OH NO!!! What do I do???

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M

MNmom

Ok I am in a bit of a panic- I totally forgot to take my 10MGs of coumadin last night- I usually take them between between 10:30 and 11. fell asleep. My weekly dose is up to 77.5 MGs- I very between 4 days of 10 and 3 days of 12.5, which is what I am supposed to take tonight. WHAT NOW?
I called the urgent care nurse, who suggested I just skip last nights dose and move on- but that would be changing my weekly dose by a big number...
:confused::confused::confused::confused:
 
update

update

The nurse called back after calling the on call doc, and suggested I take half the dose from last night - so I took 5MGs. I feel a little better, at least I wont be off by 10 for the week, just 5- should I be trying to make up that other 5 throughout the week? I just tested it on Friday and will retest next Friday. My last INR was 2.8, that was after 4.1 last Monday. I think my diet has been inconsistent- maybe i need to start writing everything down- ugh
 
First off, don't panic. Secondly, just call your doctor and see what he wants you to do. I have forgotten mine before too, and I was fine. Your Doc should make that call though.

One other rule that I will follow, is if I forget to take my dose, and it is with 12 hours of when I normally take it, I will just go ahead and take it. Now I take mine in the morning, because I get quite tired at nights, and a big fear was always forgetting to take my dose. If it has been more than 12 hours though, I will just skip it, but make a note of this when I test myself. REMEMBER THAT. Please tell your lab that you missed a dose when you get your INR checked, because the last thing you want is for them to adjust your weekly dose thinking you were low based upon what they THOUGHT your dose this last week was.
 
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If I know for sure I missed a dose, I always make it up with 1/2 extra dose for each of the next two days. That way I don't alter my weekly dose and also don't up my INR by very much for very long. However, your doctor's instructions should come before mine but you are the ultimate decision maker.

Don't panic - even if you did not notice you skipped a dose, it more than likely would not cause any issues and you might not have ever seen it in your INR depending on when you test.

I have been on coumadin for 28 years and I am sure I missed doses without realizing it. Back in the days when we all thought coumadin would cause us to spontaneously spout blood from every part of our bodies, it was more of a concern to take extra dose than worry about missing one. Now I know the opposite is true but I still don't panic about either one over one day.
 
It's not a crisis, though when your new to this, it feels like it.

You could either take your usual dose plus half of the missed dose for the next 2 days or simply forget about it and continue your normal schedule. If you just forget about it, your INR will be a little lower for the week. No big deal.

Hon stop worrying so much about your diet. Just eat like you normally would and it will all fall into place soon. If you start toying with your diet, your setting yourself up for yo yoing.
 
The usual caution from Coumadin managers is to NEVER double dose. Our Coumadin Guru, AL Lodwick once told me that a single double dose *probably* would not have any effect.

Like you, I take my dose in the evening, use a 7 day pill box and a 31 day Medication Chart to track all my meds.

WHEN (not if :) I miss a dose, I just take the WHOLE DOSE.
If I caught it in morning, I just resume my normal schedule.
If I didn't catch it until the aftrnoon, I then take 1/2 dose that night and another 1/2 dose the next morning, resuming my normal dose that evening.

Bottom Line: Spread the missed dose out over 2 days and you won't go Too Low or Too High and you will be back on track with your weekly dose in a few days.

Personally, I DO NOT like the recommendation to 'just skip it' and resume your normal dose the next night.

Skipping a dose, especially if you are a fast metabolizer (i.e. take a large dose), can cause your INR to DROP like a ROCK. That's why I take the full dose as soon as I realize I missed one and then spread my doses out from there.

By the end of this week, you will be a PRO at this ! :)

'AL Capshaw'
 
Don't panic

Don't panic

I would take the whole dose this morning and your normal dose tonight.

I’ve certainly missed a few doses in the last almost 9 years.. And that’s what I do.

I would then test myself in a few days. It's always worked out fine for me.

BUT... I'm no doctor! :) And I only take 26.5 mgs a week.
 
I take my Coumadin at bedtime. If I find in the a.m. that I missed a dose, I usually take it right away. If I don't discover it until after lunch, I take half of the dose with my regular dose that night and the next night. And I don't worry.

I take 70/week, so a held dose really drops my INR, but one missed dose isn't going to put you in jeopardy - even if you don't even realize you missed it and don't make up the dose.
 
I take my coumadin at night before I go to bed and I have forgotten to take it twice now but both instances I realized it as soon as I woke up. I have my INR managed by a Coumadin Clinic and they seem to have a good handle on managing my dose. They have told me that if I miss a dose at night that if I recognize it within 12 hours to just take the full dose. If I get beyond 12 hours call the clinic's emergency number and discuss it with a Coumadin manager. I haven't had to do that as of yet but don't fret over not taking it last night.

Scott
 
The drug is so slow acting that honestly, taking the full missed dose or doubling just one day isn't going to make a huge difference. This is why they've suggested to Doctors to stop loading doses. It doesn't make the INR rise any faster, it just causes problems when the patient is tested 3 days later because it's an artificial inflation of the true values.
 
Thank you all so much

Thank you all so much

Thanks so much- I took half the missed dose as soon as I was told to do so my the on call doc- though I now realize I should have just taken the whole missed dose as it was less than 8 hours after my usual time. I have 5 MGs to make up, so should I add 2.5 to my next two days, or just leave it as is??? I dont test again until Friday...
You guys are awesome. Cant wait until I can give out advice like you all!
Ingrid
 
Tonight you are taking the bigger dose of 12.5 if I remember correctly, so I would not add to that.
If tomorrows regular dose is 10 mg then you may want to make it 12.5, but at this point it's not a big deal.
 
If I were on your dosing schedule, I think I would take tonight's dose (12.5 mg) a little early, say 7 or 8 pm, and then take the remaining missed 5 mg tomorrow morning (7 or 8 am), followed by your usual evening dose (10 mg at bedtime).

That will get you back to your proper weekly level. The times don't have to be exact, just so you spread the missed dose over a 2 day period, you won't go too high and you won't go too low.

I think everyone goes through this kind of scenario at least once. After that, it becomes 'No Big Deal' to figure out a plan to smooth out the 'bump'.

You'll be giving advice in NO TIME, especially after you get your own tester!

Enjoy the Weekend :)

'AL Capshaw'
 
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