It was these three cases which lead the medicines agency in France to suspend the drug. Following France's action, the drug was suspended in Belgium by its Belgium distributor. Lodema is not available for sale in Canada. The Special Access Program of the Health Protection Branch, Health Canada does not allow patients to receive Coumarin as an emergency drug. Ointments and liniments applied to the skin appear to be less toxic, some studies suggesting that they have virtually no therapeutic affect.
Humans appear to metabolize coumarin differently than other species.
The long-term affects of this drug on the liver have not been determined. The rates of liver toxicity estimated to the numbers of people taking coumarin vary widely among researchers. Casley-Smith et al of the Lymphoedema Association of Australia have sponsored the production of Lodema through their association. The Association has supported seven trials, five of which have been reported, which involved 1106 patients over a 14.6 month period. They suggest that patients have their liver tested and the drug withdrawn if they develop signs of liver malfunction.