INESSS’s Position (07-05-2020)

Based on the scientific literature available when preparing the report and on the various consultations carried out, and despite a very quick review process, INESSS finds that:

  • There should not be any particular clinical issues in substituting Coumadin® with a generic version of warfarin. Section 21 of the Pharmacy Act shall apply. Therefore:
    • Depending on inventory availability, substituting Coumadin® with a generic version of warfarin will be done by the pharmacist when renewing a patient’s prescription.
    • The patient will be informed of the switch and the reasons for doing so, and that the generic version of warfarin is just as safe and effective as Coumadin®.
    • There is no need for the prescriber to see the patient for an additional visit or to be informed of this switch unless the pharmacist considers it to be useful.
  • Substituting Coumadin® with a generic version of warfarin should not have any significant impact on laboratory testing.
    • This substitution does not require closer or more frequent international normalized ratio (INR) monitoring, unless there is a specific clinical situation:
      • Patient with unstable and highly variable INR.
      • Patient at high risk (thromboembolic event or bleeding).

Link to Report

Impact of substituting Coumadin lab test results (in French)

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