Warfarin vs Coumadin

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lilteach3234

Well-known member
Joined
Mar 4, 2009
Messages
236
Location
Houston, Texas (USA)
Hello all,

I've been getting my blood tested at my cardio's office since the first week after my surgery. I really don't want to do the long drive each week, so my neurologist office has agreed to do my testing. I love my neuro as well.

In the beginning the cardio put me on warfarin. Today I had my blood tested and it was a tad bit high (3.1) so they just dropped me from 5 mg to 4 mg. The however called in Coumadin and not warfarin. I went from a 5 mg pill to 4 1 mg pills.

I know warfarin is the generic? Does this matter?

I'm also on synthroid. The pharmacist says there is an interaction between the two. I've been on this for 8 weeks and this is the first I've hear.

Do any of you take synthroid as well?
__________________
 
lilteach3234 said:
Hello all,

I've been getting my blood tested at my cardio's office since the first week after my surgery. I really don't want to do the long drive each week, so my neurologist office has agreed to do my testing. I love my neuro as well.

In the beginning the cardio put me on warfarin. Today I had my blood tested and it was a tad bit high (3.1) so they just dropped me from 5 mg to 4 mg. The however called in Coumadin and not warfarin. I went from a 5 mg pill to 4 1 mg pills.
Click to expand...

3.1 a tad high? It's just over the line. I would not have worried one iota. Your range is 2.0-3.0, isn't it? Your cardio's office has reduced your dosage by 20% for a smidgeon over range. Most of us here would not have blinked an eye at a 3.1. My range is 2.5 - 3.5 and if it hits 3.7, I'm happy and do nothing.

Remember: You can replace blood cells, but not brain cells. Tell your cardio's office that. I have told quite a few medical professionals that, and it does get them to thinking.
 
I, too, had been told that warfarin and coumadin are technically the same drug, but while taking the generic, my INR would vary between 2.3 and 6.2 on the same 4 mg dose. After consultation with my cardio, the decision was made to go to branded coumadin. Since then, I have had consistant 3.1 to 3.5, which is about perfect range for me. In the meantime, I have gone to all brand named prescriptions, which has helped stabalize A-fib. Have to pay a bit more for them, but is worth it to me.
 
Some people swear that the brand name keeps them stable. I've used every thing out there, mixed and matched them, took them seperately, you name it and not one of them made a lick of difference in my INR, just my pocket book.
 
ChuckVSP said:
I, too, had been told that warfarin and coumadin are technically the same drug, but while taking the generic, my INR would vary between 2.3 and 6.2 on the same 4 mg dose. After consultation with my cardio, the decision was made to go to branded coumadin. Since then, I have had consistant 3.1 to 3.5, which is about perfect range for me. In the meantime, I have gone to all brand named prescriptions, which has helped stabalize A-fib. Have to pay a bit more for them, but is worth it to me.
Click to expand...

I've just switched to the brand name because I'm having so much trouble getting up to my therapeutic level. I'm also on generic levothyroxine (Synthroid), but when I switched to that a few years ago, my thyroid levels fluctuated like crazy until my body got used to it. But thyroid levels aren't as critical as INRs, so I agreed to switch to Coumadin to make it easier to make sure I'm getting the same drug with the same formulation all of the time. It's a bit of a hike on the co-pay, but not unaffordable (and since I'm off the $40 co-pay Hyzaar, I'm still "making money" on the deal), so I'm happy--especially if it helps get up above 2!
 
Who on earth would make a dose adjustment for an INR of 3.1 ????
I'm sorry, but that is pointless; unless it was showing a rapid increase since the last test.
Some cardios feel the need to "earn" their money perhaps? ;)
 
Today I had my blood tested and it was a tad bit high (3.1) so they just dropped me from 5 mg to 4 mg.
Click to expand...

Doesn't make any sense to me to be adjusting 3.1.

I'm also on synthroid. The pharmacist says there is an interaction between the two.
Click to expand...

I've been on synthroid about as long as coumadin and have never heard that. My Synthroid dosage has never been changed.


ChuckVSP said:
I, too, had been told that warfarin and coumadin are technically the same drug, but while taking the generic, my INR would vary between 2.3 and 6.2 on the same 4 mg dose. After consultation with my cardio, the decision was made to go to branded coumadin. Since then, I have had consistant 3.1 to 3.5, which is about perfect range for me. In the meantime, I have gone to all brand named prescriptions, which has helped stabalize A-fib. Have to pay a bit more for them, but is worth it to me.
Click to expand...

My INR has been swinging from 1.9 to 6.6 for almost 18 years with 6 to 7 mg dose and I've taken taken coumadin. In the last month or so I've been switching to warfarin.
 
ChuckVSP said:
I, too, had been told that warfarin and coumadin are technically the same drug, but while taking the generic, my INR would vary between 2.3 and 6.2 on the same 4 mg dose. After consultation with my cardio, the decision was made to go to branded coumadin. Since then, I have had consistant 3.1 to 3.5, which is about perfect range for me. In the meantime, I have gone to all brand named prescriptions, which has helped stabalize A-fib. Have to pay a bit more for them, but is worth it to me.
Click to expand...

Do you know the Name of the Manufacturer of the Generic Warfarin you were using? Did you always receive refills from the Same Manufacturer?

FWIW, MANY of us (including myself) have seen absolutely NO DIFFERENCE between Brand Name Coumadin and Generic Warfarin from BARR (USA) and TARO (Israel).

BTW, did you know that Brand Name Coumadin has had several different manufacturers as the rights were sold from company to company.

ONE of the Coumadin Name owner's Sales Representatives liked to tell Physicians that Brand Name Coumadin had 'tighter tolerances' and therefore less variation. The story I heard was that they were sued in court and LOST. Apparently one of the Generic Manufacturers actually had less variation.

Every once in a while we have a member who claims to see a difference. The Vast Majority see NO Difference. This debate seems to never die.
 
lilteach3234 said:
Hello all,

I've been getting my blood tested at my cardio's office since the first week after my surgery. I really don't want to do the long drive each week, so my neurologist office has agreed to do my testing. I love my neuro as well.

In the beginning the cardio put me on warfarin. Today I had my blood tested and it was a tad bit high (3.1) so they just dropped me from 5 mg to 4 mg. The however called in Coumadin and not warfarin. I went from a 5 mg pill to 4 1 mg pills.

I know warfarin is the generic? Does this matter?

I'm also on synthroid. The pharmacist says there is an interaction between the two. I've been on this for 8 weeks and this is the first I've hear.

Do any of you take synthroid as well?
__________________
Click to expand...

I *assume* your recommended range is from 2.0 to 3.0

A reading of 3.1 is a TRIVIAL disparity.

I would ask the Nurse and Cardio 2 questions:

What is the TOLERANCE on their Test Method?

What Guideline are they using that recommends a 20% reduction in Dose for an INR that is 0.1 units above range? I would also ask to see a Copy of their Guidelines and for them to show you in print where a 20% reduction is recommended for your test result and recommended range.

It's stories like this that continue to convince many of us that many in the Medical Community are CLUELESS about how to properly manage anticoagulation.
 
ALCapshaw2 said:
I *assume* your recommended range is from 2.0 to 3.0

A reading of 3.1 is a TRIVIAL disparity.
Click to expand...

I also agree that a 3.1 should not have caused a dosage change.

Regarding Warfarin vs Coumadin....I was on Coumadin for many, many years because doctors back in the "olden" days would (rightly or wrongly) not permit the use of generic warfarin. A few years ago I found a doc who was not concerned about warfarin and he prescribed the generic for me. I have found no difference between Coumadin(Bristo, Myers, Squibb), warfarin(Barr Labs) and warfarin(Taro). If anything, my INR has been the most stable under Taro. Before switching I was advised by the FDA, Bristol-Myers-Squibb, Barr and Taro that ther is no difference in the "active ingretients" of the various manufacturers although there is some difference in the "innactive" ingredients which can cause some problem for some patients.
 
I am going to call the cardio Monday and get all of my readings since surgery. I never had problems with my INR seeing him.

It's when I decided I didn't want to drive 40 miles and decided to use my neurologist's office.....I love this doctor....it's this office that has changed me.

I will get it all under control and I'm sure not worried about 3.1

The pharmacist is the one the told me about the Synthroid and Coumadin. I'm taking both though and not going to stop. I need them both.
 
lilteach3234 said:
I am going to call the cardio Monday and get all of my readings since surgery. I never had problems with my INR seeing him.

It's when I decided I didn't want to drive 40 miles and decided to use my neurologist's office.....I love this doctor....it's this office that has changed me.

I will get it all under control and I'm sure not worried about 3.1

The pharmacist is the one the told me about the Synthroid and Coumadin. I'm taking both though and not going to stop. I need them both.
Click to expand...

It would be a good idea to keep a Chart of your Daily Dose by Date and also note all INR Test Results on the appropriate dates.

Perhaps I should have said "Clueless or Over-Reactive".
"Old School" Doctors and Nurses probably learned about anti-coagulation Before the INR test was developed, when maintaining a stable state *was* a challenge due in part to variations in the reagents in the testing / lab analysis. In those days, Bleeding issues *were* a Big Deal.

I recommend that you purchase a copy of AL Lodwick's Dosing Guide ($5) and show it to this Nurse (and Doctor). See www.warfarinfo.com/publications

Ross' Slogan "Dose the Diet" can be modified and applied to your medications as "Dose the Medications" which means find the appropriate Dose of Coumadin to maintain stability in your Target Range while also taking your other medications. There is a degree of "Trial and Error" involved but with SMALL changes, you should be able to 'Zero In' in short order.

Let us know how it goes.

'AL Capshaw'
 
One of the reasons I was asked to detail my meds and doses before surgery was so that they could dose me accordingly post-op. They told me to update them on any changes, including going back on Fosamax, and when I went off the hydrocodone. Presumably that's so they can plug those drugs and doses (or the absence thereof) into their little calculator. But sometimes meds have a way of behaving with their own synergies, so it's hard to calculate with 100% accuracy.
 
It's impossible. Each and everyone of us is so uniquely different that the only way things work out is small adjustments up or down depending on the circumstances. If they think they can simply put a medication into a calculator and come up with a new correct dose then pigs can fly. I wish it were that simple, but it's not.
 
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