Patients who are heterozygous for the 2C9 (*1/*2 or *1/*3) can experience an approximately 37% reduction in S-warfarin clearance. Genomic Variants: Research has shown that genetic variations in CYP2C9 affect an individual's warfarin clearance. Other minor enzymatic pathways for metabolism include CYP2C8, 2C18, 2C19, 1A2, and 3A4.

Metabolism: Hepatic metabolism, primarily through the CYP2C9 enzyme. However, the patient's international normalized ratio (INR) may increase within 36 to 72 hours after initiating treatment.ĭistribution: Small volume of distribution (0.14 L/kg) A peak therapeutic effect is seen 5 to 7 days after initiation. The onset of action: The onset of action is typically 24 to 72 hours. Each enantiomer gets metabolized through unique pathways, and the S-enantiomer is approximately three to five times more potent than the R-enantiomer.Ībsorption: Rapid and complete absorption ĭrug Composition: Warfarin is a racemic mixture composed of R and S enantiomers of the drug. Patient-specific factors such as drug metabolism, the presence of a vitamin K enriched diet, genetics, quantity of vitamin K-dependent clotting factors, concurrent disease states, binding proteins, concomitant drug interactions, laboratory testing, and medication adherence requires assessment when dosing warfarin.

The dose-response of warfarin among patients is highly variable and depends on interpatient differences. By instructing patients to take warfarin later in the day, healthcare providers can have the opportunity to individualize a patient's warfarin dose the same day based on their most current lab values. Warfarin administration can be at any time during the day, but recommendations are for administration in the afternoon or evening. Warfarin is a once-daily oral medication.

Antidote for warfarin and heparin