acetaminophen and coumadin

[sharon]

Got my aortic St. Judes valve in April of 1997. My coumadin levels have been pretty good all these years, just some minor glitches. I recently fell (the cat got under my feet), and needed surgery to put some pins into my fractured hip. I have needed a bit of help for the hip pain, and have been on tylenol on and off for a few weeks. My INR has been 4.1-4.6 for the last few times. The only difference, aside from not being as active as usual is that I've taken the tylenol. Looking back over earlier posts showed a "mixed bag" - sometimes the person had their INR go up and sometimes not. I had to take a few doses of 2 tylenol (500mg each), the day before I got tested. Could that be what's making my INR go so high?


Sharon

 

[dick0236]

I take two 500mg acetaminophen each nite before bed for neck pain without any INR problem. Doctors have always told me that acetaminophen will not interfere with INR.....and, for me, it doesn't.

 

[pellicle]

Hi

Got my aortic St. Judes valve in April of 1997. My coumadin levels have been pretty good all these years, just some minor glitches...., and have been on tylenol on and off for a few weeks. My INR has been 4.1-4.6 for the last few times....I had to take a few doses of 2 tylenol (500mg each), the day before I got tested. Could that be what's making my INR go so high?

its possible. This is of course why I love self testing ... I can answer these questions for myself and know for myself what interactions I get with things myself.

I found that when I have had bouts of headaches that taking 1000mg (that would be 2 500mg tablets) can raise my INR from 2 point something to high 3 point somethings. I've not done "specific" testing but its my general observation where I've only been able to explain a mysterious rise in my INR (and the rise coincided with my use of that).

Looking at wikipedia for a minute:
https://en.wikipedia.org/wiki/Paracetamol#Pharmacokinetics

we see that the metabolism (disposal) from your body is the P450 which is exactly what is used for warfarin (coumadin) clearing. So there is a valid reason why they may interact (trip over each other so to speak)

IF you were taking both regularly then your could simply adjust your dose of coumadin to get your INR where you want it. Its when its irregular that you really can't.

My approach is to just have one now and then and not worry about the INR effect which will be temporary anyway ... but if you are taking it regularly (for that pain) then I'd suggest that you make sure you take it regularly and drop your dose as is needed to get your INR back to your desired level (2.5 right?)

Best Wishes

 

[sharon]

Hi Dick and Pellicle,

Thanks for your posts. Dick, with the coumadin and the acetaminophen together nightly, you must have adjusted your coumadin levels without even realizing it. Pellicle, thank you for explaining that wikipedia piece. I read it and couldn't understand what the heck they were saying. It makes sense with your paraphrasing. I just went for another coumadin check today. The past week the nurse put me on 2.5 - 2x a wk and 5 - 5x a wk. I haven't taken the acetaminophen in a few days. My INR was 3.1 today. She wants me to stay on that dose for a couple of weeks and then retest. Not sure about those coumadin amts, but I guess I'll do what she says.

I had a home tester in the late 1990's. It became obsolete and because my dr started using the finger prick test in the office,I didn't want to spend thousands again. My insurance never covered the tester or the testing strips.
Again, thank you for your input. Like you said Pellicle, if I just use it occasionally, I won't sweat it.

S

 

[pellicle]

Hi

glad I could help ...

I had a home tester in the late 1990's. It became obsolete and because my dr started using the finger prick test in the office,I didn't want to spend thousands again. My insurance never covered the tester or the testing strips.
Again, thank you for your input. Like you said Pellicle, if I just use it occasionally, I won't sweat it.

should you wish to get another tester the Coaguchek XS is my recommendation they available used on eBay and are about $500 ... strips are around $140 from trusted online sellers.

I know some people worry about used gear, but ... well my XS is 3 years old and is very used ... its dragged around internationally and its still accurate. The reason is that the XS is just the machine that reads the strips. The strips are where the action is and they are always new

but if all is honky dory as it is, why do it...

Best Wishes