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).
- This substitution does not require closer or more frequent international normalized ratio (INR) monitoring, unless there is a specific clinical situation:
Link to Report
Impact of substituting Coumadin lab test results (in French)
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