Morning vs. evening anti-coagulation dose

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Keithl

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Seems all the recommendations are to take your warfarin in the evening. I see no scientific reason for this and find it easier to take my meds regularly in the AM. After 14 weeks I missed my first dose and realized it in the AM so used that as the trigger to move to morning dosing. Is everyone doing evening or have any of you moved to mornings?
 

wxman

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I take mine with lunch around noon. Don't think it really matters as long as you remember to take them every day. I have other pills in the morning and evening...so I take the warfarin and lipitor at noon.
 

dick0236

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I have always taken my warfarin in the morning......along with my small handful of other Rx's. The important thing is not to forget the pill so take it at an easy to remember time. A seven day pill box takes the mystery out of "did I, or didn't I, take my pill" ??
 

Keithl

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Yeah I use a 7 day am/pm box, and it easier to do the am pills since the box is on the kitchen table, but I’d on occasion forget evinced pills since we never eat dinner at the kitchen table. I moved to mornings now.
 

mecretired

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I think the primary reason for taking warfarin in the evening is to be able to do an inr check during the day and adjust the warfarin dose if necessary.
 

Protimenow

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It doesn't matter what time you take your warfarin. It's a slow acting drug -- it takes three days to get the full effect of a dose. Whether morning, afternoon, or evening, it really doesn't make a lot of difference - as long as you take your daily dose SOMETIME.

The effects of a dose you took last night will NOT show up in an INR you take today.

When you adjust your dosage, you're adjusting it to the dose you took a few days ago -- OTOH, if you changed your diet yesterday - perhaps eating more dark greens (or fewer) than usual, THIS may affect your INR. I've found that the effects of Vitamin K1 show up pretty quickly.
 

scott.eitman

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Mornings for me.

An anti-coag clinic I went to for a couple years had a sign on the wall stating to tell patients to take it in the evening. However, my Cleveland Clinic anti-coag clinic regularly asks if I have taken it yet when I get tested at 7:30AM
 

tom in MO

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Read the patient insert, it will always tell you if a drug has to be taken with food, a certain time of the day, or to avoid some things such as milk, alcohol etc. If I recall correctly, there is no such directions for warfarin.
 

Protimenow

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I don't think there were any instructions about taking Warfarin. I take mine at night. The important thing is to try to take it at about the same time each day.

I can't understand why a clinic would ask you if you've already taken your dose before testing - I'm not aware of a spike and then a drop after you take it. I'm not aware of any short term change in INR shortly after taking warfarin. Their question doesn't seem to make much senst to me.
 

Protimenow

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Sorry Scott - I interpreted 'asked if I had taken it yet' to mean BEFORE. I didn't think 'yet' meant the previous evening or day.
 

LondonAndy

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I agree that the most important thing is to take it at ABOUT the same time each day - I am not worried if I am an hour or two late, for example. Just that i have definitely taken it. And I greatly rely on my pillbox. My work can be very demanding, and I find I get distracted and can forget whether I have taken something or not, so the pillbox is invaluable. I keep a spare one now, as I would not like to manage without.
 

vitdoc

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Personally I take it in the morning after I eat breakfast. I don't think it really matters when you take it. However if you suddenly deviate from your schedule there might be some differences in the effect of the drug due to differences in absorption and the INR should be checked. Clearly the biggest issue is not the Warfarin dose but what you eat. So if one goes on a salad binge the INR will likely drop and more Warfarin would be needed. 36 years on Warfarin.
 

Protimenow

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I used to be concerned about the INR drop if I (rarely) binged on greens. In fact, I scared myself into using Lovenox injections to protect me during the time my INR was near 1.0.

However, I finally realized that if this was a one time binge, and my diet and activities remained otherwise consistent, my INR would return to where it was in a few days.

I don't think the risk of developing a clot on the valve, and having it travel to brain or lungs is worth worrying about if the INR is back in range within a few days. According to a study by the Duke University Clinics, it takes about a week or more with INR below range, for a TIA or other negative events to occur.

NOBODY wants a TIA (unless they're suicidal and desire this outcome), but a day or two under range probably isn't much to worry about, as long as your dosing remains consistent.

FWIW - when I was hospitalized in November, the hospital said my INR was 6.1. (I doubt that it was). They gave me a shot of Vitamin K, and it dropped below 2. I was discharged before they messed around with Lovenox.

Although my INR WAS in danger range, I was confident that taking my normal daily dose of warfarin would bring my INR back into range. In three days, it did. What I'm trying to say is that a low INR for a day or two shouldn't be considered to be too big a deal - normal dosing should return it to normal before it becomes a health risk.
 

Protimenow

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True. Even if I was suicidal, there are much easier ways to do it.

I know of a man who apparentlhy gave up hope, and stopped taking his warfarin. He had a massive stroke and spent many months vegetating in a nursing home until he finally got his wish.
 

Agian

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True. Even if I was suicidal, there are much easier ways to do it.

I know of a man who apparentlhy gave up hope, and stopped taking his warfarin. He had a massive stroke and spent many months vegetating in a nursing home until he finally got his wish.
That's terrible. The poor man.
 

Protimenow

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It WAS terrible. He had a very successful life before retirement. His wife was a really nice woman. Better home health care, regular testing to confirm that his INR is range, and maybe some psychological help for his suicidal thoughts and depression could have kept him alive quite a while longer.
Today, home testing by a visiting nurse could have detected that he was skipping his warfarin (as long as testing was weekly, and not less often).
 
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