Just ordered my CoaguChek machine...

[Elcarim]

I've been on Warfarin for going on 19 years. For many years my INR was pretty stable, but recently it has been a bit unpredictable. I was having tests every 4 weeks for ages, but over the past 6 months or so I've been having them more like every 1-2 weeks, which is a bit of a nuisance, but it has motivated me to start self-testing. I also no longer feel comfortable aiming for 4-weekly testing as a goal.

I've discussed self testing with my GP and she is all for it, and happy to support my transition away from in-clinic testing as I see fit. I've read the posts and watched the videos, so I think it should be fairly straightforward.

Interestingly, since I had what was probably very long-term iron deficiency treated with an iron infusion back in October, I have needed more Warfarin to stay in range. For many years I took a rotating 4 4 3 dose, but since the infusion we had to push it up to 5 5 4, which is a pretty significant increase. Then, over the past couple of months, I have had random high readings of 4.6-4.8 with no obvious cause. The next test I would be back down around 3 where I should be. Hence I've been testing more often than usual.

My theory is that since going from taking two tablets every night for years (2x 2mg or 1x 1mg and 1x 2mg), to instead needing to take 1x 5mg most nights I may have got a really strong habit of taking two tablets and accidentally taken 2x 5mg on a couple of occasions simply by not paying enough attention. I have caught myself tipping 2x 5mg into my hand a couple of times, and there are nights when I have marked my dose as taken on my whiteboard but I can't actually remember taking the meds. Sometimes I have to ask my family if they saw me take them because my short-term memory has just let the whole thing go. So at the moment I am dose-checking with my family every night and my INR is back in range.

 

[pellicle]

...Sometimes I have to ask my family if they saw me take them because my short-term memory has just let the whole thing go. So at the moment I am dose-checking with my family every night and my INR is back in range.

so I always advocate:

• get a pill box that is labelled each day of the week (mine goes Sunday > Sat)
• fill it once per week with the dose you determined as a result of your INR test
• set an alarm on your phone to be at the "regular convenient time to take" of your choosing
• do not snooze the alarm and "I'll get that in an hour"
• when you take your dose leave the lid up as a flag that you took it
• put it in a location that is visible in your move around the house and glance at it to check

I measure sunday and write it up.
I fill the pill box on sunday evening and use the dose I determined based on measurement.

All this sounds more than it is, but every part is needed to minimise errors and "know that INR is not based on dose errors".

Best Wishes

 

[Elcarim]

so I always advocate:

• get a pill box that is labelled each day of the week (mine goes Sunday > Sat)
• fill it once per week with the dose you determined as a result of your INR test
• set an alarm on your phone to be at the "regular convenient time to take" of your choosing
• do not snooze the alarm and "I'll get that in an hour"
• when you take your dose leave the lid up as a flag that you took it
• put it in a location that is visible in your move around the house and glance at it to check

I measure sunday and write it up.
I fill the pill box on sunday evening and use the dose I determined based on measurement.

All this sounds more than it is, but every part is needed to minimise errors and "know that INR is not based on dose errors".

Best Wishes

Thanks for this. I also take a beta blocker with the days of the week on the blister pack so I can cross-check that way, to be sure I have taken my meds for that day, but that alone doesn't make sure I took the correct Warfarin dosage. The pill box is a good idea, I will get one. I always take my meds just before dinner, and don't sit down to eat until I have done so. But because I am also the one preparing dinner the act can get a bit lost in the process.

 

[pellicle]

Hi

Thanks for this. I also take a beta blocker with the days of the week on the blister pack so I can cross-check that way

ok, so as a friend of mine is a pharmacist and some other friends are on regular drugs I know a little of this, but bear with me. Are the blister packs you are talking about sheets of (blisters) containing a dose for every day?

because:

but that alone doesn't make sure I took the correct Warfarin dosage.

so, do you like me get your warfarin (generic name, I take marevan so insert your brand here) in bottles and you then have to make up your dose? OR is it in the blister pack?

But because I am also the one preparing dinner the act can get a bit lost in the process.

that's me too ... I'm chief cook and bottle washer here (and as I live alone now its also washing, yard work and all vehicle maintenance).

lastly, and going back to your earlier post: what is the "rationale" for your 4,4,3 dose strategy and how is this helping you track your "daily dose"?

 

[Protimenow]

Ditto on Pellicle's suggestion to get a pill box. I don't leave the lid open after I take a dose -- if I look in the compartment to see if I took that day's dose, if it's empty, I know that I took it.

I have a 'box' that's actually one for AM and one for PM - the AM and PM are joined back to back. I used to, occasionally, take a night dose (with Warfarin) instead of a day dose (without Warfarin) and I think I may have taken two night doses in the same day, and probably missed my Warfarin on others.) Now, to avoid confusion, I've taken a red Sharpie and colored the tops of the night compartments. This has helped me to avoid THAT error.

I also load my compartments weekly -- after I've taken my INR, so if I rarely have to adjust for the week, I can make the adjustments when I fill the compartments.

Testing every four weeks makes no sense. I strongly suggest that you test weekly - and usually on the same day of the week. Waiting longer than 10 days can, theoretically, expose you to stroke risk. If you have a meter, the $5 or so each week is a very worthwhile investment.

 

[tommyboy14]

That pillbox was a game changer for me. Perhaps one of the best pieces of advice on this website. I good chunk of warfarin control is making sure to take it regularly.

 

[pellicle]

That pillbox was a game changer for me

I can thank my wife for this one ... conversation went approximately like this:
(in the pharmacy, she walks up with one in her hand) why don't you get one of these?

well, sure, but that's what old people do

well old man, get one and stop whinging

yep, it makes sense (nodding, knowing better than to argue against what was rational).

I see so often that:

• needing to be on medications
• having a pill box
• etc

are so often things that people avoid doing because they are signs that mean they can't pretend they are not 19 anymore.

The sooner you do it the better off you are.

PS: my pill box sits where I (mostly) charge my phone, and has done for 12 years now.

 

[Elcarim]

Hi

ok, so as a friend of mine is a pharmacist and some other friends are on regular drugs I know a little of this, but bear with me. Are the blister packs you are talking about sheets of (blisters) containing a dose for every day?

because:

so, do you like me get your warfarin (generic name, I take marevan so insert your brand here) in bottles and you then have to make up your dose? OR is it in the blister pack?


that's me too ... I'm chief cook and bottle washer here (and as I live alone now its also washing, yard work and all vehicle maintenance).

lastly, and going back to your earlier post: what is the "rationale" for your 4,4,3 dose strategy and how is this helping you track your "daily dose"?

The blister pack is the way the Toprol comes packaged, with the days of the week on the back of the foil. There is one marked 'start here' that you take first, then if the next day is Wednesday you take the tablet marked 'Wednesday' and continue like this until you've used up the whole pack.

Yes, my warfarin (coumadin) comes in bottles and I take as many of whatever mg tablets are required to make up my dosage for that day.

My 4,4,3 dose strategy was given by my old GP and I went along with it for years because I was stable on it. Taking 4mg every day was too much, alternating 4,3,4,3 was not enough, so we came up with the 3 day rotation and it worked for ages. When my dose had to go up after the iron infusion, it was a similar situation. 5mg every day was too much, 4,5,4,5 was not quite enough. I stabilised on 5,5,4. Until my INR started spiking every couple of weeks. I'm not sure if that answers your last question?

I bought a pill box today as well as a pill splitter.

 

[Elcarim]

Ditto on Pellicle's suggestion to get a pill box. I don't leave the lid open after I take a dose -- if I look in the compartment to see if I took that day's dose, if it's empty, I know that I took it.

I have a 'box' that's actually one for AM and one for PM - the AM and PM are joined back to back. I used to, occasionally, take a night dose (with Warfarin) instead of a day dose (without Warfarin) and I think I may have taken two night doses in the same day, and probably missed my Warfarin on others.) Now, to avoid confusion, I've taken a red Sharpie and colored the tops of the night compartments. This has helped me to avoid THAT error.

I also load my compartments weekly -- after I've taken my INR, so if I rarely have to adjust for the week, I can make the adjustments when I fill the compartments.

Testing every four weeks makes no sense. I strongly suggest that you test weekly - and usually on the same day of the week. Waiting longer than 10 days can, theoretically, expose you to stroke risk. If you have a meter, the $5 or so each week is a very worthwhile investment.

I've just bought a pill box. And a pill splitter. These should improve my dose management.

Testing 4-weekly was always the goal that my GPs had. Now that I know better I'll be testing once a week as soon as my meter arrives.

 

[Protimenow]

Elcarim:

I load my pill box with the same dose daily. Currently, I'm taking a 5 mg and 1/2 of a 1 mg daily -- I'll occasionally increase to 6 mg daily if my INR drops below where I'd like it to be (somewhere close to 2.5). In your case, it may make sense to try 3.5 mg/day - most easily achieved by using a 2.5 mg plus a 1 mg. This would be .16 mg less than you're averaging with your 4 4 3 method (11 mg/3 days - 3.7 mg/day). If you check weekly, your results will be more consistent than if they would be with your alternating dose -- because your INR will change from day to day because of your dosing changes.

Do what you or your doctor advise you to do - I can't tell you what to do - but if it was me, I'd work for a standard daily dose, rather than alternating 4,4,3 like you're doing.

Pellicle: I didn't realize that old people use pill boxes and younger ones can just rely on their memories (and, now, their phones or watches) for appropriate dosing. Personally, if my watch told me to take a dose, I'd probably forget, and may be troubled by having to press some button on the phone or watch confirming that I've taken it. A pill box would still be a better choice for me.

 

[pellicle]

Testing 4-weekly was always the goal that my GPs had.

uhg ... I can only assume the best and say that this 4 week protocol is centered around the bad idea that weekly venous blood sampling is

and that testing by coagucheck in their office is actually better anyway.