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" What is it used for? Treating and preventing blood clots in the blood vessels, for example in the following cases:  Preventing abnormal blood clots in conditions with increased risk, eg rheumatic heart disease, atrial fibrillation and after insertion of artificial (prosthetic) heart valves.  Treating and preventing blood clots in the veins of the leg (deep vein thrombosis). Treating and preventing blood clots that have travelled to the lungs (pulmonary embolism).   How does it work? Sinthrome tablets contain the active ingredient acenocoumarol (previously known as nicoumalone in the UK), which is a type of medicine called an oral anticoagulant. It is used to stop blood clots forming within the blood vessels.  Blood clots normally only form to stop bleeding that has occurred as a result of injury to the tissues. The clotting process is complicated and begins when blood cells called platelets clump together at the site of damage and produce chemicals that activate clotting factors in the blood. Clotting factors are proteins that are produced by the liver. Vitamin K is essential for their production. The activated clotting factors cause a protein called fibrinogen to be converted into another called fibrin. Fibrin binds the platelets together, forming a blood clot. This is the body&amp;#039;\u2019s natural way of repairing itself.  Sometimes, however, a blood clot can form abnormally within the blood vessels. This is known as a thrombus and can be dangerous because the clot may detach and travel in the bloodstream, where it becomes known as an embolus. The clot may eventually get lodged in a blood vessel, thereby blocking the blood supply to a vital organ such as the heart, brain or lungs. This is known as a thromboembolism. Some people have an increased tendency for blood clots to form within the blood vessels. This is usually due to a disturbance in the blood flow within the blood vessels. For example, fatty deposits on the walls of the blood vessels (atherosclerosis) can disrupt the blood flow, giving a tendency for platelets to clump together and start off the clotting process. Slow blood flow in the leg and pelvic veins can also result in clots forming (deep vein thrombosis). These clots can break off and travel to the lungs (pulmonary embolism). A type of fast irregular heartbeat called atrial fibrillation can also disrupt blood flow and may lead to blood clots forming in the heart. Heart valve disease can have the same effect, particularly if artificial heart valves have been fitted. Clots in the heart can detach and travel to the brain, causing a stroke. Acenocoumarol is used to reduce the risk of blood clots forming inside the blood vessels in conditions such as these.  Acenocoumarol works by preventing the vitamin K dependent production of the clotting factors described above. Acenocoumarol prevents the production of these clotting factors by inhibiting the action of vitamin K. Without the clotting factors fibrinogen cannot be converted into fibrin and blood clots are therefore less likely to occur. Acenocoumarol takes about three days to produce its full anticoagulant effect because, while it prevents the production of new clotting factors, it takes about this long for clotting factors that have already been produced to be used up. For this reason, when treating blood clots such as deep vein thrombosis (DVT) or pulmonary embolism, a faster acting injectable anticoagulant, such as a heparin, is often used as well to begin with.  The anticoagulant effect of acenocoumarol is measured in terms of the prothombin time, which is the time taken for blood clotting to occur in a sample of blood to which calcium and a substance known as thromboplastin have been added. This time is expressed as the International Normalised Ratio (INR). Your doctor will take regular blood samples and adjust your dose of acenocoumarol as necessary to make your INR fall into the range that has been shown to be effective at preventing blood clots in your particular condition.   How do I take it?  Sinthrome tablets should be taken once a day. Take your dose at the same time each day. The dose that your doctor prescribes will vary from person to person and may vary from day to day. It depends on the condition being treated and your blood clotting time (INR or prothrombin time). You will need to have regular blood tests to check this and your doctor will adjust your dose based on the results. It is important to follow the instructions given by your doctor regarding how many tablets to take each day. The tablets can be taken either with or without food. They should be swallowed whole with a drink of water. If you forget to take a dose at your usual time take it as soon as you remember, unless it is nearly time for your next dose. In this case leave out the missed dose and take your next dose as usual when it is due. Do not take a double dose to make up for a missed dose. Keep taking this medicine every day as directed until your doctor tells you to stop.   Warning!  You should take extra care when participating in physical activities while taking this medicine, as even minor injury may result in bruising or bleeding. As this medicine prevents blood clotting, too much can increase your risk of bleeding. On the other hand, too little will not be effective at preventing clotting. It is therefore important that you have regular blood tests to monitor your blood clotting time (INR) so that your dose can be altered if necessary. When first starting treatment this test should be daily or on alternate days, and as your INR becomes more stable the tests can be at longer intervals. You will probably need your INR checking after any changes to your acenocoumarol dose, if you become ill suddenly, or if you are prescribed certain other medicines. Talk to your doctor about when your INR will need checking. Drinking large amounts of alcohol in one go should be avoided while taking acenocoumarol, as this may increase its effect. In contrast, chronic heavy drinking can decrease the effect of acenocoumarol. However, it is fine to drink alcohol now and then in moderation.  As acenocoumarol works by inhibiting the action of vitamin K, changes to your dietary intake of vitamin K can alter the effect of your acenocoumarol. For this reason, avoid making sudden major changes to your diet, particularly your consumption of green tea, salad and green vegetables (eg broccoli, brussel sprouts, or spinach), which contain large amounts of vitamin K. Large amounts of green vegetables (more than 500g daily) can reduce the effect of acenocoumarol and should be avoided. Changes to your consumption of fats and oils can also alter the effect of acenocoumarol, as vitamin K is a fat soluble vitamin. The effects of acenocoumarol may also be altered by other foods, for example cranberry juice should be avoided, as it may increase the effect of acenocoumarol. Acenocoumarol&amp;#039;s effect can also be altered by sudden increases or decreases in your body weight. For these reasons you should avoid making sudden major changes to your diet during treatment with acenocoumarol. For more information talk to your pharmacist. Consult your doctor immediately if you experience any bruising, bleeding, dark stools, blood in the urine, vomiting, diarrhoea, fever or acute illness while taking this medicine, so that your INR can be checked. You will be given an anticoagulant treatment booklet when you start treatment with this medicine. This will contain details of your acenocoumarol dose and INR and will also give advice on your anticoagulant treatment. You should carry this with you at all times in case you are involved in an accident. It is important that you tell any health professional treating you, including your dentist and anyone administering vaccines or other injections, that you are taking this medicine. If you are due to have any surgery it is also important to talk to your doctor in advance about your acenocoumarol. For some surgery it may be safe to keep taking acenocoumarol, whereas if you are going to have major surgery with a higher risk of bleeding your doctor may want you to stop taking your acenocoumarol a few days before the surgery. Follow the instructions given by your doctor.    Use with caution in  Children. People over 65 years of age. People with decreased kidney function. People with decreased liver function. People with severe heart failure. People who are malnourished or who have a disorder affecting the absorption of food from the gut. People with a blood disorder called protein C or protein S deficiency &amp;amp;#65533; this would cause you to bleed for longer than normal after a cut or injury.  People with cancer. People with infections or inflammation. People with an overactive thyroid gland (thyrotoxicosis).   Not to be used in  People who are allergic to other coumarin anticoagulants, eg warfarin. People with blood disorders that increase the risk of bleeding, for example, the blood clotting disorder haemophilia or low numbers of platelets in the blood (thrombocytopenia). People with bleeding in the brain, lungs or urinary tract. People who have had a stroke caused by bleeding in the brain (haemorrhagic stroke). People with a peptic ulcer or bleeding in the gut. People with inflammation or infection around the heart (pericarditis, infective endocarditis, perciardial effusion). People who have recently had or are due to have major surgery or surgery on the brain, spinal cord or eyes. People with very high blood pressure (hypertension). People with severely reduced kidney function. People with severely reduced liver function. Pregnancy. Rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorbtion (Sinthrome tablets contain lactose).  This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.   Pregnancy and breastfeeding Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.  This medicine should not be used during pregnancy, especially during the first and third trimesters, as it may be harmful to the developing baby. It is important to use effective contraception to prevent pregnancy while you are taking this medicine. Seek further medical advice from your doctor. This medicine passes into breast milk in very small amounts. The manufacturer does not expect this to have any adverse effects on nursing infant, however, they recommend that nursing infants should receive vitamin K supplements as a precaution. Seek further medical advice from your doctor.   Side effects Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.  Common (affect between 1 in 10 and 1 in 100 people)  Bleeding and bruising. See the warning section above. Increased time taken to stop bleeding.   Rare (affect between 1 in 1000 and 1 in 10,000 people)  Decreased appetite. Nausea and vomiting. Hair loss (alopecia). Hypersensitivity reactions such as skin rashes or fever.   Very rare (affect fewer than 1 in 10,000 people)  Inflammation of blood vessels (vasculitis). Liver problems.  The side effects listed above may not include all of the side effects reported by the medicine&amp;#039;s manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist. If you think you have experienced a side effect from a medicine or vaccine you should check the patient information leaflet. This lists the known side effects and what to do if you get them. You can also get advice from your doctor, nurse or pharmacist. If they think it&amp;amp;#65533;s necessary they&amp;#039;ll report it for you. You can also report side effects yourself using the yellow card website: www.mhra.gov.uk/yellowcard.   How can this medicine affect other medicines? The anticoagulant effect of acenocoumarol can be affected by many medicines. It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to make sure that the combination is safe.  The following medicines affect blood clotting and are not recommended for use in combination with acenocoumarol as they may increase the risk of bleeding:  antiplatelet or &amp;#039;blood thinning&amp;#039; medicines such as low-dose aspirin, clopidogrel, dipyridamole apixaban bivalirudin dabigatran duloxetine fondaparinux the herbal remedy ginko glycoprotein IIb/IIIa receptor antagonists such as eptifibatide, tirofiban and abciximab heparin ketorolac low molecular weight heparins, eg dalteparin prasugrel rivaroxaban SSRI antidepressants such as paroxetine or fluoxetine venlafaxine.   The following medicines may enhance the effect of acenocoumarol. This may increase your INR and increase the risk of bleeding. Your INR should be checked more frequently if you take any of these with acenocoumarol, particularly when starting or stopping any of these medicines. Your acenocoumarol dose may need reducing while you are taking any of these:   allopurinol amiodarone anabolic steroids (eg oxymetholone, stanozolol) antibiotic medicines (eg amoxicillin, cefaclor, ciprofloxacin, clarithromycin, co-trimoxazole, erythromycin, metronidazole, tetracycline, neomycin, chloramphenicol) aspirin (may also irritate the stomach lining, which can result in bleeding from the stomach or intestine in people taking acenocoumarol)  azole antifungal medicines (eg fluconazole, ketoconazole, itraconazole, miconazole, voriconazole) capecitabine the herbal remedy Chinese angelica cimetidine danazol the Chinese herbal remedy danshen disulfiram dronedarone erlotinib esomeprazole etoposide exenatide ezetimibe fibrate medicines for lowering cholesterol (eg bezafibrate, ciprofibrate, clofibrate) fluorouracil flutamide glucagon (large doses) glucosamine supplements ifosfamide iloprost lactulose leflunomide methylphenidate non-steroidal anti-inflammatory drugs (NSAIDs, eg ibuprofen and particularly azapropazone, diclofenac, flurbiprofen, ketorolac, indometacin, phenylbutazone, piroxicam. NSAIDs may also irritate the stomach and intestinal lining, which can result in bleeding from the gut in people taking acenocoumarol. The interaction does not generally apply to NSAIDs applied to the skin.) You should not take this type of painkiller while you are taking acenocoumarol unless it has been specifically prescribed by your doctor. paracetamol (long-term regular use, occasional painkilling doses should not affect acenocoumarol significantly) propafenone quinine sitaxentan sorafenib statins for lowering cholesterol such as rosuvastatin, fluvastatin, simvastatin sulfinpyrazone tamoxifen testosterone thyroxine (levothyroxine) toremifene tramadol zafirlukast.   The following medicines may reduce the effect of acenocoumarol. This could decrease your INR and make the acenocoumarol less effective at preventing blood clots. Your INR should be checked more frequently if you take any of these with acenocoumarol, particularly when starting or stopping any of these medicines. Your acenocoumarol dose may need increasing while you are taking any of these:   azathioprine barbiturates, including phenobarbital and primidone bosentan carbamazepine colestyramine enzalutamide eslicarbazepine griseofulvin mercaptopurine raloxifene rifampicin sucralfate the herbal remedy St John&amp;#039;s wort (Hypericum perforatum) vitamin K.  The following medicines may also alter the effect of acenocoumarol and your dose of acenocoumarol may need to be adjusted up or down (as INR may be increased or reduced by the following medicines):  corticosteroids the herbal remedy ginseng nevirapine oestrogens phenytoin progestogens protease inhibitors for HIV such as ritonavir.  The weight loss medicine orlistat (Xenical or Alli) may reduce the absorption of vitamin K from food and may therefore affect the action of acenocoumarol. Your INR should be monitored if you start or stop taking orlistat while you are taking acenocoumarol.   Other medicines containing the same active ingredient There are currently no other medicines available in the UK that contain acenocoumarol as the active ingredient.   Further reading For background information about our medicine factsheets, including the references used to produce them, click here.  Last updated 06.01.2015 "^^<http://www.w3.org/2001/XMLSchema#string>
<http://www.netdoctor.co.uk/medicines/heart-and-blood/a7533/sinthrome-acenocoumarol/>