Can't get my coumadin right!

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Consuela

Active member
Joined
Oct 7, 2005
Messages
43
Location
New York
I am new to the medication and go once a week for a reading.I had a valve replacement on December 13, 2005. I am feeling great and the depression I had, went away. I go once a week for my blood test and the readings are either up or down. One week, my readings were good (3.0). I thought I was on the right track, then the following week it shot up to 4.7! My doctor changes my dosage intake weekly, because of the erratic readings.
My question: How long does it take before readings will be in the range?
 
Consuela, it's so good to hear from you again! And really glad to hear the depression has passed.

It sounds like your md is making changes in your dosage that are too large, rather than the 10 - 15 % of weekly dosage recommended.

If you could share a little more information - like what's your range? What's your current dosage? What did your md have you do when your inr was 4.7 (did he have you skip a dose?) If we have a little more information those on the site who are coumadin pros can give you better advice.

Also - know that coumadin is a strange drug. But you should be stabilizing by now. In fact, most folks at 2 - 3 months out have trouble keeping it high enough because as they recover they are more active and coumadin is metabolized more quickly, requiring a bit higher dosage. It sounds like your inr is swinging wildly, which is why I suspect that your doc is changing doses too often or by too much.

Let us know the additional information.
 
Consuela- There are a lot of things that can affect your INR reading. A really great place to start to learn about this is a web site created by one of our own members who operates a Coumadin clinic. Al Lodwick is his name and we are lucky to have him. Go to www.warfarin.com and have a look see. In the meantime, we need to know what your reccommended range is, and how much your current dose is. Typically, the dosage adjustment for an INR in the 4.7 area would be to hold (don't take) your dose for a day, and then reduce your weekly dosage by 10%. This would be for a person with a 2.0 - 3.0 range. Be sure and read as many posts on this site as you can as it will help you to understand how to manage variations and get comfortable with the whole process.
 
Can't get my coumadin right!

Thank you both for getting back to me. I need to be in the 2.5 to 3.5 range.

I take 2.5 coumandin and 5.0. I have had many different ways of taking the medicine. I have taken 2.5 every day and 5.0 on Sunday. I have taken 2.5 every day. I have taken 2.5 and 5.0 every other day and so on. I also have been on 2.5 every day and 5.0 on Saturday and Sunday.
I also love my vegetables and salad. I told my surgeon and my doctor and they said eat them, but don't stop for one week and then say I think I will have a large salad. I any case, I would think that the Vit. K that is in salads and vegetables would make my INR go down. This is not the case. It spikes.
As I said in my last post, I had 3.0 as my reading last week and I was thrilled that maybe now I am going to maintain the count, but this week's reading was 4.7!!! I did nothing different with my eating, so I am puzzled.

I Have that website bookmarked (wafarin.com) and read it many times.
 
2.5x5=12.5+5x2=10 for a total of 22.5mg per week.

2.5x4=10+5x3=15 for a total of 25mg per week

2.5x6=15+5x1=5 for a total of 20mg per week.

Vit K is NOT making you spike and it will lower your INR. Something else is missing from this puzzle. Are you taking any antibiotics or some other drugs or herbs that may be making it rise? Another thought, are you having problems with water or fluid gain?

Diet plays a very small part in your INR. It would take an awful lot to upset the balance in the way of greens and such. I'm thinking your provider has you seesawing by changing doses every week. When it was 3.0, did they change the dose then?
 
Can't get my coumadin right!

Hi Ross,

No, I am not on any antibiotics and I do exercise by walking in the evenings. When it was 3.0, they left me on my dosage until the following week. I have no water retention. I feel great except for this see saw readings that I am getting.

Consuela
 
Do you remember what dose you were taking when it was 3? If so, I'd go back to that and make it two full weeks before testing. It's either because they are changing your dosing so frequently or it was simply a bogus test result. They are making small 10% changes, but I don't think they're giving it enough time to smooth out. the reason I say this is the small dose you are on. I would think your metabolizing the drug slower then most people do, so it takes a little longer for peak concentrations with you. I could be all wrong too, but that's my thought.

Al Lodwick may be able to pick out something were missing, so see what he has to say about it all.
 
I think that the attitude that "shot up" to 4.7 is contributing to this. Any value under 5.0 does not qualify for "shot up" status. I usually save that for 8 or greater.

I agree that it is probably the result of frequent dosage changes.

Doctors fear high numbers - bleeding.
People with valves fear low numbers - strokes.

There is no logic to fearing a high number more than a low number.
 
Hi Consuela,
I too have been see-sawing for the past few months (AVR 10/17/05). It's very frustrating, I'm either bruising myself or fearing a stroke, not a good way to be living a daily life that's for sure. Thank goodness for this site because I would be totally lost without it and it's where I go for all my questions, information, and just to check that I'm not going crazy (always debatable! :D ) I'm supposed to be in the 2.5-3.5 range. Most recently my INR was 4.7, my GP told me to skip 3 days!!! From the fine, intelligent, caring and very knowledgable people on this site, I knew that was very bad advice. What I ended up doing is skipping a dose for 1 day, then went back to my regular dose for the remainder of the week. My latest INR level? 2.2. I'm thinking that I'm very sensitive to skipping dosages and next time I would be more inclinded to reduce my dose by 1/2 rather than skipping. My GP then told me to up my dose to 8mg from my usual 6 1/2. I then went to the chart that I got off of this sight and figured out what to do with my dosage. My weekly dosage is 6.5 a day x 7 days=45.5mgs/week. According to the chart, with an INR in the 2.0-2.4 range I should increase the weekly dose by 5-15%. I chose 10% just because it was in the middle. So that would mean, 45.5 + 4.6 =50.1. 50.1 divided by 7 days=7.15 or 7.2 mgs/day. I'm going for my next INR around Wednesday of next week to give myself a chance to stabilize a bit.
I'm seeing my GP on monday and my cardio on Tuesday. I'm bringing the dosage chart with me to my GP and I'm going to talk with him, yet again, to support home monitoring, it may be a losing battle. I think the most important thing is for you to educate yourself, be your own best advocate, and constantly research this site for the answers to your questions, suggestions for your "next steps," and of course to participate in the fellowship that is available 24/7. Take care of yourself. Linda
 
Just a comment

Just a comment

You have received great advice here. One thing I think every pt. should do if they are having trouble staying in range is to track their INRs and their warfarin dosage. My best bet would be that if you did a correlation and regression analysis of some long term data, the results would show a grouping of average data point about the middle of your target range, meaning that in most cases, your proper dose should be an average of all the highs and low dosage amounts.

For years my doctors would make changes to my doses when one test showed my INR was just out of range. Then I would spend the next several months being wiped-sawed back and forth with more test and more changes.
When we finally got it steady, we settled on the same dose I was on before we started to make the change.

Now, my dose has remained the same for about six years, except for (special events). My INR is sometimes out of range, but never by much. I may eat a little more or less greens depending on which way I want my INR to go and that seems to be enough. As any dietitian will tell you, one of the keys to good health is eating a balanced diet everyday, so actually my warfarin usage has forced me in to better health habits. Wow- I bet nobody ever said that about warfarin therapy!:eek: :rolleyes: :D
 
can't get my coumandin right!

can't get my coumandin right!

Thanks for the info Linda. I see your dosage is higher then mine. We have only been working on 5.0 and 2.5. I had my valve replacement on December 13. They have me doing 2.0 and 5.0 in so many different combinations. I too, think that my doctor is changing my dosage too often, but since I go once a week, this has to be.The one time that he left my dosage the same, it spiked. That was after the 3.0 reading.
Since I am away from home right now and will be back home in May, I go to the labs here and they fax the results to my doctor. I do keep a record of every visit and the result and the combination of the dosage.
When I get home, I will make copies and go to see the cardiologist and get his feedback. Right now I try to eat healthy and walk everyday. I do feel great, except for this coumadin see saw.
 
Consuela just because you test every week doesn't mean they have to change the dose every week. I honestly think they need to stop playing with you and, put you on the medium dose (22mg Per Week) and leave it that way for 2 weeks, then see what is going on. It's never going to stabilze if they aren't giving it enough time to do so. Just my thoughts.
 
Linda - I know that I react poortly to skipped doses too. It sounds like you are learning fast. If you take too much of a change from the 10% solution, then next time try the 5%. Some doctors think that if they are going to make a change, they need to make it look good enough. Most would probably scowl to find that there are times, at 69 a week, when I will adjust down or up only 1 mg a week. But that seems to do the trick for me. But since I've learned to not be afraid to finesse my dose a little, I find I rarely have to change it.

Much like diabetics need to learn how they react to their insulin doses, so do we need to learn how we react to change in our warfarin doses.
 
up down up down

up down up down

Wow....It's like dejavu. Wishing you the very best and I believe that your coumadin levels will eventually level out to your normal range. I struggled with this same problem (still do) but thanks to everyones help here (Thanks to you too Al Lodwick:D) I'm able to understand things much better. Good luck to you;)
 
Ross said:
Consuela just because you test every week doesn't mean they have to change the dose every week. I honestly think they need to stop playing with you and, put you on the medium dose (22mg Per Week) and leave it that way for 2 weeks, then see what is going on. It's never going to stabilze if they aren't giving it enough time to do so. Just my thoughts.
Click to expand...

My thoughts , too !
 
can't get my coumandin right!

can't get my coumandin right!

Thank you all for your input. I will talk to my doctor. I am so glad to get your responses.
 
Three weeks and I am staying within my guidelines!

Three weeks and I am staying within my guidelines!

I am finally getting good readings. It is almost a month and my readings are good with the Coumindin. I skipped two weeks and gave the medicine a chance to work and it's been good. The one change is that I am walking 2 miles in the morning in addition to my evening walks. Could the exercise be doing it? Thank all for your comments.
Consuela
 
Increased excercise can lower INR because more blood is passing through the liver and being filtered.
 
Another thing you may want to do is order Al Lodwick's "Dosing Guide (cost is only $5)" from his website www.warfarinfo.com Depending how receptive your Doctor is to patient provided information, you may even want to show it to him / give him a copy.

Doctors are notoriously poor at regulating Coumadin if they don't have many patients on it. Real Coumadin Clinics are much better, and believe it or not, HOME Monitoring and Adjusting (usually) produces the BEST stability, once the patient has a good 'feel' for how they react to dose changes.

BTW, the SAFE Range for INR is considered to be between 2.0 and 5.0 so your 4.7 wasn't really 'alarming'. Below 2.0 the risk of STROKE goes up linearly and above 5.0 the risk of BLEEDING *MAY* go up, but is 'usually' not serious until it exceeds 8.0. Al Lodwick's Dosing Guide explains what to do at each level.

'AL Capshaw'
 
I will say that I think it is totally foolish to take different doses on different days of the week. As far as I can tell we are trying to maintain a weekly or bi monthly reading. It does not make any sense to me for Doctors who have you taking different doses for different days, besides who can rember this stuff?

I am no expert but I would try to keep the dosage stable for a week or 2 and then retest and go up or down in small percentages of your total weekly intake. Divide your new dose by seven and there you go. I got the chart from Al and I no longer call my Doctor.
Good Luck
 
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