HELP! The bottom has fallen out!

[twinmaker]

I need a little help ya'll. I just took my INR and it's 1.9. I held my dose on Monday night, took 6mg. Tuesday night (one half dose) and am supposed to go back on my regular doses tonight with 13 tonight, Friday and next Monday. And 12.5 on T, Th, Sat, and Sun. My dosing chart says for an INR of 1.9 to do an additional dose and increase weekly dose by 10 to 20%. With the withheld dose and half dose, I don't even really know what my weekly dose is. Do I go by my last weekly schedule? I haven't been this low in some time and especially not from withholding doses without some bridging going on. Any help would be appreciated. I took my 13 mg. right before testing. How much more should I add tonight? LINDA

 

[Karlynn]

So I'm wondering how accurate your 6.0 was then. Did you retest? I don't recall.

Don't freak - you haven't been 1.9 for long.

I think you need to go back to your regular weekly dose prior to your 6.0 reading.

I would take at least 1/2 an extra dose tonight and then resume your regular dosing. Or if you think you need to make up for that missed dose and 1/2, you could do that over the next 3 days.

Shooting from the hip - if it were me, I'd probably take an extra dose tonight and then resume my regular dose. But I'm just kind of thinking out loud here.

And to repeat - you can't have been 1.9 for long and given the margin of error, you may not be that far out of range (looking on the positive side)

You'll be fine.

 

[twinmaker]

Karlynn, I did recheck my INR but not until the next morning. Just didn't think about doing it at the time because 1) my machine has never given me a wrong reading that I know of, 2) I had been on the antibiotic, 3) I was taking quite a bit of Tylenol, and 4) I wasn't eating a lot. Live and learn, I guess. When I retested the next morning, it was 4.0. Still a little high. When I told the Coumadin nurse about the retest, she still wanted me to half the next dose. I questioned her on that but decide I would do it and see what happened and go from there. I'm supposed to call her tomorrow morning, so I guess she will understand my not wanting to half that dose on Tuesday night. Anyway, thanks for your input on tonight's dose. LINDA

 

[Ross]

I would simply go back to my normal schedule and test again in a week. Don't increase anything. It'll smooth out again, just going to take a little time.

 

[ALCapshaw2]

I've always worried about SKIPPING even a single dose since that can 'ring the system' pretty hard.

For 'moderately high' readings I 'think' I would be more comfortable taking a half dose for one (maybe two) day(s).

Note that I DO NOT self dose, but 'converse' with my Coumadin Nurse (we tend to agree) and just 'observe' what is said here.

'AL Capshaw'

 

[RandyL]

I need a little help ya'll. I just took my INR and it's 1.9. I held my dose on Monday night, took 6mg. Tuesday night (one half dose) and am supposed to go back on my regular doses tonight with 13 tonight, Friday and next Monday. And 12.5 on T, Th, Sat, and Sun. My dosing chart says for an INR of 1.9 to do an additional dose and increase weekly dose by 10 to 20%. With the withheld dose and half dose, I don't even really know what my weekly dose is. Do I go by my last weekly schedule? I haven't been this low in some time and especially not from withholding doses without some bridging going on. Any help would be appreciated. I took my 13 mg. right before testing. How much more should I add tonight? LINDA

Good for you getting together with the Nurse, makes life much easier. I take the same dose you take only 12.5 a day for 7 days. If you are like me with that high dose if you hold a dose you will drop drastically. I had some procedures done lately that required me to go off coumadin. After 24 hrs I dropped 50% ans after 48hrs I dropped the rest and registered a 1 which is normal fo most people with no couimadin.
Now it took me 10 days to get therapuetic after I started back up again.


This is a what I said on your other thread and as you can see you dropped fast. I would do like what Ross said and go back to your regular dose, it will catch up in a couple of days. 1.9 is certainly not the end of the world. Us high dosers have to make small corrections or we will be chasing our own tail.

 

[twinmaker]

Thanks for all the info guys. I did add an extra half dose tonight. So instead of taking just 13mg., I took 19.5. I know this will bump me up, but I'd rather be on the high side. I'll let you all know how it goes. Still feeling pretty cruddy. Called the doc back about my sore throat, and he wants to see me at 8 tomorrow morning. LINDA

 

[Ross]

Just don't alarmed if it's a little high on your next test. Stay with your normal dose.

 

[twinmaker]

I won't be alarmed Ross. I'm just anxious to get over whatever I have (sore throat, etc), start to feel better, and get my INR back to where it belongs. Since I've been down the road of a major bleeding episode, I know that there are usually some warning signs and time is a little more on your side. On the other hand, being too low and having a stroke definitely scares the "you know what" out of me. Thanks for responding, Ross. LINDA

 

[Ross]

I didn't mean to give you mononucleosis. Sorry.

 

[Guest]

I'm constantly preaching that there is almost no reason to hold or cut a dose for an INR of 4. The 1.9 was almost exactly what would have been predicted for someone who takes a large dose like you do. The dosing schedules work best for people who take about 5 mg per day. If you take more than 5 mg your INR will drop dramatically with a held dose. If you take less than 5 mg the INR will drop very slowly for a held dose.

You are almost always better off with an INR of 4 than one that is too low.

 

[twinmaker]

Ross, I was beginning to think I had mono. Just couldn't figure out who gave it to me. Just got back from the doc. He thinks the lining around my carotid artery is inflamed. Hence the continued sore throat. He put me on some antiinflamatories. I understand what you're saying Al. I just had a discussion with this PCP and he said for an INR of 6.0, he'd be giving vitamin K. I told him what holding a dose does to someone like me, and he wouldn't be giving me vitamin K. It's funny how some docs are much more afraid of a high INR than a low one. I told him I was much more scared of the 1.9. LINDA

 

[Karlynn]

Did you tell him it's easier to replace blood cells than brain cells?

 

[Guest]

Giving vitamin K also makes the person resistant to warfarin for up tp two weeks depending on the dose and route.

 

[DrAllan]

Hi twinmaker

Just one thing to discuss. You are not clear whether you have a soreness of the inside of your mouth or throat and any pain with swallowing. Carotidynia, which is pain with inflammation of the covering of the artery, is locally tender to touch. Needless to say turning the head or any movement stretches the artery and causes pain. If you have a true sore throat, especially without fever, and nothing obvious by looking in your mouth, then a good ENT exam is needed. You could have any of a multitude of diseases. Esophageal reflux is statistically most likely followed by a cancer of the larynx. Just to get lighter in the discussion, the nerves that go to the ear also go to the throat. It is possible for something as simple as wax impaction in the ear to give persistent sore throat.

If your doc made a diagnosis of Carotidynia without the above mentioned tenderness to palpation, then he is really ignorant about pain syndromes of the head and neck. If this is the case make the appointment with the ENT without a referral if possible.