin E, cephalosporins (cefamandole), clofibrate, stanozolol, piracetam, propranolol, salicylates (acetylsalicylic acid, diflunisal), tetracyclines, ticlopidine, clindamycin.

• Medications and products that may decrease the response to ALDOCUMAR: aminoglutethimide, carbamazepine, phenazone, griseofulvin, barbiturates, rifampicin, estrogen-based contraceptives, cholestyramine, corticosteroids, diuretics, mercaptopurine, vitamin K, sucralfate, ginseng, ascorbic acid.

• Other medications and products that may increase or decrease the response to ALDOCUMAR: alcohol, chloral hydrate, disopyramide.

Tell your doctor or pharmacist if you are using or have recently used any other medication, even those purchased without a prescription.

Taking ALDOCUMAR with food and drinks

Consumption of alcoholic beverages should be avoided during treatment with ALDOCUMAR.

Foods rich in Vitamin K (cereals, broccoli, cabbage, carrots, poultry giblets, etc.) may influence the effect of ALDOCUMAR.

Use in children

There are not enough clinical data to support the use of the preparation in children.

Pregnancy and breastfeeding

Pregnancy:

Oral anticoagulants derived from coumarin, such as warfarin, cross the placenta and are not recommended for use during pregnancy. Congenital malformations and other adverse effects on fetal development have been described in children born to mothers who took this medication during the first trimester. Oral anticoagulants cross the placenta with a risk of fetal or placental bleeding when administered weeks before delivery. In cases where anticoagulant therapy is essential, the use of heparin is recommended, especially during the first trimester, as it does not cross the placenta.

Tell your doctor as soon as you suspect you may be pregnant or if you wish to become pregnant. Consult your doctor or pharmacist before taking any medication.

Breastfeeding:

Warfarin is not detected in breast milk, so no adverse effects are expected in the breastfed infant.

Tell your doctor if you are breastfeeding. Consult your doctor or pharmacist before taking any medication.

Driving and using machines

Not described.

Important information about some of the components of ALDOCUMAR

This medication contains lactose. If your doctor has told you that you have an intolerance to certain sugars, consult with them before taking this medication.

This medication may cause allergic reactions because it contains the colorant Amaranto (E-123).

3. How to take ALDOCUMAR

Follow your doctor's instructions for taking ALDOCUMARexactly. Consult your doctor or pharmacist if you have any doubts.

Before taking the medication, check the expiration date.

The ALDOCUMARtablets should not be removed from their packaging until the time of administration.

The dosage and administration of ALDOCUMARshould be individualized for each patient according to their particular response to the medication.

Follow your doctor's instructions carefully, which may differ from the information contained in this package leaflet.

Your doctor will indicate the duration of treatment with ALDOCUMAR; do not exceed the recommended treatment duration.

The dosage should be adjusted based on the INR value, which is generally between 2.0 and 3.5, depending on the clinical condition.

Recommended INR values according to different pathologies:

• Venous thromboembolism (including pulmonary embolism): INR of 2.0-3.0

• Atrial fibrillation: INR of 2.0-3.0

• Post-myocardial infarction treatment: INR of 2.5-3.5

• Mechanical and bioprosthetic heart valves: INR of 2.5-3.5.

• Recurrent systemic embolism: In cases where the risk of thromboembolism is high, a higher INR may be necessary, but not exceeding 4.0.

Your doctor will determine the review periods for INR.

Initial dosage:

Generally, it is recommended to start therapy with 2 to 5 mg of warfarin per day, making dose adjustments based on INR determination results.

Maintenance:

Most patients are satisfactorily maintained with a daily dose of 2 to 10 mg. The individual dose and interval should be adjusted according to the patient's response.

Duration of therapy:

The duration of therapy in each patient should be individualized. In general, anticoagulant therapy should be continued until the risk of thrombosis and embolism has passed.

If you take more ALDOCUMAR than you should

Consult your doctor or pharmacist for biological follow-up of an overdose without clinical repercussions, as it requires adequate dose reduction and constant monitoring.

The steps to follow are as follows, depending on whether or not there are hemorrhagic complications:

• In case of overdose with INR <6 and in the absence of bleeding: temporarily interrupt anticoagulant restart therapy with a lower dose, based on inr.< li>
• In case of overdose with INR > 6 and in the absence of severe bleeding: administer 0.5 mg of vitamin K1 injectable in continuous perfusion for 20 to 30 minutes. Increase the dose to 1 mg if INR > 10.
• In case of overdose with severe bleeding: administer 10 to 20 mg of vitamin K1 injectable in slow continuous perfusion for 1 hour, along with a transfusion of fresh frozen plasma or whole blood or a commercial Factor IX complex.

In case of overdose or accidental ingestion, consult your doctor or pharmacist immediately or call the Toxicology Information Service. Telephone 915620420, indicating the medication and the amount ingested.

If you forget to take ALDOCUMAR

The anticoagulant effect of ALDOCUMARpersists for more than 24 hours. If you forgot to take the prescribed dose of ALDOCUMARat the determined time, you should take the dose as soon as possible on the same day.

Do not take a double dose to make up for forgotten doses, but consult your doctor.

If you have any other doubts about the use of this medication, ask your doctor or pharmacist.

4. Possible side effects

Like all medications, ALDOCUMARcan cause side effects, although not all people experience them.

Inform your doctor immediately if you experience any of these side effects. The adverse reactions that have been reported are:

Frequent (at least 1 in 100 patients)

Bleeding from any tissue or organ and other hemorrhagic complications, as a consequence of the anticoagulant effect. The signs and symptoms will vary according to the location and degree or extent of the bleeding.

Uncommon (at least 1 in 1000 patients)

Liver problems (hepatic), allergic reactions (hypersensitivity), alopecia, abdominal pain, nausea, vomiting, diarrhea, and fatigue.

Very rare (less than 1 in 10,000 patients)

Skin necrosis, dermatitis, and pruritus.

Frequency not known

A painful skin rash. In sporadic cases, warfarin can cause serious skin problems, such as calciphylaxis, which can start with a painful skin rash but can lead to other serious complications. This adverse reaction occurs more frequently in patients with chronic kidney disease.

Alteration of renal function that occurs with excessive anticoagulation and presence of blood in the urine (anticoagulant-related nephropathy).

Reporting of side effects

If you experience any type of side effect, consult your doctor or pharmacist, even if it is a possible side effect that is not listed in this package leaflet. You can also report them through the Spanish Medication and Healthcare Product Vigilance System. https://www.notificaram.es. By reporting side effects, you can contribute to providing more information on the safety of ALDOCUMAR.

5. Storage of ALDOCUMAR 1 mg tablets

Keep ALDOCUMAR out of the sight and reach of children.

Store in the outer packaging to protect it from light.

Expiration date

Do not use ALDOCUMARafter the expiration date that appears on the bottle after Exp:. The expiration date is the last day of the month indicated.

Medications should not be disposed of through wastewater or household waste. Deposit the packaging and medications you no longer need at the SIGRE point in your usual pharmacy. If in doubt, ask your pharmacist how to dispose of the packaging and medications you no longer need. This will help protect the environment.

6. Contents of the pack and further information

Composition of ALDOCUMAR 1 mg tablets

The active ingredient is warfarin sodium.

The other components (excipients) are: lactose monohydrate (63.63 mg/tablet), microcrystalline cellulose, sodium carboxymethyl starch, colloidal silicon dioxide, magnesium stearate, and colorant Amaranto (E-123).

Appearance of the product and contents of the pack

ALDOCUMAR 1 mg tabletsare presented in a box containing 2 blister packs with 20 tablets each, pink in color, odorless, with a notch on one face and the anagram 1 on the other face.

Marketing authorization holder and manufacturer

Laboratorio Aldo-Unión, S.L.

Baronesa de Maldá, 73

08950 Esplugues de Llobregat

Barcelona - SPAIN

Date of the last revision of this package leaflet:November 2021.

Detailed and updated information on this medication is available on the website of the Spanish Agency for Medicines and Healthcare Products (AEMPS) http://www.aemps.es/