Acenocoumarol

Generic name
Acenocoumarol
Brand name
ATC Code
B01AA07

Acenocoumarol

Dosages
Side effects in children
Warnings & precautions in children
Contra-indications in children

Interactions
PK
Renal impairment
References

Pharmacokinetics in children

No information

dose recommendation of formulary compared to licensed use (on-label versus off-label)

No information is present at this moment.

Available formulations

No information is present at this moment.

Dosages

Anticoagulation
  • Oral
    • < 1 year
      • Day 1: 0.2 mg/kg/day in 1 dosis
        Day 2: 0.15 mg/kg/day in 1 dosis
        Day 3: 0.1 mg/kg/day in 1 dosis
        Afterwards titrate based on INR.

    • 1 year up to 5 years
      • Day 1: 0.15 mg/kg/day in 1 dosis
        Day 2: 0.1 mg/kg/day in 1 dosis
        Day 3: 0.05 mg/kg/day in 1 dosis
        Afterwards titrate based on INR.

    • ≥ 5 years
      • Day 1: 0.1 mg/kg/day in 1 dosis, max 6 mg
        Day 2: 0.05 mg/kg/day in 1 dosis, max 4 mg
        Day 3: 0.025 mg/kg/da in 1 dosis, max 2 mg
        Afterwards titrate based on INR

Renal impaiment in children > 3 months

Adjustment in renal impairment as specified:

GFR 50-80 ml/min/1.73 m2
Dose adjustment is not required.
GFR 30-50 ml/min/1.73 m2
Dose adjustment is not required.
GFR 10-30 ml/min/1.73 m2
Consider lowering the loading dose.
GFR < 10 ml/min/1.73 m2
Generalized recommendations cannot be given.
Clinical consequences

Haemorrhages.
In a study with warfarin, patients whose creatinine clearance was less than 30 ml/min needed a lower warfarin dosage to achieve an INR inside the target range than patients with better renal function. In addition, bleeding occurred more often in these patients and they often had an INR outside the target range.

The complete list of all undesirable drug reactions can be found in the national Summary of Product Characteristics (SmPC) – click here

Side effects in children

Tendency to bleed.

The complete list of all contra-indications can be found in the national Summary of Product Characteristics (SmPC) – click here

Contra-indications in children

Punctures, biopsies and operations are contraindicated during coumarin use.

The complete list of all warnings and precautions can be found in the national Summary of Product Characteristics (SmPC) – click here

Warnings & precautions in children

It takes 5-7 days for the therapy to be stable. Watch out for a tendency to bleed. In cases of bleeding when coumarin is used, phytomenadione can be administered as an antidote. It takes about 3 hours before the phytomenadione takes effect. If the effect is not fast enough, prothrombin complex can be used.

Interactions

The complete list of all interactions can be found in the national Summary of Product Characteristics (SmPC) – click here

ANTITHROMBOTIC AGENTS

This pages provides a list of drugs from the same ATC class for comparison. This does not necessarily mean that these drugs are interchangeable.

Vitamin K antagonists
B01AA04
Heparin group
B01AB04
B01AB09
B01AB05
B01AB01
B01AB06
B01AB10
Platelet aggregation inhibitors excl. heparin
B01AC06
B01AC04
B01AC09
Enzymes
B01AD02
B01AD01
B01AD04
Direct thrombin inhibitors
B01AE07
Direct factor Xa inhibitors
B01AF02
B01AF01

References

  1. Rademaker C.M.A. et al, Geneesmiddelen-Formularium voor Kinderen, 2007
  2. NVK., Werkboek Kinderhematologie, http://www.hematologienederland.nl, 30 sept 2012, Geraadpleegd 03-02-2014
  3. Spoor N et al, Phenprocoumon and acenocoumarol treatment in paediatric patients., Thromb Haemost. 2, 012, Dec;108(6):, 1238-41
  4. NVK, Diagnostiek en behandeling van veneuze trombo-embolie bij kinderen, www.nvk.nl, jan 2014
  5. Nederlandse Vereniging voor Kindergeneeskunde, sectie kinderhematologie, Richtlijn Diagnostiek en behandeling van veneuze trombo-embolische complicaties bij neonaten en kinderen tot 18 jaar, https://hematologienederland.nl/kwaliteit/werkboek-kinderhematologie/, 2020, Jan, Rev1
  6. Rademaker C.M.A. et al, Geneesmiddelen-Formularium voor Kinderen, 2007

Changes

Therapeutic Drug Monitoring


Overdose