Anti-clotting drug can work, but watch dosage

Q. I'm 80 years old, with numerous medical issues. When asked who my primary care physician is, I respond, "Dr. Gott." It isn't long before your column will discuss one of my medical problems with better advice than from any other doctor.

You've often mentioned Coumadin serves an important purpose, but you haven't indicated why it is always referred to as a bad drug (rat poison, etc.). It appears that I am condemned to using it for the rest of my days. What side effects can I expect? I find none listed anywhere.

A. Coumadin (warfarin) slows the speed of blood-clotting when prescribed in an appropriate dosage. It is ordinarily used in patients who tend to form clots, such as patients with heart irregularities, venous thrombosis in the lungs, strokes and other disorders. Too little warfarin is of no therapeutic value; too much is dangerous and can lead to uncontrolled hemorrhaging. (This is why the drug is used in rodent control.)

Patients taking warfarin must be monitored closely for blood-clotting. Inadvertent overdosing is the major complication of therapy. Other side effects are mostly insignificant (bruising, etc.).

I urge patients taking warfarin to discuss the dangers with their doctors. Also, discussion about length of treatment is useful. Not all patients need warfarin indefinitely. During treatment, patients should have a MedicAlert wristband so that in case of emergency trauma, the physicians in the emergency department can be made aware of the warfarin and can deal with the possible consequences.

Q. I am 80 years old and have had moderate to severe leg cramps for many years. I tried many home remedies including the soap-in-the-bed method. Nothing worked for me. I finally went to my doctor, who then prescribed quinine pills. Finally, something that worked. But now my pharmacist says that he can no longer dispense quinine pills. Is it safe for me to use my remaining supply? My prescription is still current. Is there something else that I can use in its place?

A. Quinine has been pulled from the market for use in relieving nocturnal leg cramps following reports that it can cause cardiovascular disease. It also has a host of other serious side effects and drug interactions. It is still marketed under its original use as an antimalarial drug. I recommend that you dispose of your remaining pills and, instead, drink 8 ounces of tonic water, which contains less quinine (about 15 milligrams per 6 fluid ounces) before bed time. This option is safe, inexpensive and often useful. Your physician may have other ideas and is a good place to start.

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