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Another INR question

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Cactus52

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Oct 10, 2017
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Forgive me I am still new to all this dosing and maintaining my INR. A week ago I went into the hospital for complications after my AVR. When I got there my INR was 2.5. when I was discharged they gave me antibiotics and told me to cut my warfarin dose in half for the 5 days I was on them. Had my INR checked yesterday (day 4 of antib) and it was 1.4. now they want me to take 10mg tonight and then 5mg till Monday along with 3 days off lovenox shots when I get rechecked. Does this sound like overkill or do I need to get it up fast?

Thanks
 

dick0236

Eat the elephant one bite at a time
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In hindsite the dosage reduction was incorrect. The 10mg should help get your INR back into a safer range and since you will recheck in a few days you should be OK. My experience has always been to make small changes. Can't comment about the Lovenox.......I have never used it in all the years I have been on warfarin.

I don't think any warfarin change should have been made until you knew if, or how, it would affect your INR....but I don't think it poses a serious problem.

After you have 90 days "under your belt" try to go to self testing.......it makes life a lot simpler.
 

Cactus52

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Thanks

My cardio said the same. The discharge doc at the hospital said I should cut it in half. If I only knew. I have a meter on order and will hopefully have it in a few weeks.
 

Warrick

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Not all antibiotics will affect your INR and one antibiotic might affect your INR and not affect the next one on warfarin.
Ive been up to INR 7.7 with an antibiotic that “might” affect my INR, test and see is the best way before adjusting for what “might” happen imo
 

tom in MO

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Not all antibiotics will affect your INR immediately either. With me if I am on them, I usually check my INR on 3 and 10 days after starting to take them. Some, such as amoxicillin and Cipro, I now know have no effect on my INR, so I don't bother to test more frequently.
 

slipkid

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Schwenksville, PA, USA
Is there a way to know in general which antibiotics might affect your INR (and in which way - up or down?). Or is it a crapshoot, having to see how your body reacts?

I have to take Azithromycin (1000mg) for my dental/cleaning visits. I've not thought to test my INR more frequently afterwards, was told by Dr it should not affect it.
 

dick0236

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I can't remember a time when I was on an "exotic" antibiotic and none of the standard antibiotics have caused a significant change, up or down, in my INR. For dental visits, I have always taken Amoxicillin 1000mg with no effect on INR. I have asked the pharmacist a time or two if an antibiotic that my doc ordered would affect INR........so I pretty much knew if I could expect any changes.
 

Warrick

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I find the one off dose antibiotic dose for the dentist has no affect whatsoever, same as a couple of doses of paracetamol (Tyenol) on the same day doesnt but then if I take a couple of doses of paracetamol over a few days like last time I had a filling that ached for a few days my INR went up around 4.0,
so its a length of time thing too

As said dose changes should only be made according to the result of an INR test not hypothetical “may affect” guesses, gotta have the test numbers
 
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tom in MO

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Is there a way to know in general which antibiotics might affect your INR (and in which way - up or down?). Or is it a crapshoot, having to see how your body reacts?

I have to take Azithromycin (1000mg) for my dental/cleaning visits. I've not thought to test my INR more frequently afterwards, was told by Dr it should not affect it.
I do two things. First I ask the prescribing physician about it's effect on my INR. Then I call my cardiologist's nurse and she usually gets back to me in a day.
 

Superman

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I was infected with mycobacterium back in 2010 not long after my last open heart. They blasted me with every antibiotic they could in the hospital. IV stuff that made my whole body feel prickly. Wasn’t until a dermatologist figured out what it was that I was put on a long course of a consistent antibiotic. Regardless, INR was monitored as per usual. Response was to actual change, not in anticipation of a guessed change.

Recommend if the circumstances should arise again, ask your cardio or Coumadin clinic. Despite our knocks against them at times, they’re still better than the discharge Dr. Best response is, “Thanks for the guidance, I’ll confirm with my cardiologist.”

And, yes, sometimes it is a crapshoot how something may affect you.
 

Mister_James

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When you go to the dentist it is one huge dose at one time. It is not over a week as a most antibiotic treatments. So you don't need to adjust your dosage.
On the other hand of week long antibiotic treatment, i would ignore dose changes and test mid week and let that INR reading be my guide to dose modification.
If you start at 2.5 and you are stable, it will take some work to double your INR in a week at your regular dosage.
At anytime you take something that could potentially change your INR, the question is, is it a once off event which you can ignore. Like an extra helping of guacamole on cinco de mayo or its protracted like your spouse cooked extra helpings of dark green veggies and they cannot go to waste so you have a week of eating, then you make a slight adjustment to your total weekly dose.
My two cents.
 

Warrick

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Another few cents...
As much as “dr google” gets alot of flak, if you sift thru theres still plenty of good information on drug interactions and what has been clinically observed to interact with warfarin
 

slipkid

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I do two things. First I ask the prescribing physician about it's effect on my INR. Then I call my cardiologist's nurse and she usually gets back to me in a day.
Yeah, I have been through that and was told it will not affect my INR. But then my Drs have told me many things which have been 100% wrong. Don't get me started. Actually I may start a thread on a recent echo which makes no sense, blows my mind and may be entertaining for y-all.
 

jlcsn2015

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Sep 21, 2015
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Location
Toronto
Ah, didnt see this postings before, was looking for experiences in taking Antibiotics with Warfarin. I dont knwo yet what kind i will receive, but will know for sure next week after all lab results come back to the doctor;
 

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