Help!!!

[twinmaker]

OK Guys...I was sitting here on my computer when my nose started to bleed. I was going to test my INR later tonight, but decided to do it a little early. My INR is 6.0. I'm on Amoxicillin for my sore throat, cough, and UTI. My dosage on that is 1500 mg. twice a day. Right now my Coumadin dose is 12 mg. four days a week and 13 mg. three days a week. My INR last week was 3.6 and I was on 13mg. four days a week and 12 three days. So I actually cut my dose over the last week. I'm sure it's the antibiotics making my INR go up, right? I've only been on the Amoxicillin since Friday night. Should I hold my dose of Coumadin tonight? Thanks for any help. P.S. Also have a few bruises on me. LINDA

 

[Karlynn]

I would. If you started the amox on Friday, you'll probably be on it for another week? So it will continue to keep your INR up. So then the question is, what to do after today?

You are on a lot, so your INR will drop quickly. Al says that holding Coumadin will result in a reduction in INR of 50% in the first 48 hours.

So do you hold again tomorrow or what? If it were me, and nowing how my INR drops, I'd probably do 1/2 a dose tomorrow and then a 20% reduction the rest of the week, but I'd test again on Thurs. or Friday to see what it's doing.

I'm hoping others will weight in too.

 

[twinmaker]

Thanks Karlynn. I knew I could count on you to come to my rescue here. I haven't had an INR that high in quite some time. Just kind of threw me for a minute when I saw it. LINDA

 

[twinmaker]

Was just doing a little research, and have found where some studies show that taking Tylenol can also cause the INR to go up. I've been using Extra Strength Tylenol for my throat pain. Guess I should also stop that? LINDA

 

[geebee]

Was just doing a little research, and have found where some studies show that taking Tylenol can also cause the INR to go up. I've been using Extra Strength Tylenol for my throat pain. Guess I should also stop that? LINDA

Linda,
I have never found Tylenol to make a difference in my INR which is why I feel comfortable taking it. Hopefully Al will chime in on this one.

 

[Karlynn]

Thanks Karlynn. I knew I could count on you to come to my rescue here. I haven't had an INR that high in quite some time. Just kind of threw me for a minute when I saw it. LINDA

And of course, right at the time you're trying to convince your new cardio that you can handle home testing and dosing. Just an added plus to the whole experience.

 

[twinmaker]

Gina, I never had a problem using Tylenol either but I have been taking more than usual since I developed this sore throat. That's why I googled it to find out if it had anything to do with this.

Karlynn, Since I've been having to call the Coumadin nurse with my testing results, I always have MY dosing plan ready and tell her what I would do. I will do the same thing tomorrow when I call her. We'll see what she says. I can also tell her that I realize the reason for this rise. I just hope she doesn't freak out about it. Some of these people have a tendency to do that. LINDA

 

[Sagebrush]

Karlynn I agree!!

Karlynn I agree!!

I agree with Karlynn....and if the nurse gives you any greif tell her that she should only freak out if the inr is over 10 or 15...I think Al says your in real danger if your inr is around 20? Sorry I can't remember Al. I am sure he will be along shortly!!

 

[catwoman]

Linda:

Are you running a temp? Any dehydration?

Just in case it was a false reading -- did you retest?

 

[Ross]

Depending on how fast you drop, I'd withhold one dose possibly even two, drop the overall by a conservative 10% and retest in 5 days. Once over your antibiotics, go back to your normal schedule.

 

[twinmaker]

Marsha, I'm not running any temp. I was taking the Tylenol strictly for the throat pain. This is the worst sore throat that I've EVER had. Can't sleep at night because of it. It must be that it's viral because the antibiotic isn't touching it. My urinary tract infection is MUCH better though. The doc didn't do a throat culture. (My husband was upset about that). They did a urinalysis that showed the UTI and also cultured it. I asked about the throat culture, but they said I'd be on an antibiotic anyway for the UTI, so no need to culture the throat. They said my throat was only a little red. But I swear, I can hardly swallow. The soreness feels very deep down my throat. I'm getting ready to call the Coumadin nurse. This ought to be fun. Oh, and I am drinking fluids as much as I can. I don't think there's any real dehydration. Ross, I agree. I do want to be conservative on cutting my dose. I don't want to have to fight my way back up. LINDA

 

[twinmaker]

Ok, I talked with the Coumadin nurse and she didn't freak out! YEH! Anyway, we're doing half a dose tonight and then back to regular dose tomorrow night and then I'll retest and see where we are. Thanks for your all's help. I'm going back to bed. My throat is killing me. LINDA

 

[Guest]

I'd be suspicious of any "coumadin nurse" who freaked out over an INR of 6.

My guess is that it is not the amoxicillin that caused the high INR. It ius more likely that the sore throat caused you to eat less and that caused the high INR.

Tylenol can increase the INR but only if you egt up over 19 extra-strength doses in a week. Many of the websites that a google search will turn up quote Dr. Elaine Hylek on this subject. She did one of the main studies on this but was widely mis-quoted in the press, on CNN etc so don't put too much emphasis on those. I have had dinner with Elaine and discussed this with her.

 

[ALCapshaw2]

Ok, I talked with the Coumadin nurse and she didn't freak out! YEH! Anyway, we're doing half a dose tonight and then back to regular dose tomorrow night and then I'll retest and see where we are.

LINDA

WELL, this sounds encouraging.

Maybe after this is over, the two of you will decide to trust each other a little more and be able to arrive at a better working relationship. It just takes time.

 

[Karlynn]

Glad to hear the call went well. And the nurse is less cautious than me! Interesting point Al made about eating less. I can't take any penicillan-type antibiotic, so the only antibiotics I've take do jack up my INR.

And the nurse is probably more assured by you, when you told her you skipped last night's dose.

 

[RandyL]

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.

 

[catwoman]

Al:

Whew! I'm glad you don't suspect the amoxi. I occasionally take amoxi at high doses (4,000 mg several days in a row for scratches, bites) and haven't seen any increase in INRs. Drop/change in food intake does sound more like the culprit.

 

[twinmaker]

Al, that's a good point about the food intake. My food intake has dropped just because it's so hard to swallow. A couple of nights ago, it was hard to even swallow my pills, but I did choke them down. Soup does go down easier, so that's what I'm trying to eat. Can't taste much anyway. Maybe I'll lose some weight! LINDA

 

[Granbonny]

Linda

Linda

Send your Hubby down to the drugstore for a bottle of Tylenol Sore throat medicine....It helps for at least 4 hours. google it. and you will see how great it is. I bought it last year. helped me.. ....I have a sore throat at least once a year. this new medicine really worked for me.and didn't bother my INR... .Amox has never bothered my INR. Take it for dentist..so i don't think that is bothering yours..diet will..for everytime, I try to diet. Inr goes up.. ..Bonnie

 

[Guest]

So many warfarin educators lock in on foods and say don't eat this and that. I say that it is muchg easier to not eat and cause a high INR than it is to eat and cause a low INR.