Warfarin 7mg Tablet Availability
No, Coumadin (warfarin) does not come in a 7mg tablet formulation. The available tablet strengths require combining multiple tablets to achieve a 7mg dose.
Available Tablet Strengths
The standard warfarin/Coumadin tablet strengths available are:
- 1 mg
- 2 mg
- 2.5 mg
- 3 mg
- 4 mg
- 5 mg
- 6 mg
- 7.5 mg
- 10 mg 1
Achieving a 7mg Dose
To prescribe 7mg of warfarin, you must combine tablets, such as:
- One 5mg tablet + one 2mg tablet
- One 4mg tablet + one 3mg tablet
- Two 3mg tablets + one 1mg tablet
The European Society of Cardiology guidelines reference standard maintenance doses of 5mg daily for warfarin, 3mg daily for acenocoumarol, and 20mg daily for fluindione, but do not mention a 7mg formulation 2.
Clinical Dosing Considerations
When initiating warfarin therapy, the American College of Cardiology recommends starting with 5mg daily (or 2-4mg in elderly patients) rather than loading doses 3, 1. The maintenance dose varies widely among individuals, ranging from 0.5mg to 14mg daily based on individual response 4.
For outpatients requiring faster therapeutic anticoagulation, a 10mg loading approach for the first 2 days achieves therapeutic INR faster than 5mg initiation (86% vs 45% by day 5), though this must be balanced against bleeding risk 3.
The target INR for most indications is 2.0-3.0, with mechanical prosthetic valves potentially requiring 2.5-3.5 or 3.0-4.0 3, 2. European guidelines specifically note that warfarin doses ≤5mg per day are associated with lower embryopathy risk in pregnant patients with mechanical valves 2.
Practical Prescribing Approach
When a patient requires 7mg daily:
- Prescribe the tablet combination that minimizes pill burden (e.g., 5mg + 2mg is simpler than multiple smaller tablets) 1
- Ensure patients understand which tablets to take to avoid dosing errors
- Monitor INR closely during dose adjustments, checking 2-4 times weekly initially, then extending to every 4 weeks once stable 3, 2
Generic warfarin formulations are interchangeable with brand-name Coumadin without differences in INR control or dosage adjustment requirements 5.