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<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE" /><meta name="citation_inbook_title" content="Drugs and Lactation Database (LactMed®) [Internet]" /><meta name="citation_title" content="Acenocoumarol" /><meta name="citation_publisher" content="National Institute of Child Health and Human Development" /><meta name="citation_date" content="2020/11/16" /><meta name="citation_pmid" content="30000568" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK501508/" /><meta name="citation_keywords" content="ACENOCOUMAROL" /><meta name="citation_keywords" content="Acenocoumarin" /><meta name="citation_keywords" content="Nicoumalone" /><meta name="citation_keywords" content="Nitrovarfarian" /><meta name="citation_keywords" content="Nitrowarfarin" /><meta name="citation_keywords" content="Nicumalon" /><meta name="citation_keywords" content="Sinthrome" /><meta name="citation_keywords" content="Sintrom" /><meta name="citation_keywords" content="Acenocumarol" /><meta name="citation_keywords" content="Syncoumar" /><meta name="citation_keywords" content="Sinkumar" /><meta name="citation_keywords" content="Syncumar" /><meta name="citation_keywords" content="Acenocoumarolum" /><meta name="citation_keywords" content="Sincoumar" /><meta name="citation_keywords" content="Sinthrom" /><meta name="citation_keywords" content="Ascumar" /><meta name="citation_keywords" content="Syntrom" /><meta name="citation_keywords" content="Zotil" /><meta name="citation_keywords" content="Acenokumarin" /><meta name="citation_keywords" content="Neositron" /><meta name="citation_keywords" content="Sintroma" /><meta name="citation_keywords" content="Acenocumarolo" /><meta name="citation_keywords" content="Acenocumarolum" /><meta name="citation_keywords" content="Trombostop" /><meta name="citation_keywords" content="Acitrom" /><meta name="citation_keywords" content="Acenokumarin [Czech]" /><meta name="citation_keywords" content="Acenocumarolo [DCIT]" /><meta name="citation_keywords" content="Acenocoumarolum [INN-Latin]" /><meta name="citation_keywords" content="152-72-7" /><meta name="citation_keywords" content="Nitrophenylacetylethyl-4-hydroxycoumarine" /><meta name="citation_keywords" content="UNII-I6WP63U32H" /><meta name="citation_keywords" content="Acenocoumarol [INN:BAN:NF]" /><meta name="citation_keywords" content="HSDB 3201" /><meta name="citation_keywords" content="EINECS 205-807-3" /><meta name="citation_keywords" content="I6WP63U32H" /><meta name="citation_keywords" content="G-23350" /><meta name="citation_keywords" content="3-(alpha-Acetonyl-4-nitrobenzyl)-4-hydroxycoumarin" /><meta name="citation_keywords" content="G 23350" /><meta name="citation_keywords" content="3-(alpha-Acetonyl-p-nitrobenzyl)-4-hydroxycoumarin" /><meta name="citation_keywords" content="G-23,350" /><meta name="citation_keywords" content="G23350" /><meta name="citation_keywords" content="3-(alpha-p-Nitrophenyl-beta-acetylethyl)-4-hydroxycoumarin" /><meta name="citation_keywords" content="3-(alpha-(p-Nitrophenol)-beta-acetylethyl)-4-hydroxycoumarin" /><meta name="citation_keywords" content="4-Hydroxy-3-(1-(4-nitrophenyl)-3-oxobutyl)-2H-1-benzopyran-2-one" /><meta name="citation_keywords" content="3-(alpha-(4'-Nitrophenyl)-beta-acetylethyl)-4-hydroxycoumarin" /><meta name="citation_keywords" content="2H-1-Benzopyran-2-one, 4-hydroxy-3-(1-(4-nitrophenyl)-3-oxobutyl)-" /><meta name="citation_keywords" content="Coumarin, 3-(alpha-acetonyl-p-nitrobenzyl)-4-hydroxy-" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Acenocoumarol" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="National Institute of Child Health and Human Development" /><meta name="DC.Date" content="2020/11/16" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK501508/" /><meta name="description" content="Acenocoumarol is not approved for marketing in the United States by the U.S. Food and Drug Administration, but is available in Canada and other countries. Because of the low levels of acenocoumarol in breastmilk, amounts ingested by the infant are small. No changes in coagulation measurements or adverse reactions in breastfed infants have been reported from maternal acenocoumarol use during lactation. There is a consensus that maternal acenocoumarol therapy during breastfeeding poses little risk to the breastfed infant.[1-3] No special precautions are necessary." /><meta name="og:title" content="Acenocoumarol" /><meta name="og:type" content="book" /><meta name="og:description" content="Acenocoumarol is not approved for marketing in the United States by the U.S. Food and Drug Administration, but is available in Canada and other countries. Because of the low levels of acenocoumarol in breastmilk, amounts ingested by the infant are small. No changes in coagulation measurements or adverse reactions in breastfed infants have been reported from maternal acenocoumarol use during lactation. There is a consensus that maternal acenocoumarol therapy during breastfeeding poses little risk to the breastfed infant.[1-3] No special precautions are necessary." /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK501508/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-lactmed-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="bk-non-canon-loc" content="/books/n/lactmed/LM619/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK501508/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} </style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/book-toc.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script>
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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. </p></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK501508_"><span class="title" itemprop="name">Acenocoumarol</span></h1><p class="small">Last Revision: <span itemprop="dateModified">November 16, 2020</span>.</p><p><em>Estimated reading time: 2 minutes</em></p></div><div class="body-content whole_rhythm" itemprop="text"><p>CASRN: 152-72-7</p><a href="https://pubchem.ncbi.nlm.nih.gov/substance/135269912" title="View this structure in PubChem" class="img_link" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem"><img src="https://pubchem.ncbi.nlm.nih.gov/image/imgsrv.fcgi?t=l&sid=135269912" alt="image 135269912 in the ncbi pubchem database" /></a><div id="LM619.Drug_Levels_and_Effects"><h2 id="_LM619_Drug_Levels_and_Effects_">Drug Levels and Effects</h2><div id="LM619.Summary_of_Use_during_Lactation"><h3>Summary of Use during Lactation</h3><p>Acenocoumarol is not approved for marketing in the United States by the U.S. Food and Drug Administration, but is available in Canada and other countries. Because of the low levels of acenocoumarol in breastmilk, amounts ingested by the infant are small. No changes in coagulation measurements or adverse reactions in breastfed infants have been reported from maternal acenocoumarol use during lactation. There is a consensus that maternal acenocoumarol therapy during breastfeeding poses little risk to the breastfed infant.[<a class="bk_pop" href="#LM619.REF.1">1</a>-<a class="bk_pop" href="#LM619.REF.3">3</a>] No special precautions are necessary.</p></div><div id="LM619.Drug_Levels"><h3>Drug Levels</h3><p><i>Maternal Levels.</i> Twenty women were anticoagulated with oral acenocoumarol starting on the first day postpartum with 4 mg, followed by 2 mg daily for 2 days, then adjusted individually based on prothrombin time. After at least 5 days of therapy, milk samples were obtained before and at 1, 4, 7, and 10 hours after the dose. No breastmilk sample had acenocoumarol detected by HPLC assay (lower limit not stated).[<a class="bk_pop" href="#LM619.REF.1">1</a>]</p><p>Sixteen patients who required anticoagulation immediately postpartum were given acenocoumarol in a dosage according to their clinical need. Two had their dosage titrated to an international normalized ratio (INR) between 1.5 and 1.9, nine were titrated to an INR between 2.0 and 2.5, and 4 were titrated to an INR between 2.6 and 3.5. Milk samples were analyzed for acenocoumarol on days 5, 15, 30 and 45 postpartum. On days 5 and 15 postpartum, acenocoumarol was detectable in only 4 patients at a concentration of 10 mcg/L. On days 30 and 45 postpartum, the average acenocoumarol concentrations in milk from all mothers were 11 and 12 mcg/L, respectively. On these latter days, the average dosage that an exclusively breastfed infant would receive would be about 1.6 and 1.8 mcg/kg daily, respectively, which is far below anticoagulant doses reported in the literature for infants.[<a class="bk_pop" href="#LM619.REF.4">4</a>]</p><p><i>Infant Levels.</i> Relevant published information was not found as of the revision date.</p></div><div id="LM619.Effects_in_Breastfed_Infants"><h3>Effects in Breastfed Infants</h3><p>Nineteen infants were breastfed (extent not stated) while their mothers were anticoagulated with acenocoumarol immediately postpartum. Despite not receiving prophylactic vitamin K at birth, none of the infants had abnormal blood clotting as measured by the Thrombotest after at least 5 days of maternal therapy.[<a class="bk_pop" href="#LM619.REF.1">1</a>]</p><p>Seven infants were exclusively breastfed by mothers who were receiving long-term anticoagulation with acenocoumarol for thromboprophylaxis following heart valve replacement. All women were therapeutically anticoagulated and receiving an average of 21 mg of acenocoumarol per week (range 12 to 45 mg per week). Each infant received 1 mg of vitamin K prophylactically at birth and had their prothrombin time measured after at least 7 days of breastfeeding. The prothrombin times of the infants was not different from those of a control group of 42 breastfed infants whose mothers were not anticoagulated. No instances of bleeding were reported.[<a class="bk_pop" href="#LM619.REF.5">5</a>]</p></div><div id="LM619.Effects_on_Lactation_and_Breastmil"><h3>Effects on Lactation and Breastmilk</h3><p>Relevant published information was not found as of the revision date.</p></div><div id="LM619.Alternate_Drugs_to_Consider"><h3>Alternate Drugs to Consider</h3><p><a href="/books/NBK501508/">Acenocoumarol</a>, <a href="/books/n/lactmed/LM80/">Dalteparin</a>, <a href="/books/n/lactmed/LM104/">Enoxaparin</a>, <a href="/books/n/lactmed/LM133/">Heparin</a>, <a href="/books/n/lactmed/LM1169/">Rivaroxaban</a>, <a href="/books/n/lactmed/LM279/">Warfarin</a></p></div><div id="LM619.References"><h3>References</h3><dl class="temp-labeled-list"><dt>1.</dt><dd><div class="bk_ref" id="LM619.REF.1">Houwert-de Jong M, Gerards LJ, Tetteroo-Tempelman CAM, et al. May mothers taking acenocoumarol breast feed their infants? <span><span class="ref-journal">Eur J Clin Pharmacol. </span>1981;<span class="ref-vol">21</span>:61–4.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/7333347" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7333347</span></a>]</div></dd><dt>2.</dt><dd><div class="bk_ref" id="LM619.REF.2">Clark SL, Porter TF, West FG. Coumarin derivatives and breast-feeding. <span><span class="ref-journal">Obstet Gynecol. </span>2000;<span class="ref-vol">95</span>(6 Pt. 1):938–40.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/10831996" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10831996</span></a>]</div></dd><dt>3.</dt><dd><div class="bk_ref" id="LM619.REF.3">Bates SM, Rajasekhar A, Middeldorp S, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: Venous thromboembolism in the context of pregnancy. <span><span class="ref-journal">Blood Adv. </span>2018;<span class="ref-vol">2</span>:3317–59.</span> [<a href="/pmc/articles/PMC6258928/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6258928</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30482767" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30482767</span></a>]</div></dd><dt>4.</dt><dd><div class="bk_ref" id="LM619.REF.4">Nava LE, Gómez AB, González VM. <span><span class="ref-journal">Ginecol Obstet Mex. </span>2004;<span class="ref-vol">72</span>:550–60.</span> [Plasma and milk concentrations of acenocoumarin in breast-feeding women during post partum] [<a href="https://pubmed.ncbi.nlm.nih.gov/15986763" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15986763</span></a>]</div></dd><dt>5.</dt><dd><div class="bk_ref" id="LM619.REF.5">Fondevila CG, Meschengieser S, Blanco A, et al. Effect of acenocoumarine on the breast-fed infant. <span><span class="ref-journal">Thromb Res. </span>1989;<span class="ref-vol">56</span>:29–36.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/2595672" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2595672</span></a>]</div></dd></dl></div></div><div id="LM619.Substance_Identification"><h2 id="_LM619_Substance_Identification_">Substance Identification</h2><div id="LM619.Substance_Name"><h3>Substance Name</h3><p>Acenocoumarol</p></div><div id="LM619.CAS_Registry_Number"><h3>CAS Registry Number</h3><p>152-72-7</p></div><div id="LM619.Drug_Class"><h3>Drug Class</h3><p>Breast Feeding</p><p>Lactation</p><p>Anticoagulants</p></div></div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_top_margin"><p><b>Disclaimer: </b>Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.</p></p></div></dd></dl></div><div id="bk_toc_contnr"></div></div></div>
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