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• Preventing abnormal blood clots in conditions with increased risk, eg rheumatic heart disease, atrial fibrillation and after insertion of artificial (prosthetic) heart valves • Treatment and prevention of blood clots lodged in the veins of the leg (deep vein thrombosis) • Treatment and prevention of blood clots that have travelled to the lungs (pulmonary embolism).


• Allergy to other coumarin anticoagulants, eg warfarin • Active bleeding • People who are more prone to bleeding than normal, eg due to the blood clotting disorder haemophilia • Severe kidney disease • Severe liver disease • Bacterial infection of the heart valves and the lining surrounding the heart (bacterial endocarditis) • Uncontrolled high blood pressure (hypertension) • Peptic ulcer • Pregnancy • People who have recently had or are due to have surgery on the brain, spinal cord or eyes. • This medicine is not recommended for children.

Adverse reactions:

• Bleeding • Increased time taken to stop bleeding • Bruising • Loss of appetite • Nausea and vomiting • Skin rashes • Fever • Hair loss (alopecia) • Liver problems


The following medicines may enhance the effect of acenocoumarol (increased INR; acenocoumarol dose may need reducing): • allopurinol • amiodarone • antibiotic medicines (eg ampicillin, ciprofloxacin, co-trimoxazole, erythromycin, metronidazole) • antifungal medicines (eg fluconazole, ketoconazole, miconazole) • anabolic steroids (oxymetholone, stanozolol) • aspirin (may also irritate the stomach lining, which can result in bleeding from the stomach or intestine in people taking acenocoumarol) • certain chemotherapy regimens • cimetidine • danazol • dextropropoxyphene (found in co-proxamol/Distalgesic) • diflunisal • dipyridamole • disulfiram • fibrate medicines (eg bezafibrate, ciprofibrate, clofibrate) • flutamide • glucagon (large doses) • non-steroidal anti-inflammatory drugs (NSAIDs, eg ibuprofen and particularly azapropazone, diclofenac, flurbiprofen, 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.) • omeprazole • paracetamol (long-term regular use, occassional painkilling doses should not affect acenocoumarol significantly) • propafenone • statins such as rosuvastatin, simvastatin • sulfinpyrazone • tamoxifen • thyroxine (levothyroxine) The following medicines may reduce the effect of acenocoumarol (decreased INR; acenocoumarol dose may need increasing): • aminoglutethimide • azathioprine • barbiturates, including phenobarbitone and primidone • carbamazepine • certain chemotherapy regimens • colestyramine • griseofulvin • oestrogens • progestogens • raloxifene • rifampicin • sucralfate • the herbal remeday St John’s wort (Hypericum perforatum) • vitamin K


• Elderly people • Decreased kidney function • Decreased liver function • People who have had recent surgery, bleeding or major injury • Infections • Tumours • Thyrotoxicosis



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