Fun with pain meds & coumadin

[kbheart]

I need some advice. A couple weeks ago I was having some back and shoulder pain so my doctor put me on a muscle relaxant, Skelaxin. Last Monday my INR was a bit high at 3.7. It might have been due to the Skelaxin but it was probably because I wasn't exercising as much because my back hurt. I decreased my weekly warfarin dose from 38 to 36mg.

The back pain was really bad this weekend so I was taking some leftover Vicodin at night so I could sleep, and not doing any exercise. This morning my INR was at 5.5. I'm still waiting to hear back from the coumadin clinic.

Meanwhile, I saw my primary care doctor this morning and she wants me to take Aleve every day for a month (until I get the back pain under control). She also prescribed some Valuim to help me sleep at night. I'm not making this up. This just keeps getting crazier!

So here are my questions...how much do I decrease the warfarin to get back in range? Do I wait to start the Aleve until my INR is back in range so that I don't start a bleeding problem? Will valuim affect my INR? And would someone please just give me a different back so that I can get off all of these meds and start exercising again. Sorry, I'm feeling a bit loopy from a lack of sleep.

You guys are the greatest!

 

[Cooker]

I'm not sure if pain meds cause INR to rise, never did with me. And I would not take Alieve for a month, period. That does not sound right.

 

[Ross]

No interactions were found for the drugs you selected.
You searched for interactions between the following drugs:

Coumadin
Skelaxin

None of them should cause a problem. I question whether that 5.5 isi correct. You might want to draw her attention to Aleve being no no on Coumadin.

 

[Bina]

I would have done a re-check on that 5.5 reading.

 

[tobagotwo]

It's not so much your INR that's concering with Aleve.

Naproxen sodium is probably the mildest of the NSAIDs, but taking it for a month on Coumadin is risky. Repetitive use of any NSAID can cause irritated areas that are more susceptible to bleeding. You could easily have a stomach bleed that would far outweigh the concern you have for your back and shoulder.

I would not rule out the possibility of internal bleeding from some muscle relaxants or antiinflammatories, either, as many of them are chemical cousins. Be sure to look them up or ask your pharmacist (preferably both).

That said, it doesn't leave you with many good outs for the pain. Usually, a poppy-based drug is used for more severe pain in anticoagulated people. Tylenol works for some folks, but lacks the antiinflammatory effects of the NSAIDs.

While the execise seems to have allowed your back to get worse, you should keep moving (you know this), to help it loosen up.

I would seriously consider looking up a sports doctor for the best help out of this type of pain. Or at least a heated whirlpool...

Best wishes,

 

[kbheart]

Thanks! I may try the Aleve for a few days but definitely not until my INR comes back down.

The nurse from the coumadin clinic asked if I ever calibrate my home testing machine. I aksed her how and she didn't know. Have any of you home testers calibrated your machines? Would I just go into the clinic and compare their results with my machine?

The nurse suggested that I skip 2 days of coumadin and test again on Wednesday. Does that seem like too long to go without any coumadin. I was taking 36 mg a week and my INR is at 5.5 right now. She says that it tends to come down 1 point for every day you skip so she thought it would be down to 3.5 on Wednesday. But if it leaves you completely in 3 days, that doesn't sound right.

 

[Bina]

The new Coaguchek XS do not require calibration. Check your manual for your machine.
If it was me......I would not hold for 2 days, that is drastic.
I would hold 1 day and take a half dose the next day OR take 2 days of half doses.
Then test again in 5 days.

 

[geebee]

I would want to make sure the 5.5 is accurate but, assuming it is, I would hold one day and then decrease my weekly dose by about 10% and retest in a week. Since you are not sure why your INR went up, I would hesitate to make any drastic changes until you are certain of the test results.

 

[Philip B]

INR Jump

INR Jump

My INR jumped drastically when I had to stop exercising due to a broken foot. I didn't skip any days. Instead, I reduced my dosage by half until I dropped back into range.

-Philip

 

[kbheart]

I tested myself again this morning. It's already down to 3.6 just by skipping one day! Or the 5.5 was a faulty reading?? Anyway, it's a good thing I checked before skipping 2 days. I'll just decrease the dose until I'm back in the swing of exercising.

Thanks for all of your advice! I don't know what I would do without this forum. It can be so frustrating dealing with these health problems.

 

[Ross]

Yes it drops about 50% with one missed dose for most folks. So are you going to take only a half dose today? You do realize that 3.6 is on the way down, not up. It will drop lower and if you skip 2 doses, you'll likely be too low.

 

[kbheart]

Yes it drops about 50% with one missed dose for most folks. So are you going to take only a half dose today? You do realize that 3.6 is on the way down, not up. It will drop lower and if you skip 2 doses, you'll likely be too low.

I just took 4 mg instead of my regular 6 mg. It's going to be tricky because I hope to start exercising within the next couple days. But the plan is to gradually increase both the exercise and coumadin back to "normal".

 

[aussigal]

I have taken Valium while on Warfarin and the Valium has had no effect on my INR. It did wonders for helping me sleep though!.