Acenocoumarol


Concise Prescribing Info
Indications/Uses
Thromboembolic disorders.
Dosage/Direction for Use
Adult : PO Initial: 2-4 mg/day for 2 days, or 6 mg on 1st day, followed by 4 mg on 2nd day. Subsequent dose adjusted according to response. Maintenance: 1-8 mg/day.
Dosage Details
Oral
Thromboembolic disorders
Adult: Initially: 2-4 mg daily for 2 days. Alternatively, 6 mg on the 1st day as loading dose, followed by 4 mg on the 2nd day. Subsequent dose adjusted according to response. Maintenance: 1-8 mg daily. Administer at the same time each day.
Elderly: Reduce dose if necessary.
Renal Impairment
Severe: Contraindicated.
Hepatic Impairment
Severe: Contraindicated.
Contraindications
Haemorrhagic diathesis and blood dyscrasia (e.g. haemophilia, thrombocytopenic purpura, leukaemia), peptic ulcer or haemorrhage of the GI tract, urogenital tract or resp system; cerebrovascular haemorrhage, acute pericarditis, pericardial effusion, infective endocarditis, severe HTN. Recent or potential surgery of the eyes/CNS. Recent surgery resulting in increased fibrinolytic activity (e.g. surgery of the lung, prostate, uterus). Uncooperative patient (e.g. unsupervised senile, alcoholic, psychotic, w/ dementia). Severe hepatic and renal impairment. Pregnancy.
Special Precautions
Patient w/ severe heart failure, known or suspected protein C or S and vit K deficiency. Mild to moderate hepatic and renal impairment. Elderly. Lactation.
Adverse Reactions
Rarely, urticaria, rash, dermatitis, purpura, skin necrosis; fever, decreased appetite, nausea, vomiting, diarrhoea; alopecia; hepatic dysfunction, jaundice, pancreatitis; purple toe syndrome.
Potentially Fatal: Haemorrhage.
MonitoringParameters
Determine prothrombin time (PT)/INR (daily or on alternate days in early days of treatment, then at longer intervals depending on response). Monitor CBC, hepatic and renal function.
Overdosage
Symptoms: Haemorrhage, haematemesis, haemoptysis, haematuria (w/ renal colic), haematoma, menorrhagia, GI and cutaneous haemorrhage, vaginal, gingival, joint, and nose bleeding; tachycardia, hypotension, peripheral circulatory disorder, nausea, vomiting, diarrhoea, abdominal pain, high PT/INR value, prolonged thromboplastin time. Management: Oral vit K1 (phytomenadione) may be given for moderate to severe haemorrhage. Administer fresh blood/frozen plasma, complex concentrate/recombinant factor VIIa supplemented w/ vit K1 for severe and life-threatening haemorrhage.
Drug Interactions
Increased effect w/ antiarrhythmics (e.g. amiodarone, quinidine), antibiotics (e.g. broad spectrum antibiotics, tetracyclines, chloramphenicol), antifungal (e.g. metronidazole), SSRIs (e.g. citalopram, fluoxetine, sertraline, paroxetine), antigout (e.g. allopurinol), lipid-regulating drugs (e.g. atorvastatin, fluvastatin, simvastatin), and inhibitors of CYP2C9 isoenzyme. Reduced anticoagulant effect w/ antineoplastics (e.g. azathioprine, 6-mercaptopurine), antivirals (e.g. ritonavir, nelfinavir), thiazide diuretics, oral contraceptives, and inducers of CYP2C9, CYP2C19, and CYP3A4 isoenzymes. May increase the serum hydantoin concentration of phenytoin. May potentiate the hypoglycaemic effect of sulphonylurea derivatives (e.g. glibenclamide, glimepiride).
Potentially Fatal: Increased risk of haemorrhage w/ other anticoagulants (e.g. warfarin, heparin, LMWH), antiplatelets (e.g. dipyridamole, clopidogrel, ticlopidine), antibiotics (e.g. clindamycin), analgesics (e.g. salicylates, pyrazolone derivatives, COX-2 inhibitors), high dose IV methylprednisolone.
Food Interaction
Reversed anticoagulant effect w/ foods high in vit K (e.g. beef and pork liver, green tea, green leafy vegetables). Increased metabolism and reduced PT/INR w/ chronic alcohol consumption; conversely, acute ingestion reduces metabolism and increases PT/INR. Increased INR and may cause severe bleeding w/ cranberry juice. Reduced effect w/ St. John’s wort.
Action
Description: Acenocoumarol, a coumarin derivative, is a vitamin K-epoxide-reductase complex 1 (VKORC1) antagonist, depleting functional vit K reserves, thus, reducing the synthesis of coagulation factors II (prothrombin), VII, IX, and X, as well as proteins C and S. It also reduces γ-carboxylation of certain glutamic acid molecules, important for blood clotting initiation.
Pharmacokinetics:
Absorption: Rapidly absorbed from the GI tract. Bioavailability: 60%. Time to peak plasma concentration: 1-3 hr.
Distribution: Crosses the placenta; enters breast milk (small amounts). Volume of distribution: 0.16-0.34 L/kg. Plasma protein binding: 99%, mainly to albumin.
Metabolism: Both S- and R- isomers are metabolised in the liver by CYP2C9 isoenzyme via oxidation; R-isomer is also metabolised by CYP1A2 and CYP2C19. Undergoes nitro-reduction by gut flora.
Excretion: Via urine (approx 60%, as inactive metabolites) and faeces (29%, as metabolites). Elimination half-life: 8-11 hr.
Chemical Structure

Chemical Structure Image
Acenocoumarol

Source: National Center for Biotechnology Information. PubChem Database. Acenocoumarol, CID=54676537, https://pubchem.ncbi.nlm.nih.gov/compound/Acenocoumarol (accessed on Jan. 20, 2020)

Storage
Store between 15-30°C.
ATC Classification
B01AA07 - acenocoumarol ; Belongs to the class of vitamin K antagonists. Used in the treatment of thrombosis.
References
Anon. Acenocoumarol. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 05/08/2016.

Buckingham R (ed). Acenocoumarol. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 05/08/2016.

Buckingham R (ed). Acenocoumarol. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 05/08/2016.

Disclaimer: This information is independently developed by MIMS based on Acenocoumarol from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
Register or sign in to continue
Asia's one-stop resource for medical news, clinical reference and education
Sign up for free
Already a member? Sign in