Missed dose

[psalmist]

I missed my dose (I have been taking it around 10:00pm. What should I do? its 6:00am now. My INR was in range on the low end

 

[Ross]

Well you can either just forget it and resume schedule or take half of the missed dose with todays and tomorrows dose or take 2 doses tonight. You could also just take the missed dose NOW. It'll all work out in the end.

 

[ALCapshaw2]

I also take my Warfarin just before bedtime. On those (rare) occassions when I discover I forgot to take my Warfarin,
I just take the full missed dose immediately. If it has been less than 12 hours, I just continue my usual dosing schedule.
If over 12 hours, I break the next dose in half, taking a half dose that evening and the other half the next morning.
Using this method will restore you to your normal Weekly Allocation in 2 days minimizing the chance of going into the 'rollercoaster' effect caused by over or under dosing.

AL Lodwick, RPH and Certified AntiCoagulation Care Provider, once posted that "in his opinion", a Double Dose taken one time probably would not cause a problem. At one time, some Doctors / providers would Double Dose when starting (or re-starting) anticoagulation after discontinuation.

'AL Capshaw'

 

[Bina]

I would do a half dose this morning, and regular dose tonight.
Hope you are well Seth.

 

[prdraper1]

Forget about it and continue as usual at 10:00 p.m.DO NOT TAKE 2 DOSES or alter your routine. his was the advice given to me by my doctor when I forgot. My INR was not affected when I next had it checked.

 

[ALCapshaw2]

Forget about it and continue as usual at 10:00 p.m.DO NOT TAKE 2 DOSES or alter your routine. his was the advice given to me by my doctor when I forgot. My INR was not affected when I next had it checked.

The Down Side of the "Forget about it" recommendation is that you are then in the position of having Skipped One Dose which can lower INR, especially in High Metabolizers.

With the method I outlined above, normal dosing is realized after 3 days without Double Dosing.
I would like to emphasize the importance of taking the Missed Dose ASAP since that will Stop the INR drop due to the missed dose. Waiting until the next night to do anything only exacerbates the drop in INR.

Breaking the next dose in half is easy, it prevents Double Dosing, and minimizes the spike (in either direction). That's why I have gone to this protocol after playing with several mathematical analysees trying to spread the missed dose over up to 3 days.

Edit: One more argument in support of the protocol I now use:

INR tends to Drop Faster than it Rises, especially for high metabolizers (who typically take larger doses).
Taking the FULL Missed Dose as soon as you recognize that you missed it helps to reverse that fall.
Splitting the Next Dose and taking it over the next 24 hours spreads it out so that you are not Double Dosing at any given time.
FWIW, the well-trained CRNP (Certified Registered Nurse Practicioneer) I see at my Coumadin Clinic concurred with this protocol.

'AL Capshaw'

 

[psalmist]

Thanks guys. I appreciate the help. I took a partial dose this morning. I do metabolize fast.

 

[Ross]

Seth in the end, it'll always work out no matter which way you go. Don't sweat it.