Synonyms in a broader sense
- Phenprocoumon (active ingredient name)
- Coumarins
- Vitamin K antagonists (inhibitors)
- Anticoagulants
- Anticoagulant
Side effects of Marcumar
Side effects (so-called UAW’s, adverse drug reactions) and interactions with other drugs Among the most common undesirable effects of coumarin therapy are lighter bleeding with haematoma. These are usually harmless (2-5% of patients), so discontinuing the drug is sufficient until the concentration of coagulation factors in the blood increases again in two to three days. More threatening are bleedings from the draining urinary tract or in the stomach, which can occur especially after an overdose.
In such cases, there is not enough time for the coagulation factors to be newly synthesized and vitamin K must be administered so that new coagulation factors can be formed immediately in the liver. Coagulation then normalizes within a few hours. In (rare) emergencies, e.g. life-threatening bleeding within the brain, the missing clotting factors are infused directly (administered via the vein as a concentrate).
A likewise very rare but serious complication of coumarin therapy is caused by the initially increased coagulation: very small clots (so-called microthrombi) block tiny veins and capillaries that supply the skin and the underlying (lat. : subcutaneous) fatty tissue. As a result, the affected cells die (medical term: necrosis) and become bluish-black.
This circulatory disorder occurs three to eight days after the start of treatment with CoumarinenMarcumar® and is initially noticeable by a painful reddening of the skin. The treatment must then be discontinued and continued with heparin, which, however, cannot be taken in tablet form but can only be administered directly into the vein by infusion. A blue-spotted discoloration on the soles of the feet or toes can occur, but in contrast to the “coumarin necroses” described above, it is harmless and reversible: this “Purple Toes Syndrome” can occur after a longer treatment with CoumarinenMarcumar®, lasting about three to eight weeks, and improves by elevating the feet.
This side effect of the CoumarinMarcumar® therapy is also rare. In a survey conducted by the health portal Sanego, 6% of 354 people reported a weight gain during treatment with Marcumar®. The extent to which there is a direct correlation between weight gain and the drug has not been fully clarified.
Rarely has appetite loss been observed as a side effect that is more likely to be associated with weight loss. However, since everyone reacts individually to medication, weight gain cannot be excluded. The most important and common side effects associated with treatment with Marcumar® are bleeding.
These are usually caused by overdosing. In principle, bleeding can occur anywhere in the body. Occasionally, bleeding can occur into the intestinal wall.
Red or black discolored stools can indicate bleeding in the gastrointestinal tract. The doctor should be consulted. Liver inflammation is a frequent side effect of treatment with Marcumar®.
It can occur with or without jaundice. In some cases, liver tissue damage and liver failure have been observed as very rare side effects. In these cases, the liver failure required a liver transplant or led to death.
However, this occurs very rarely. Regular checks of liver and blood values and discussions with the doctor in case of complaints or uncertainties reduce the risk. Occasionally, a rash, red wheals in the form of so-called hives, itching and skin inflammation occur during therapy with Marcumar®.
In addition to the side effects on the skin, temporary diffuse hair loss may occasionally occur. Marcumar® inhibits all vitamin K-dependent factors. It thus also inhibits the so-called protein C. This protein has an anticoagulant function.
So-called skin necrosis can occur due to the shorter half-life of protein C compared to the other vitamin K-dependent factors. This is because when treatment with Marcumar ® begins, the protein C blood level first drops. This can lead to skin or venous thrombosis.
To prevent this, heparin is administered at the beginning. Very rarely, severe skin damage with permanent disability, or as a fatal consequence, can be recorded. General allergic skin reactions have also rarely been observed.In a survey conducted by the health portal Sanego, 6% of 354 people reported fatigue as side effects of Marcumar therapy.
Possibly there is a connection with a changed blood pressure since the therapy. But it is also possible that the fatigue is influenced and caused by other factors. Depending on the extent to which the fatigue manifests itself, it can have an effect on the affected person’s ability to concentrate.
Inadequate ability to concentrate can limit the activities of daily life or even cause self- or third-party harm. In such cases, it is essential to consult the doctor treating the patient. In a survey conducted by the health portal Sanego, 1% of 354 people reported impotence as a result of Marcumar treatment.
To what extent there is a direct context to the drug and impotence or whether other factors play a role in combination is still unclear. Not all authors report impotence as a side effect of treatment with Marcumar®. For example, the Yellow List and the manufacturers’ technical information do not list erectile dysfunction as a side effect of treatment with Marcumar®.
In the book “Manual der Impotenz”, the author Prof. H. Porst writes that erectile dysfunction is possible with Marcumar®, among other things, but that the mechanism of action is unclear. During treatment with Marcumar®, blood in the urine is a very common side effect. This can possibly be a sign of an overdose.
The discoloration of the urine may indicate bleeding in the urogenital tract. Therefore, these should always be reported to the treating physician. It is advisable to check the blood clotting values and possibly the kidney.
If necessary, the dosage must be changed. After months of using Marcumar®, this can occasionally lead to a reduction in bone mass or so-called osteoporosis. The reason for this is that Marcumar® inhibits vitamin K. Vitamin K is necessary for the formation of the bone matrix.
Consequently, prolonged use of the drug can lead to a disturbance in bone metabolism. This increases the risk of fractures, especially in people with a corresponding predisposition. However, the administration of vitamin K cannot inversely improve bone density.
In a survey conducted by the health portal Sanego, 2% of 354 people stated that they had (increased) sweating since treatment with Marcumar. They mostly reported that they would sweat faster than before the time of treatment. The extent to which there is a direct link between sweating and treatment with Marcumar® has not been fully clarified. However, it cannot be ruled out that the drug may alter vegetative processes in the body. Consequently, this could also have an influence on sweating.
