Inr readings

[bigsidster]

HELLO ALL (my range is 2.0 to 3.0)

My INR on DEC 24 was 2.6 right where I like it.On DEC 28 it dropped to 2.1 but still in range.I think the reason for the drop was that I had a fever and the start of pnemonia and was on Levaquin for 2 days prior to test.I was retested on DEC 30 and was 2.0 .My doctor had me on 6 mg of coumadin all through this.On Jan 4 I tested at 3.0 taking 6mg and on JAN 12 I tested 3.9 on 6mg.The doc has me now on 5mg until next test.Is the levaquin that bad.I have been off the levaquin since jan 6.

 

[ALCapshaw2]

Anti-Biotics are KNOWN to affect INR readings, and typically cause them to rise.

Ask your Pharmacist about the amount of interaction between Levaquin and INR or check one of the on-line Prescription Drug Websites.
Most have an option to check for interactions between drugs (e.g. Levaquin and Warfarin, etc.)

'AL Capshaw'

 

[Protimenow]

When is your next test scheduled? If you've been on 42 mg/week (6 x 7), then dropping you to 35 (a 14.14% drop) may be a bit much. If your test is some time next week, I wouldn't stress about it, but if you're not scheduled for another test for two or more weeks, there's a possibility that your INR may drop below the safe range.

What dosage were you taking before you started the antibiotics. It's not unlikely that, if you were taking 5 mg/day before you got sick, then going back to the dosage now that you're feeling better and not taking antibiotics may bring you to the range you were in before you got sick.

Of course, if you had your own meter, you can check your INR in a few days or a week, if you aren't getting a blood draw at your lab, and be able to tell where your INR is. (And even if you ARE set to get a test at your doctor's office or a lab, it would probably STILL be easier to do a finger stick test yourself).

 

[normofthenorth]

Sid, it sounds as if you're doing one INR test per week, which may be about right for straightening it out now. If you wanted to, you could probably do two draws a week for a week or two.

My team set me up for 2 tests per week "until further notice", for some reason -- though I've actually made it to the lab more like once per week, esp. through the holidays, when they were closed so often (and it was mostly bitter cold, too!).

 

[ALCapshaw2]

Sid,

I'm confused about your dosing schedule.
Were you taking 6 mg all the time when your INR went from 2.6 to 2.1?
When did you change to 5 mg/day?
It would help to see your Daily Dose listed by date along with the INR test results (by date).

It's not clear to me why your INR Dropped.
I suspect the Levaquin caused your INR to go up.

'AL Capshaw'

 

[bigsidster]

My INR was 2.6 and the doc had me go from 6mg to 5 mg for 2 days then test agian and I went down to 2.1 so she raised it back to 6mg.I started with a fever and was put on antibiotics (Levaquin) and was taking 6mg and tested 3.0 after a week.With a 3.0 INR the doc lowered me to 5mg again for 2 days and then back to 6mg.After a week I tested 3.9 but was also introduced to NIACIN 2000mg by my cholestrol doc who knows I am on coumadin.I took the Niacin for the whole week before testing and was taking 6mg.Now the doc has me on 5mg for 2 days and get tested on Jan 13.

 

[Freddie]

IMHO there was nothing wrong with a 2.6 result and your dosage shouldn't have been changed to 5mg for 2 days.

What would really help, if you can provide it, is your total dosage per/week and when you started the new prescriptions.
Example:
6mg, 6mg, 6mg, 6mg,6mg, 6mg 6mg = 42mg/wk = INR 2.6
6mg 6mg 6mg 5mg 5mg 6mg 6mg = 40mg/wk - INR 2.1
Started antibiotics with a dosage of .............

So you test again tomorrow, when did you take the first 5mg for this week? Allow 3 days for that first 5mg to start working, I'm thinking you should have taking it on Monday with the second 5mg on Tuesday. Other wise that dosage change may not show up tomorrow.
Are you completely done with your antibiotics?

Sounds like you might be a candidate for alternating 5 and 6mg; such as, 6mg 6mg 6mg 5mg 6mg 6mg 6mg = 41mg (btw which is exactly what I'm taking)

Sorry for my rambling, hope it makes sense.

 

[Protimenow]

Freddie: It sure didn't seem to me as if you were rambling. Your post was probably equal to some of my shorter ones.

You're of course correct about the length of time it takes changes in warfarin dosing to show up in the INR. (Diet can make changes more quickly, but I won't get into this).

Sid: A test tomorrow will show what your INR is at the time the blood is taken, but it won't show the full effect of yesterday's 5 mg dose. Perhaps this is what the doctor wants - just to see where the INR drops. However, with all the things you've gone through in the past month - antibiotics, niacin (which may have no effect on INR - but I don't know either way), etc., it's no surprise that your INR hasn't been stable.

Once everything is back on track, you should again be able to keep your INR well within range.

As long as your INR doesn't drop into the 'danger' range (below 2), there shouldn't be a lot to worry about. (I suspect that tomorrow's test will confirm that you're still above 2.0)

 

[normofthenorth]

From some quick Googling, it isn't obvious to me that Niacin has an effect on INR, or that it has any serious interactions with Warfarin, either. One study at http://www.medscape.com/viewarticle/409200 seemed to give one or both to a group of patients, and discusses the results in the RESULTS section -- but it looks pretty boring to me. I don't think I'd worry about the Niacin, Sid.

 

[bigsidster]

Thanks for all the replies .We will see what new INR is on Friday---I test on Thursday and get results friday.Since december 17 I have taken 6mg of coumadin and the doc has changed this to 5mg for 2 days then back to 6mg depending what the readings were.26 days have passed and i was on 5mg for only 5 of those days and 6mg all the rest.Levaquin started Dec 26 and ended jan5.Niacin started Jan 6 2000mg a day.Since dec 17 I have been tested 5 times----test dec 16 was 2.1 and dropped to 1.9 was 5mg now go to 6mg-----dec 21 tested 2.4 on 6mg and continue 6mg----dec 23 test 2.6 was 6mg drop back to 5mg for 2 days then back to 6mg.--Dec 29 Test 2.1 stay at 6mg----started Levaquin dec 27 for 10 days---dec 31 test 2.0----continue at 6mg-----Jan 4 tested at 3.0 on 6mg drop to 5mg for 2 days and then back to 6mg.-----jan 5 started 2000mg of Niacin------jan 11 tested 3.9-on 6mg---drop back to 5mg for 2 days then retest.

PS---going to Florida Feb 10 to May 1 and then when I get home I am going to lokk into getting my own testing equipment.

 

[Protimenow]

Sid:

A couple things:

If you'll be gone for nearly three months, how will you monitor your INR? Doesn't it make more sense to get your meter NOW so you can bring it with you and monitor your INRs when you're in Florida? There's probably still enough time to get meter and supplies, and being able to test on your own will probably save you some hassles that you might run into in Florida. InRatio and CoaguChek XS strips don't require refrigeration and should travel well.

From your INR results, it almost looks like you've hitched a ride on the INR roller coaster. Did your doctor tell you what range he prefers for you? It looks as if he drops your dosage when you get near 3.0. It looks as if 5 mg twice a week (Tuesday and Thursday? Monday and Wednesday? Monday and Thursday?) may have been the most effective at keeping you in range.

I'm glad to see that you were able to tolerate that much Niacin. I couldn't (my skin got red, felt hot, and I developed a rash). There are other OTC medications that can help reduce cholesterol, without resorting to statin drugs -- if you develop a sensitivity to Niacin, send me a private message and I'll tell you more.

 

[Freddie]

PTN - depending on what kind medical/travel insurance Sid has/gets, he can tested in Florida with no charge.

 

[Bina]

Mr. Big, your docs are clearly over reacting to your INR readings.
Even the 3.9 would have probably straightened itself out after a couple of days with NO dose change,
Micro managing is useless....I don't alter my doses for little blips.

 

[Bina]

PTN - depending on what kind medical/travel insurance Sid has/gets, he can tested in Florida with no charge.

Yes, and hopefully he can find a good weekly dose and stick with it.

 

[Protimenow]

Bina:

It looks like he probably HAD a good weekly dose before he got sick and started with the antibiotics.
It's also good to assume that he'll find a clinic near where he'll be in Florida and the insurance will provide 100% coverage. It sounds like he's gone to Florida a few times in the past, so he probably knows whether or not bringing his own meter is worthwhile (although this may be a good reason to get one, regardless of how close the clinic is and what kind of coverage he has).

 

[catwoman]

From some quick Googling, it isn't obvious to me that Niacin has an effect on INR, or that it has any serious interactions with Warfarin, either. One study at http://www.medscape.com/viewarticle/409200 seemed to give one or both to a group of patients, and discusses the results in the RESULTS section -- but it looks pretty boring to me. I don't think I'd worry about the Niacin, Sid.

I've been taking 1,000-2,000 mg/day of niacin for nearly 1 year -- no effects on my INR whatsoever.

 

[bigsidster]

HELLO ALL

Got tested again yesterday and results today are 2.8 INR and doc wants me to continue at 5mg.What do you think?I was taking 6mg a day and went to 3.9 because of antibiotics.Was lowered to 5mg for 2 days and tested 2.8.If i stay at 5mg like she wants wont I go down toward 2.0 and have to go back to 6mg.Would it not be better to alternate 6mg ,5mg,6mg,5mg,6mg5mg,6mg for the week/

 

[Freddie]

Sounds like a good idea to me - You won't know until you try. That would give you a total of 39mg for the week. What was your total mg this past week?

 

[Bina]

HELLO ALL

Got tested again yesterday and results today are 2.8 INR and doc wants me to continue at 5mg.What do you think?I was taking 6mg a day and went to 3.9 because of antibiotics.Was lowered to 5mg for 2 days and tested 2.8.If i stay at 5mg like she wants wont I go down toward 2.0 and have to go back to 6mg.Would it not be better to alternate 6mg ,5mg,6mg,5mg,6mg5mg,6mg for the week/

I am quite sure that staying on 5mg daily will put you too low again, which is really not a good place to be.
They really should have left your dosing alone when you were at 3.9 but that is history now.
Either alternate 5 and 6 mg or I would even go back on 6 mg daily and enjoy my salads as usual.

 

[ALCapshaw2]

Jan 4 tested at 3.0 on 6mg drop to 5mg for 2 days and then back to 6mg.-----jan 5 started 2000mg of Niacin------jan 11 tested 3.9-on 6mg---drop back to 5mg for 2 days then retest.

Sid -

It would be easier to see exactly what is going on if you listed your dosing / testing / INR / changes by Date as below

Jan 4 6 mg
Jan 5 6 mg
Jan 6 (what days did you take 5 mg?)
......

Jan 13 ? mg INR=2.8 Doc sez change to 5 mg/day

*Assuming* you took 6 mg for 5 days and 5 mg for 2 days before testing, that comes to 40 mg/ week
At 5 mg/ Day you would be getting 35 mg/week which is a 12.5% reduction in dose.
That is not unreasonable *IF* the above 'assumption' about your dosing is correct and the effect of taking the 5 mg tablets was fully reflected in your latest tests. It will *probably* take you lower than your 2.8 reading which is a perfectly acceptable place to be. Many of our members actually prefer to be at the high end of their target range to give them a wider margin for preventing STROKE (INR too Low). If I remember right, the Bleeding Risk and Stroke Risk lines cross over each other around INR 2.5

Alternating 5 and 6 mg would be a more conservative approach that would be less likely to take you too low.

'AL Capshaw'