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Sutro
December 26th, 2001, 02:22 PM
First cardiologist tells me not to take aspirin, take Motrin, writes me a prescription for it in industrial strength. I take it a few times, it works. Next cardiologist tells me that I'm very lucky - Coumadin patients should never take Motrin. I should take Tylenol instead. Take it (2 X 500mg) a couple of times, helps with pain but my INR spikes to 11 and there's blood in my urine so I stop. I know that's only supposed to happen with long-term use, but I guess I'm just lucky.

So far only pain med with no problems is Vicodin, but docs treat you like a junkie if you ask for it and especially if you ask for a refill, hate to go snivelling to the doc for a 'script every time I've got an owie, anyway, and that stuff's so constipating I can't take it for more than a few days, anyway.

Waah! Before I went under the knife (St. Jude's replacement for mitral valve) I never had to fuss with doctors and meds and all that nonsense and had never caught myself whining with health complaints.

What pain killers have folks found work with Coumadin? I suspect that the only one without Coumadin interactions and without having to deal with suspicious physicians would be scoring some heroin on the street, and that doesn't sound like a real bright idea.

RobThatsMe
December 26th, 2001, 04:24 PM
Hi Sutro,

I believe your 2nd doctor was correct. Only Tylenol with Coumadin. Actually, any non-aspirin based pain killer will be OK.

My cardiologist also mentioned Tylenol when taken with some caffine, (Coffee), will act much like Excedrin.

There are also some prescription meds that have Tylenol as a base. You may ask for some of those. Who cares if they think you are a druggie. Just think of youself as an Over-the Counter Drug Challanged Patient. hehehehe..

I am on an enteric (coated Aspirin) and Coumadin daily routine. I think that helps me with my headaches and other pains.

Wishing you good health.

Rob

Nancy
December 26th, 2001, 05:12 PM
Hi Sutro-

My husband Joe has been on Coumadin for 24 years and the only painkiller OTC that he can take is Tylenol. Everything else interferes with the INR, as you have already found out.

By the way, welcome to the site. It's wonderful, with so many understanding and knowledgeable people who really can relate to what you're saying.

LUVMyBirman
December 26th, 2001, 05:23 PM
Hi and welcome

My doctor believes in pain management. If you are taking the medication just when needed for the pain.... that doesn't make you a drug addict.

I take my pain meds when needed and life is much better. Darvocet and Vicodin "do not" have an effect on the INR.

Straight Tylenol never worked for me. I could take 3-4 tabs at once and nothing. Motrin and other NAIDS are a no no.

Sutro
December 27th, 2001, 08:53 AM
Thanks to all for the responses above!

Alas, sounds like I'm pretty much stuck where I thought I was: NSAIDS are out, Tylenol is OK except for long-term use but my body doesn't seem to know that (scared myself half to death when I started peeing blood). That pretty much just leaves narcotics like Darvocet, Vicodin, and Percocet.

Thankfully I don't care for narcotics all that much, so they're pretty safe for me to take.

Somewhat in defense of the docs, as much as they annoy the heck out of me, they really are in a bad position when it comes to narcotics. Thanks to the so-called War on Drugs, they've got the DEA looking over their shoulders, ready to pursue criminal charges and license revocation if they don't abide by the under-prescribing standards of care established by law-enforcement officers with no medical training. Between the Feds and the constraints of managed care systems, it seems that the docs have to spend more time abiding by guidelines than practicing medicine.

Thankfully I don't have chronic pain, although if I did it sounds like I could consistently take an aspirin/Coumadin combo that produced the proper INR.

This board is wonderful, and copious thanks to those who established it!

allodwick
December 28th, 2001, 09:10 PM
The -cet in Darvocet and Percocet stands for acetaminophen which is the only ingredient in Tylenol. So if Tylenol affected you to cause an INR of greater than 11, then you might have problems with these. Acetaminophen is in Vicodin also.
Most people on warfarin can take either Celebrex or Vioxx without much problem. There have been a few reports of problems, but RARELY have they been serious enough to cause hospitalization. I have been paid by the Celebrex people to give talks to groups of doctors. You could say that the money clouded my judgement or you could say that I had to know what I was talking about to stand up there and take questions from them. Take your pick.
On the Tylenol issue, the real definitive study on this was done by Dr. Elaine Hylek. Her finding was that if you took more than about 19 Extra-Strength Tylenol in one week, then you had a higher chance than usual of having an INR of greater than 6. She was widely misquoted in the press and on CNN. I talked to her about this and she said that she would never again give an interview on tape, because they so distorted what she said. She also confirmed that what I have on my website at www.warfarinfo.com/acetaminophen.htm is accurate.
What I would be interested in knowing is how well regulated were you when the Tylenol caused the INR of 11? Were you on the same warfarin dose for many months? There is a long check list that I go over with my patients if the have a high INR. If you wish to provide details, I would be willing to go into this farther with you.
You might also be interested in www.warfarinfo.com/ibuprofen.htm
It might be a few days before I reply. I'm leaving town until New Years Day. Then it may take a few days to catch up with all of the e-mail. I'm going to close the year with about 75,000 visitors to my website during 2001, so I get quite a volume of e-mail.

Sutro
January 8th, 2002, 02:23 PM
So warfarinfo.com is you, Allodwick? That's a pretty good site - I had stumpled across it in the course of surfing the 'Net looking for info. Congrats!

My INR's have been consistently unstable, driving me nuts. I've been a very good boy, watching my diet, avoiding booze, complying with med regimen, switched to brand-name Coumadin when I read that it was somewhat less likely to produce unstable INR's. But by "unstable" I mean range from 2.0 to 5.0 or so, so I was astonished when it shot up to 11. Since this has happened only once, and then immediately after taking Tylenol, I'd have to do repeated trials with the Tylenol to determine for a fact that that's what caused the spike. But I'm too afraid of going through disgusting high-INR unpleasantness again to do a repeat trial to figure out whetherattributing it to Tylenol is a "post hoc ergo proper hoc" fallacy or not.

Thanks for the leads on Celebrex and Vioxx.

Zipper
January 8th, 2002, 09:10 PM
Hi,

I recently had to take Vioxx for inflamation of trapezoids. My Doc said ok IF I had PT/INR checked in one week. I did ...and two weeks in a row my level went LOW...down to 2.1 and 2.3. As I am told to keep it between 2.5 and 3.5, I stopped the Vioxx and it returned to normal. I found taking a Tylenol #3 and an extra strength tylenol eased the discomfort without affecting my level.

Is this a usual reaction, or is it just me ??? Appreciate any responses.

Thanx,

Zipper *~*

Nancy
January 9th, 2002, 05:09 AM
My husband Joe took Vioxx and it interfered with Coumadin and also with Lasix. It was a bad deal for him. Caused serious CHF symptoms. He gained 10 pounds in 3 days. He went off it almost immediately.

It had been prescribed by his pcp. When discussing this with his cardiologist, the cardiologist said that if he really needed Vioxx for pain, he would have adjusted the Coumadin level and Lasix to accommodate the interactions.

Well, anyway, I don't think he'll be using it in the near future.

I must say though, that millions of people use it with no problems.

allodwick
January 9th, 2002, 05:15 AM
I think it was just you, Zipper.

Nancy, got it right when she said that millions of people take it without any problems. But when millions take it there are bound to be some problems.

It is only 6:13 AMand this is the second time I've dealth with this question this morning, so you get an idea that a lot of people are interested.

Zipper
January 10th, 2002, 09:04 PM
Hi Nancy and allod??? (sorry..too long to remember :>)

Thank you so much for your responses...I had aproblem due to the ER/ED Doc wanting me to take an anti-inflamatory and my Cardio says NOOOO...then PCP says take Vioxx..will not upset INR...called Cardio..he said..."well--ok..but..we will monitor it closely".. As usual ..I go against "the usual" and my INR drops...as it does with antibiotics...So I stopped it in fear of clotting...ended up just doing excercises and taking pain pills (in moderation as much as possible) and eventually worked it out.

It's a problem for me, tho, as I have a UN-ergomomical workplace (albeit I work in a hospital!lol!) and the trapezoids constantly flare. I prefer pain pills to increased coumadin (aka..rat poison) dosage. Any thoughts welcome...

Thanx..you guys are Gr8...

Zipper/Joan *~*

allodwick
January 11th, 2002, 05:06 AM
Pain pills do not "cure" anything. If you can make it without them, then you have less chances of interactions etc.

Zipper
January 11th, 2002, 10:42 AM
Well, I certainly agree...that's a no brainer for sure. I hope I did not offend anyone by stating my reaction to Vioxx. Very sorry if I did.

Zipper

Sutro
January 11th, 2002, 11:11 AM
Zipper, if folks take offense at reports of drug interactions we'll just have to start a new thread on what antipsychotic meds are best to take with Coumadin.

Gail in Ca
February 9th, 2002, 07:45 PM
I have used darvocet with good results after surgery.
If I need to take something for pain due to cramps I am allowed to take one dose of aleve or motrin, so said my cardio. I have actually taken two doses but a day apart with no increase in inr to the out of range.
Gail

allodwick
February 9th, 2002, 08:06 PM
Alleve and Motrin work on the platelet portion of clotting. So, they do not affect the INR. Their danger is that they will cause an gastrointestinal bleed. This happens without warning.

I know this will touch off a number of people who say that their INR went up when they took one of these with warfarin. However, it is more likely that the INR went up because they were in pain and were not as active as they previously were. Inactivity slows warfarin metabolism thereby raising the INR.

Lisa in Katy
February 10th, 2002, 11:24 PM
When I had pericarditis, I was taking Vicodin as often as possible with Tylenol in between. My INR spiked, but it may have been the pericarditis and it may have been the necessary overdosing with Tylenol, so hard to say. However, Vicodin contains 500 mg of Tylenol, so it should affect you the same way.

Thankfully, Vioxx was put on the market because I've had no problems with it. I took it for the last few flareups of pericarditis, up to 2 weeks in a row, so I swear by it. In fact, I call it my miracle drug!

Zipper
February 10th, 2002, 11:35 PM
I find it very interesting that we all vary in our reactions to anti-inflamatories/antibiotics/pain meds. I differ from you in that my INR changed on Vioxx but with Tylenol and even Tylenol #3 I remain stable.

Has anyone done/or know of studies that would help us understand this ?

All I know is that I try to keep my Coumadin level low and consistant..don't want to do anything that will 'up' my dosage.

Sure do miss my green salads tho..LOL!

This site is such a great resource..THANKS HANK!!!

Zipper *~*

Zipper
February 10th, 2002, 11:47 PM
Sorry..to disagree..my Cardiologist would never agree to my taking Alleve or Motrin....anti-inflamatories as well DO generally affect the INR and have to be closely monitored if a real necessity arises.

Folks...please be careful...Vioxx and Celebrex can be GREAT when needed...but I stress the fact that the INR CAN be compromised!!!!Be sure your Cardiologist...not your PCP...is aware of any of these and follow his/her recommendations. I'm really stating this from my own personal knowledge.

Zipper *~*

Perrster
February 11th, 2002, 04:35 AM
Sutro,

Welcome to the HIGH-MAINTENANCE club! This exclusive worldwide conglomeration of medical miracles is for all sexes.

I too, had nothing to do with modern medicine (never saw a doc for 30 years!) until having valve replacement. Now, I must call the doc anytime I think there's something weird or strange going on. Luckily, it hasn't been too often.

How long ago was you surgery?

Anyway, just keep whining as it can only mean that you are taking control of your situation. Unfortunately, you have to follow the "rules of a Coumadin lifestyle." There are many no-no's relative to being on this drug.

Hang tough.

Cheers!

allodwick
February 11th, 2002, 04:52 AM
Don't just depend on a person's title to decide whether they know what they are doing (ie cardiologist vs PCP). I've had cardiologists tell me that they want nothing to do with warfarin. That it should be managed by the PCP.
"I didn't do all this schooling and specialty training to wind up dosing Coumadin. That is the primary doc's job."

Marty
February 11th, 2002, 07:07 AM
I have found that many of my fellow MD's have little knowledge and even less interest in managing warfarin.
This includes PCP's, cardiologists, heart surgeons.etc. They often leave it up to their office nurse or lab tech which can be OK or not so good. At Kaiser where I now practise, the pharmacists, like Al ,run the program and do it very well.

allodwick
February 16th, 2002, 07:19 AM
The reason we get good at it is that we do so many. Monitoring warfarin is all that I have done for the past 4.5 years. I have seen about 12,000 patient visits. If a physician saw two patients on warfarin a day for 250 days per year they would have to have 25 years experience to have seen as many warfarin patients as I have. If I was not doing a good job, then the doctors would soon quit sending patients to me and I'd be back working rotating shifts.

LUVMyBirman
February 16th, 2002, 07:40 AM
Hi Al

If you don't mind me asking....what is your usual protocol when a patient has an out of range higher end INR, say 4.5+?

Thank you

allodwick
February 16th, 2002, 02:45 PM
This is why I don't like computer programs for dosing, I try to treat each case on an individual basis. I had the statistician at out medical center look at over 2,500 patient visits. We broke the INRs down into three categories. Group 1 was INRs of 1.0 to 3.5. (Everybody in, or below a therapeutic range recommeded by the Chest Physicians guidelines). The next group was 3.6 to 5.0 (slightly elevated and below where the Chest Physicians recommends giving any treatment). The last group was all INRs above 5.0. At every visit I ask people if they had any bleeding problems. Almost every problem was a bloody nose. Group 1 and Group 2. reported bloody noses at the same rate. Group 3 reported bloody noses at a higher rate. So we concluded that people who have an INR of 5.0 or less and who get their INR checked about monthly had no higher risk of bleeding than if their INR was at any number less than 5.0. (I presented this at the Anticoagulation Forum meeting in Washington DC in May 2001 and it was published in the journal Thrombosis and Thrombolysis.)

With this background, I'll get to the answer to your question. If the person has been taking a steady dose of warfarin and keeping their INR in ranges for six months or so and then suddenly has an INR of 4 to 5, and reports no problem, I'll try to find out why. But, in the majority of cases, you cannot find an answer. (I suspect that taking an extra dose because people forget they already took one is fairly common.) So in this case I will have them hold one warfarin dose and resume the same dose and check them again in about 4 weeks. If it is still elevated in four weeks, and there is still no problem, I'll do one of two things, either the same thing that I did the month before or I'll reduce their warfarin dose by the equivalent on one day's dose of warfarin per week. (If they are taking 5 mg/day [35 mg/wk] reduce it by 5 mg to 30 mg/wk.) Only 7.6% of people reported minor bleeding in this group, so it is hard for me to get excited about an INR of 4.5

I also reported in my study that we live at 4,700 feet elevation in one of the driest places in the United States. We receive less than 12 inches of moisture per year (often 4 inches will come in less than one hour) and the humidity is often less than 10%. This causes a lot of cracking of the nasal passages.

One other thing that has to be considered is the reason for taking warfarin. If someone has lupus anticoagulant, the INR reading is often falsely elevated. I have two women patients with this. If their INR ever drops below 2.0 they are in the hospital with blood clots in their legs, sometimes going to their lungs. They are both quite happy to keep their INR in the 4 to 5 range. They will trade a bloody nose for a clot any day of the week.

So the answer is that I do not have a protocol. I try to treat each person as an individual. I also give them my reasoning for the decision. If they disagree, we try to reach a compromise.

Zipper
February 16th, 2002, 02:59 PM
It sure sounds like you do a terrific job for your patients and are very knowledgeable.

My Cardiologist does monitor mine, and I'm thankful that he does. To my knowledge we don't have anyone like you in my area that has the expertise, so prefer my Cardiologist to my PCP for monitoring.

Thanks for all the great info you are giving us!!!

Zipper *~*

LUVMyBirman
February 16th, 2002, 04:38 PM
Thank you Al for you response. Wish there were more individuals out there like you. As we know... Coumadin is very individualized.

My cardiologist still can't believe that when holding one day.... I hit rock bottom.

What works for me is cutting my dose in half for one day with reading 4.0 - 5.5. Resuming my regular dose if I was within range for my last few tests. If not, decrease 10% for the next week. 5.5 - 6.5, subtract 4 mg from my daily intake. Anything higher than that and I would be calling it in.

allodwick
February 16th, 2002, 05:58 PM
Gina, didn't you say that you take 20 mg/day. That is another individual thing that I did not mention. If you take more than about 10 mg/day, you are a rapid metabolizer of warfarin. That is why you need such a big dose. Usually the INR will decline by about half over 48 hours. But anyone who takes more than about 10 mg/day will probably metabolize warfarin rapidly enough that it will only take about 24 hours to clear it from the body. The largest dose of warfarin ever reported was 660 mg/day. That is correct 66 of the 10 mg tablets daily!!! There is a guy in this area, not my patient, who takes over 100 mg daily. The biggest reported at my clinic is 25 mg/day, but I kind of don't believe that he takes it every day. He is a cowboy who has hepatitis C, so I think he takes some other stuff out there with the livestock, and I not referring to locoweed. Around here locoweed is Datura stramonium not Cannabis sativa!!

Zipper, If you want to know if there is a clinic similar to mine in your area, look at our professional organization's website www.acforum.org and click on clinic locations.

LUVMyBirman
February 16th, 2002, 06:40 PM
Hi Al

I am a straight 6-1/2 mg a day. At times 6mg straight.
Recall reading....over 5mg a day would be considered fast matabolizer, correct?

Can add greens by upping 1mg-2mg for the week. Iceburg Lettuce Salad, occasional asparagus and broccoli. By this, I am able to enjoy these veggies 3-4 times weekly.

Zipper
February 16th, 2002, 10:26 PM
Thanks Al, I did check that site and found several clinics here in the Bay Area in California. Since they are Stanford, Kaiser, Veterans, and S.M Co. General they are not ones I could use.

Since I work for a hospital and am insured through them..I must stay with 'the program' in order to be covered. I work for CHW..it's connected with the San Francisco Heart Institute as is my cardiologist and surgeon. I do thank you so much, tho for the information.

For both you and Gina...As she referred to changing dosage in order to eat some 'greens', it brought another question to mind. I dearly miss my salads, and the only time I indulge is when dining out or having company in. At these times, I normally will have wine with dinner. I have not experienced any change in INR at these times....Does this indicate, in any way, that the wine may offset the greens ??? I do not intend to encourage consumption of wine at all...it just brought up a question in my mind. I also will state that this an infrequent occurance and therefore could very well be why no change occurs. Hmmm..just curious...

Thanks again,

Zipper *~*

allodwick
February 17th, 2002, 08:01 AM
I doubt that one salad and one glass of wine would have any significant effect on the INR.

I tell my patients that there is no need to avoid green vegetables. I have they eat what they like and adjust the warfarin dose around it. I think that most people eat about the same amount of vegetables over the course of a week. Since I dose warfarin on a weekly basis, I don't find that there is anything significant happening. What I do say is that if you go out to dinner and really pig out on the salad bar, then eat corn, cauliflower or something else low in vitamin K the next day and it will all iron out.

Remember that the INR guidelines are just that, guidelines. They are not absolutes. It does not mean that if you stray out of the line by 0.1 units for one hour that you will have a clot.

Zipper
February 17th, 2002, 02:51 PM
The reason I try not to eat too many greens is because I'd rather NOT have to up my dosage. I remain stable at 5mg daily. Prior to taking coumadin, I was a big salad eater..on a daily basis...that's why I miss it. Still, I prefer the occasional enjoyment of greens and keep my dosage as low as possible. I think many of us may do this, and still be properly nourished.

Zipper *~*

allodwick
February 17th, 2002, 04:23 PM
The main thing is to do things that you can live with.

LUVMyBirman
February 17th, 2002, 05:01 PM
Zipper....

I was pretty close to being a vegetarian before my MVR. So, needless to say the transition was difficult. For the first two years, wouldn't touch anything high in K. As time went on I discovered how to enjoy my salads without the fear of having an incident.

Home testing makes it so very convenient. I take a straight 6MG or 6-1/2 depending upon what I eat. The funny thing is.....that is how I would fluctuate without eating salads.

Al's theory about having a small salad here or there has to be right on. I also drink an occasional glass or two of wine, a few times a month. It does not seem to effect my levels.

Zipper
February 17th, 2002, 06:47 PM
Thank you Gina...I think if I had the home testing kit, I could experiment a bit and discover how I'd vary each time I had salad or two, or if indeed it wouldn't effect me. I guess it's the 'not knowing' that keeps me using caution that may not be needed.

My insurance company denied payment for home testing...so I'm hoping the price will eventually lower or I can buy one soon.

Zipper *~*

LUVMyBirman
February 17th, 2002, 06:56 PM
Hi Zipper

"I guess it's the 'not knowing' that keeps me using caution that may not be needed".

I hear you. Was very much a skeptic, cautious, etc when I could not experiment. Do hope more insurance companies start recognizing the 'savings' with patient home testing!

In my case, my provider covered my unit purchase but refused to pay for supplies, not even a portion. Ridiculous, huh? One box of strips runs me $90, 12 tests. One visit to the lab costs them exactly $90. Hummmm? Seems like a no brainier.

Have given up my battel as we have changed carriers and they don't cover a thing. Anyone know if Medicare finally approved INR home test units?

merryreader
February 21st, 2002, 09:05 AM
Hello. This is my first post. I'm in the process of trying to obtain a at home Inr test unit. Holy smokes!! you would think I'm asking for moon rocks or something!!! I had my "zipper" done back in 1995, spent a month in the hospital. Not due to surgery complacation but becasue they could not get my INR level to coperate, and it hasn't gotten any better!!!!. My INR levels have to be between 2.5 and 3.5 prefably 3 and above. So as you can tell I take "high" doses of coumadin, generally 10mg or higher a day. I get blood drawn every other week:mad: I guess my question is..... does anyone else have this much trouble in maintaing thier INR levels??

Christina
February 21st, 2002, 03:41 PM
Merryreader,

I can identify with you!
I had two AVR surgeries within eleven days in August 2000. Second one because of a blood clot due to too low INR (1.4). The hospital sent me home with a prescription of Lovenox in addition to the Coumadin I was taking. My INR also did not come up as it should but they sent me home anyway. Well, we ran out of Lovenox and were unable to make contact with the cardiologist office other than getting their voicemail. We left 5 messages in total and when they finally got back to us I had missed three injections. The following morning I was in trouble and was back in the hospital and the whole surgery needed to be redone, including a new valve. If anyone had pointed out to us how important those Lovenox injections were we would have bought the Lovenox ourselves, but we had no idea. What did we know?
I bought my Protime unit after 6 months of being on Coumadin. Had to buy it myself because insurance refused to pay. The first 11 months I had a horrible time with my INR level. It also did not help to have a jerk for a doctor (regular PCP by then) who kept changing the dosages of Coumadin, was extremely rude to me and my INR kept jumping around. I was a nervous wreck every week! When I did not have the machine yet, I at times went to the lab two to three times a week. Really scary! And to try to get the office to call me back the same day is another story. It would help if doctors do this so the patient can start taking the adjusted dosage that same day. DUH!!!
When I got the Protime unit things got a bit better because I no longer had to run to the lab all the time. That doctor still kept changing the dosages, still was rude, and my INR still kept jumping around. INR=IT'S NEVER RIGHT!
Well, I ended up firing that doctor and found a new one, but before I was able to get in for an appointment I had to wait approx. 6 weeks, but I did just fine alone. I was a bit scared but I did fine! I have been stable since July of last year.
My new doctor keeps me on the same dosage pretty much, and that seems to do the trick for me. He also likes the Protime unit, knows how to regulate Coumadin and trusts me completely. I had to demonstrate to them that I was capable of operating the unit and getting INR results.
I am on 20 mg a day. God only knows how I metabolize vitamin K and Coumadin, but in order to stay safe thats what I need. My new doctor is also not afraid of an INR higher than 3.5. He doesn't want me to go over 5 he tells me, but anything under 5 is just fine. He believes it is easier to deal with a bloody nose than to suffer a stroke or blood clot. That can be fatal! I wholeheartedly agree. Been there done that!
I no longer have many problems with INR. I take a test once every two weeks, and unless I am low I don't retake it. At times I am a little high. Last week it was 4.8, but there were no problems with bleeding. He kept me on the same dosage. I just need to intake about the same amount of vitamin K every day and if I do that I am fine. I have not eliminated anything from my diet, and I eat a fair amount of greens daily.
The protime unit is great Merryreader. It will give you freedom! I am going on vacation soon and don't have to worry about finding a lab to go to. I love it!
If your doctor doesn't want to write the prescription for the Protime machine, find another doctor. You are the boss!

Go get em!

Christina
Aortic Stenosis
AVR's 8/7/00 & 8/18/00
St. Jude's Mechanical
Coumadin 20mg a day

allodwick
February 21st, 2002, 09:10 PM
merryreader,

The fact that you take about 10 mg of warfarin daily means that you are a fast metabolizer of warfarin. The significance of this is that you should never hold warfarin for more than one day, for an INR below 5 ( and maybe even higher). If you take about 5 mg of warfarin daily, your INR will drop by half every 48 hours that you do not take warfarin. If you take more than 5 mg daily, it will take less than 48 hours for your INR to drop by half. Less than 5 mg means it will take more than 48 hours.

This may be part of your problem, the person monitoring your warfarin may not understand this.

You might want to look at my website www.warfarinfo.com

Zipper
February 21st, 2002, 09:21 PM
Now that makes sense to me...when I had to have an ultrasound fine needle biopsy for thyroid, it took 3 days for my level to get low enough. I didn't realize the difference in how one metabalizes this. I just keep learing!!!

I know someone on coumadin that 'eats' marijuana in cooking ? Isn't this dangerous ? I tried searching the web on this but came up blank. This is a younger person that has 'smoked' it in the past. They seem to think it's not a problem...Yikes...anyone know ??? Sounds risky to me!!!

Zipper *~*

allodwick
February 22nd, 2002, 05:18 AM
I've got a little bit on my website at http://www.warfarinfo.com/marijuana.htm

Zipper
February 22nd, 2002, 08:26 PM
Al, That was a brief bit well said..I did fwd it to the person I was referring to..(actually a family member). I wish there was more info somewhere..but I guess those are difficult studies due to the illegal nature of substance used.

This person has a script for it (pot) ...probably from some 'quack' Doc tho..that's why it concerns me. I'll keep searching for more info...

Zipper *~*

Icarus
February 25th, 2002, 10:22 AM
Hey Sutro,
I was recently given a Tynelol-like pain killer which really works (for me anyway). It's called Ultracet and I don't have a clue as to how long it's been around or if it's brand new. It contains 375Mg of Acetaminophen (Tynelol) and 37MG (?) of Tramadol.
The best part of this is it works so well you don't have to take too many of them to get rid of your aches and pains.
Ask your doctor if he's heard of it. Like I said, it works well.
Regards,
Icarus