Phenprocoumon vs. Warfarin

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bvostok

New member
Joined
Nov 4, 2010
Messages
4
Location
Munich, Germany
Looking around here on the forum, Phenprocoumon (brand names: Liquamar, Marcoumar etc) seems to be widely unknown in North America. And instead doctors prescribe Warfarin.
How comes? Here in Germany 99% of the affected patients get Marcoumar and there is even the widely used term "Marcumarisierung" (marcoumarization)!

Historical reasons? Medical reasons? Influence of lobbyists?
 
Looking around here on the forum, Phenprocoumon (brand names: Liquamar, Marcoumar etc) seems to be widely unknown in North America. And instead doctors prescribe Warfarin.
How comes? Here in Germany 99% of the affected patients get Marcoumar and there is even the widely used term "Marcumarisierung" (marcoumarization)!

Historical reasons? Medical reasons? Influence of lobbyists?

Warfarin is the generic name here in the USA. The drug was patented by Dupont Chemicals under the name Coumadin many years ago. I am not familiar with Phenprocoumon, but since it has "coumon" in its name, I suspect it may be the same as warfarin(Coumadin). I have been on the drug since my surgery in 1967 and so far, no drug has been developed that does as well as warfarin. The warfarin brand I favor is manufactured by Taro, an Israeli company, although several other manufacturers sell the product in the USA. My answer to your question would be Medical reason.
 
I also take the generic warfarin brand Taro, but was on Coumadin for some years. To me there really is no difference. I would have to answer your question as to whether 'historical, medical or influence of lobbyists' as all of the above, however; I would think the medical reasoning would trump the others.
 
Wikipedia:
Phenprocoumon (marketed under the brand names Marcoumar, Marcumar and Falithrom) is an anticoagulant drug, a derivative of coumarin. It is a vitamin K antagonist that inhibits coagulation by blocking synthesis of coagulation factors II, VII, IX and X. It is used for the prophylaxis and treatment of thromboembolic disorders (thrombosis/pulmonary embolism).

Phenprocoumon inhibits vitamin K reductase.[1]

HemOnc Today:
http://www.hemonctoday.com/article.aspx?rid=41583
Hematology
Posted July 14, 2009
Warfarin anticoagulation superior to phenprocoumon


Treatment with warfarin led to better anticoagulant control compared with phenprocoumon, according to the results of a randomized controlled trial.


Answer: Coumadin/Warfarin works better.
 
I don't know much about Phenprocoumon, but from quick google, it looks like both Coumadin and Phenprocoumon are made from Coumarin. http://en.wikipedia.org/wiki/Coumarin
I also found this article from 2009 about a study that showed "Warfarin anticoagulation superior to phenprocoumon" http://www.hemonctoday.com/article.aspx?rid=41583 but it looks like that wasn't about which one worked better, but that patients on coumadin were in range more often than patients on phen.
This article had a sentence "Phenprocoumon (Liquamar, Organon) has been discontinued in the United States" but it doesn't say when or why, just that is was discontinued.
 
They don't appear to be very different, as far as the clotting factors they affect (see below from wikipedia on each). Also, something on the history of the name warfarin.


Phenprocoumon (marketed under the brand names Marcoumar, Marcumar and Falithrom) is an anticoagulant drug, a derivative of coumarin. It is a vitamin K antagonist that inhibits coagulation by blocking synthesis of coagulation factors II, VII, IX and X. It is used for the prophylaxis and treatment of thromboembolic disorders (thrombosis/pulmonary embolism).

Phenprocoumon inhibits vitamin K reductase.[1]

And

(on warfarin):

Warfarin inhibits the vitamin K-dependent synthesis of biologically active forms of the calcium-dependent clotting factors II, VII, IX and X, as well as the regulatory factors protein C, protein S, and protein Z.[2][26] Other proteins not involved in blood clotting, such as osteocalcin, or matrix Gla protein, may also be affected.




Warfarin is a synthetic derivative of dicoumarol, a 4-hydroxycoumarin-derived mycotoxin anticoagulant originally discovered in spoiled sweet clover-based animal feeds. Dicoumarol, in turn, is derived from coumarin, a sweet-smelling but coagulation-inactive chemical found naturally in sweet clover and many other plants. The name warfarin stems from its discovery at the University of Wisconsin, incorporating the acronym for the organization which funded the key research (WARF, for Wisconsin Alumni Research Foundation) and the ending -arin, indicating its link with coumarin.
 
"Phenprocoumon (Liquamar, Organon) has been discontinued in the United States" but it doesn't say when or why, just that is was discontinued.

Probably due to economic reasons, as Warfarin dominates the market...

My clever book here also says that Coumadin starts to have effect after 36-48 hr, while Marcoumar after 48-72 hr. (compare Bernardo / Halhuber: Gerinnungs-Selbstkontrolle leicht gemacht. Stuttgart, 1999).

So Warfarin possibly has some minor advantages. Still, company "Roche" dominates everything here and it is a one-stop solution with their Phenprocoumon-Marcoumar and the CoaguChek-device.

And as I am curious, another question:
What is price for 100 tablets Warfarin 3 mg? I had a quick search and it said
100 tablets $136.12.
So expensive? 100 tablets Marcoumar 3 mg are converted $27.75 here (a fixed price). At a 1st glance looks much cheaper!
 
My doctor prescribes name brand Coumadin for me for the past 5 years. No problems at all and not expensive.
60 pills of 3 mg each cost $22.
For my testing supplies I deal with Roche Montreal and I receive friendly and superb service.
Grusse von Kanada. Meine Eltern sind von Hamburg !
 
And as I am curious, another question:
What is price for 100 tablets Warfarin 3 mg? I had a quick search and it said
100 tablets $136.12.
So expensive? 100 tablets Marcoumar 3 mg are converted $27.75 here (a fixed price). At a 1st glance looks much cheaper!

Several Pharmacies in the USA now offer special pricing on many Generic Drugs, including Warfarin.

Typical pricing is $4 (or 5) for 30 pills and $10 (or 12) for 90 pills.

'AL Capshaw'
 
"Typical pricing is $4 (or 5) for 30 pills and $10 (or 12) for 90 pills."
At which pharmacies in particular are these sort of prices available? I keep hearing about this but every time I ask at a pharmacy they are charging over $40 per 90. Yesterday at CVS they actually said $60/90 generic!
I've been buying online for $30/90 but I would rather buy local for 10 if that were possible.
 
"Typical pricing is $4 (or 5) for 30 pills and $10 (or 12) for 90 pills."
At which pharmacies in particular are these sort of prices available? I keep hearing about this but every time I ask at a pharmacy they are charging over $40 per 90. Yesterday at CVS they actually said $60/90 generic!
I've been buying online for $30/90 but I would rather buy local for 10 if that were possible.

Most of the big pharmacy chains in the USA agressively compete on many generic drugs. I have to tell the pharmacist that "I want the Walmart price" and I get it. Walmart seems to drive this market in Kentucky and you can currently buy any strength warfarin for $4/30 tabs, or $10/90 tabs at Walmart, CVS, Riteaid, Walgreens, etc., etc......but who knows what 2011 will bring.
 
Ahh.. thanks for that. I'll try mentioning Walmart next time I'm in and see what happens. Failing that, I'll just go to Walmart I guess.
 
Ahh.. thanks for that. I'll try mentioning Walmart next time I'm in and see what happens. Failing that, I'll just go to Walmart I guess.

The downside, in Kentucky, of going to Walmart is they dispense most of their meds in "punch-out cards" that are a pain in the A--. I really don't want to go to Walmart, 'cause my pharmacy dispenses in convenient bottles....I just threaten too go to Walmart.:tongue2::wink2:....and it works.:biggrin2:
 
I get the generic warfarin at the prices noted above ($4/30, $10/90) at my local Ralph's Pharmacy. (Ralphs is a Kroger market, so the pharmacy may be a Kroger pharmacy in other parts of the U.S.). Target and Walmart also sell generic warfarin at that price. (Here in California, the 5 mg is priced higher - it's $23 (or something) for 100 -- in that case, just get the 10 mg and break them in half).

Asking for the Walmart price is an interesting tactic - if I go to another pharmacy, I'll probably do that.

As far as Walmart dispensing the pills in little punch out packs - that's a real pain. The ones I get at Ralphs come in a bottle.

If you CAN'T get warfarin at these prices, you might consider buying them from India. Before I discovered the Ralphs Pharmacy an its generic pricing, I bought warfarin from an Indian pharmacy - alldaychemist.org (I hope I can say this - there doesn't seem to be a problem saying Ralphs or Walmart), for a few cents a pill. These came in the little punch out cards that Dick mentioned.

I wasn't sure I could absolutely trust that the pills were biologically equivalent to Coumadin I had been taking, so I tested my INR after switching and found no difference.

In Germany, with no local Ralphs Pharmacies, you might consider a foreign source (like the one I used) for less expensive warfarin. You may wind up paying more for the shipping than you do for the warfarin, so you may want to order a few hundred at a time to keep the cost per pill down. And, as noted above, it doesn't hurt to test your INR to make sure of the accuracy of the dosage - but, in my experience, this really wasn't necessary.
 
The downside, in Kentucky, of going to Walmart is they dispense most of their meds in "punch-out cards" that are a pain in the A--. I really don't want to go to Walmart, 'cause my pharmacy dispenses in convenient bottles....I just threaten too go to Walmart.:tongue2::wink2:....and it works.:biggrin2:
It may be your particular Walmart location that has warfarin in blister cards. I dislike those blister card dudes.
The Walmarts, Krogers, Costco, etc., that I've dealt with in Texas dispense tablets in traditional plastic bottles with child-proof caps (unless you request "adult" caps).
 
My dear friend,

I also live in a german-speaking country such as Austria, and the doctors have told me that in case I decide myself for an AVR with a mechanical valve, then I would have to take Marcoumar for the rest of my life. However, while researching, I found more information about Coumadin (Warfarin) than of Marcoumar; and also some research works where it says that Coumadin works a bit better than Marcoumar? I hope that Marcoumar has the same or better effects than Coumadin, and not the other way...

Regards!

Erik
 
My dear friend,

I also live in a german-speaking country such as Austria, and the doctors have told me that in case I decide myself for an AVR with a mechanical valve, then I would have to take Marcoumar for the rest of my life. However, while researching, I found more information about Coumadin (Warfarin) than of Marcoumar; and also some research works where it says that Coumadin works a bit better than Marcoumar? I hope that Marcoumar has the same or better effects than Coumadin, and not the other way...

Regards!

Erik

Hello Erik,
If you choose a mechanical valve, then the doctors will start you on the drug that they are familiar using and have available in your country.
In a country like Austria I would not worry about this.
Viel Gluck :)
 
Hello Erik,
If you choose a mechanical valve, then the doctors will start you on the drug that they are familiar using and have available in your country.
In a country like Austria I would not worry about this.
Viel Gluck :)


Thanks Bina! How are you doing btw with your mechanical valve? Works all fine? How old were you when you had this aortic valve replacement?
 
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