Last update Dec. 7, 2022



Safe substance and/or breastfeeding is the best option.

Coumarin-type anticoagulant drug vitamin K antagonist with actions similar to those of warfarin used for the treatment and prophylaxis of thromboembolic disorders. It works by depressing the hepatic synthesis of vitamin K-dependent coagulation factors.Oral administration. 

Its high plasma protein-binding capacity would explain the very low excretion observed into breast milk. (Houwert-de Jong 1981, Nava 2004)

No clinical side-effects and/or blood test disarrangements were observed in infants whose mothers were treated with acenocoumarol. (Houwert-de Jong 1981, Fondevila 1989)

Several medical societies and experts authors consider the use of this medication to be safe or very probably safe during breastfeeding. (Bates 2018, 2012 & 1997, Middeldorp 2011, Clark 2000, Olthof 1993)


We do not have alternatives for (RS)-4-Hydroxy-3-[1-(4-nitrophenyl)-3-oxobutyl]coumarin since it is relatively safe.

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

(RS)-4-Hydroxy-3-[1-(4-nitrophenyl)-3-oxobutyl]coumarin is Acenocoumarol in Chemical name.

Is written in other languages:

(RS)-4-Hydroxy-3-[1-(4-nitrophenyl)-3-oxobutyl]coumarin is also known as


(RS)-4-Hydroxy-3-[1-(4-nitrophenyl)-3-oxobutyl]coumarin belongs to this group or family:


Main tradenames from several countries containing (RS)-4-Hydroxy-3-[1-(4-nitrophenyl)-3-oxobutyl]coumarin in its composition:


Variable Value Unit
Oral Bioavail. 60 %
Molecular weight 353 daltons
Protein Binding 99 %
VD 0.08 l/Kg
pKa 5.09 -
Tmax 1 - 3 hours
8 - 11 hours
Theoretical Dose 0.002 mg/Kg/d
Relative Dose 1 %


  1. Bates SM, Rajasekhar A, Middeldorp S, McLintock C, Rodger MA, James AH, Vazquez SR, Greer IA, Riva JJ, Bhatt M, Schwab N, Barrett D, LaHaye A, Rochwerg B. American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy. Blood Adv. 2018 Nov 27;2(22):3317-3359. Abstract Full text (link to original source)
  2. Bates SM, Greer IA, Middeldorp S, Veenstra DL, Prabulos AM, Vandvik PO; American College of Chest Physicians. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e691S-e736S. Abstract Full text (link to original source) Full text (in our servers)
  3. Middeldorp S. How I treat pregnancy-related venous thromboembolism. Blood. 2011 Abstract Full text (link to original source) Full text (in our servers)
  4. Nava LE, Gómez AB, González VM. [Plasma and milk concentrations of acenocoumarin in breast-feeding women during post partum]. Ginecol Obstet Mex. 2004 Abstract
  5. Bates SM, Ginsberg JS. Anticoagulants in pregnancy: fetal effects. Baillieres Clin Obstet Gynaecol. 1997 Abstract
  6. Olthof E, de Vries TW. [Breast feeding and oral anticoagulants]. Tijdschr Kindergeneeskd. 1993 Abstract
  7. Fondevila CG, Meschengieser S, Blanco A, Peñalva L, Lazzari MA. Effect of acenocoumarine on the breast-fed infant. Thromb Res. 1989 Abstract
  8. Houwert-de Jong M, Gerards LJ, Tetteroo-Tempelman CA, de Wolff FA. May mothers taking acenocoumarol breast feed their infants? Eur J Clin Pharmacol. 1981 Abstract

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