Negative ramifications of taking higher doses of coumadin?

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Jiddo

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Joined
Jun 2, 2007
Messages
139
Location
San Francisco, Bay Area
Hi All.

I think I know the answer to this but just wanted to make sure. I know everyone takes different doses of coumadin to be in range; however, are there any negative ramifications if you are one of those people that have to take a lot of coumadin to be in range? In other words, are side effects or risks worse with the more you take?

I spoke with a lady who is taking 4 mg/day and she was surprised to hear that my dad takes 12.5 mg/day. That got my mom a little nervous so I thought I would double check.

Thanks.
Jennie
 
Negative ramification of taking higher doses of coumadin?

Negative ramification of taking higher doses of coumadin?

I have been taking 12 mg of warfarin for over a year. After my AVR surgery in November of 2005, my dose continued to be increased until my INR was in range. I think the question has been asked on this site, "What is too much coumadin?" The response was there is no such thing as too much coumadin. It's whatever your body needs to keep your INR within therapeutic range.

I commented to my internist last year about the large dose of warfarin I was taking on a daily basis. He said that was a good thing because that meant my body/liver was metabolizing the warfarin quickly. Has anyone ever heard that explanation? Anyway, tell your mother not to worry about your dad's 12.5 mg daily dosage. I've experienced NO ill side effects from taking 12 mg daily.

Susie Q
 
Hon no. Your dads liver is metabolizing the drug very quickly and some peoples do. You can ask Christina, I think she's on like 23mg a day, the most of anyone I know, but this is what is required to maintain range.
 
SusieQ - yes, I have heard that. The internist is correct.

I had one Coumadin "manager" (before home testing) that looked at my dose and said "We need to try and figure out how to get your dose lower. You're taking an awful lot." I asked to never see or speak to that manager again.
 
I've always had trouble staying within range, but the usual dose is 12mg. Lately though, since being on a renal type diet and eating green things more than I ever have, my current dose is 14-16 until I get back in range. Being that high and the lovenox kind of bothers me.
 
Peggy, being on that much Coumadin shouldn't bother you in the least, particularly if it gets you in range. I can't speak to Lovenox, as I've never been on it.
 
PeggyM said:
I've always had trouble staying within range, but the usual dose is 12mg. Lately though, since being on a renal type diet and eating green things more than I ever have, my current dose is 14-16 until I get back in range. Being that high and the lovenox kind of bothers me.
If 14-16 is what it takes to keep you in range, then don't let it bother you. Now taking both together, that would bother me.
 
Karlynn said:
Peggy, being on that much Coumadin shouldn't bother you in the least, particularly if it gets you in range. I can't speak to Lovenox, as I've never been on it.

Karlynn, it just seems so unreal to me that you have never had to experience the lovely Lovenox! No eggplant belly or anything!:)

Jiddo, you've gotten some good answers here and I hope your mind is more at ease as well as your mom's.
 
As I understand it, we all metabolize Coumadin / Warfarin at different rates, hence different doses.

One comment that I have seen in posts is that Fast Metabolizers (i.e. people on high doses) then to have their INR 'Drop like a Rock' when told to "Hold a Dose".

Too many (non-heart) Doc's ask patients to Hold a Dose (or several) for various invasive procedures. Often this is NOT necessary (such as for most dental procedures).

Too many (out of date) Coumadin / Warfarin managers suggest "Holding a dose" for slightly elevated INR's. Most of us think that cutting back (i.e. taking no less than 1/2 a dose) is the appropriate response to a high INR that is below 5.0.

'AL Capshaw'
 
bvdr said:
Karlynn, it just seems so unreal to me that you have never had to experience the lovely Lovenox! No eggplant belly or anything!:)

Being 32 when my valve was installed has probably helped me go this long without Lovenox (meaning no procedures). I'm not delusional enough to think I can go forever without the Lovely Lovenox experience. I'll look to those of you "in the know" to guide me through.:)
 
People who take alot of coumadin daily to keep themselves in range do drop quickly when told to hold the dose "few days".Yes usually the healthy high exercise eat right people tend to have a higher mg daily dose as they do process the coumadin faster due to healthier livers. Those kind also can cut their INR in half by just holding for 1 day.They drop fast!!As far as side effects go with high doses, I think someone has mentioned the osteoporosis factor. Taking a high quality calcium can override that.Finding a good natural one with 2-3 kinds of calcium blend along with some vit D,boron,phosphorous,and magnesium would be a good choice.This does NOT include the synthetic junk out there folks!! Taking a VERY high protein diet can sometimes pull calcium out of the bones so variety and balance is important in your diet. Side effects of course with coumadin itself would be "too high-too low" bleeding/blood clots problems.
 
Jennie, I take 2.5 to 3 mgm/day average total 19 to 20 a week. I was 72 when I started. My doctor wanted me to take at least 5 mgm daily after the surgery. I discovered early that on this dose my INR ran above 5 into 6 and 7. I quickly reduced my dose, told my doctor I would no longer follow the instructions from his office, and a few weeks after surgery received my first Coaguchek.I've self dosed ever since and would advise all patients to do so if they can. A review of the literature revealed several papers documenting that old people are sensitive to warfarin and cannot be dosed like young vigorous patients. At that time the nurses in my doctors office who ran the anticoagulants followed a "one size fits all" algorithm. I hope they are doing better now. Marty
 
Check out vitamin K

Check out vitamin K

Jennie:
Did you know that our bodies make Vitamin K? Now that your dad is healing and regaining his health, his body is likely to be making more Vitamin K. This means that his INR will be lower and he will need more Coumadin to keep his INR in range. For more info on the three types of Vitamin K, see below. I think the last paragraph might be most helpful to you.

Someone should report that woman who is regulating your Dad's anticoagulation. She is misinformation could well be dangerous. Additionally, when she tells this to new patients, like your dad, she is probably scaring the heck out of them. The anitcoagulation clinic is not a place for one who has the competence of ignorance.

Regards, Blanche

Vitamin K
Vitamin K is important to help support proper coagulation (blood clotting). The liver uses vitamin K to synthesize blood-clotting proteins. Without vitamin K, the level of the blood-clotting proteins drops, and clotting time is prolonged. Vitamin K has also been recognized for its role in helping to maintain the health of bones. There are three types of vitamin K:

Phylloquinone, which was discovered in Denmark and termed vitamin K for the Danish word koagulation, is the natural vitamin K found in alfalfa and other foods. It is known as K1.

Menaquinone, produced by intestinal bacteria, is K2. Menadione, a synthetic compound with the basic structure of the quinones, is K3.

Vitamin K is found in dark leafy greens, most green plants, alfalfa and kelp. Blackstrap molasses and the polyunsaturated oils, such as safflower, also contain some vitamin K. Animal sources of vitamin K include liver, milk, yoghurt, egg yolks and fish liver oils.

Absorption of vitamin K takes place primarily in the upper part of the small intestine with the help of bile or bile salts and pancreatic juices. It is then carried to the liver for the synthesis of prothrombin, a key blood-clotting factor.

Since natural vitamin K (K1) is fat soluble, it requires bile and pancreatic juice in the intestine for optimal absorption. In contrast, some of the synthetic vitamin K compounds (K3) are water soluble and more easily absorbed. So people who do not tolerate natural vitamin K, such as those with decreased bile acid secretion, may find K3 helpful.

Menaquinone (K2), which is produced by intestinal bacteria, may be the most beneficial source of vitamin K. This is why vitamin K supplementation may be particularly important for those whose normal balance of intestinal bacteria has been disrupted.
 
Was on 15mg for years

Was on 15mg for years

I have dropped down to 10mg 5 days, and 11mg 2 days a week. I am much less physically active these days, and some of it may be age, but I'm not metabolizing it as fast. When I'm more active I do have to boost the dose a little. I'd guess I was on 15mg per day for about 15 years, and never noticed any side effects:) Brian
 

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