Please tell me I am doing this right..

[chris.c]

I have a question here: My wife and I would buy liver 6-8 times a year and have a treat of liver and onions with mashed potatoes. Now liver is high in vitamin K. So somewhere down the line i would like to have this treat again. So i understand what this person was saying about taking extra coumadin 2-3 days before the splurge. So how should i tackle this splurge? I don't want my INR to drop so low as to throw a clot and this is not a normal everyday meal. Any advice other than don't eat liver ever again........

 

[dick0236]

Don't change your dose based on what you might eat, or how it might affect your INR if you do eat it. Enjoy the liver and onions every once in a while, just don't make it a regular part of your diet. If you decide you want it several times a month, you might, or might not, have to increase your routine dose a little. Trying to "anticipate the warfarin affect" will drive you up the wall.....and may create unecessary problems.

 

[Bina]

I have a question here: My wife and I would buy liver 6-8 times a year and have a treat of liver and onions with mashed potatoes. Now liver is high in vitamin K. So somewhere down the line i would like to have this treat again. So i understand what this person was saying about taking extra coumadin 2-3 days before the splurge. So how should i tackle this splurge? I don't want my INR to drop so low as to throw a clot and this is not a normal everyday meal. Any advice other than don't eat liver ever again........

I don't know what your testing schedule is, but I would try the liver dinner and then test my INR within 24 hours just to make sure you
are still in range. If all goes well, then don't worry about your treat But don't try to predict any changes are you will get bitten in the butt.

 

[lance]

Chris
Enjoy your liver and onions as you always have.
I eat liver and onions and have never had a problem.
And please don't increase your dose of warfarin without knowing what your INR is.

 

[Protimenow]

Being below 2.0 for a day or two will NOT make you throw a clot, according to some of the studies that I have seen. Increasing your warfarin in advance of a meal that may be high in Vitamin K is not the way to deal with this.

If your INR is low for a week or longer, your risk of a stroke increases -- but for just a day or so, I wouldn't worry about it.

If you have a meter, it certainly wouldn't hurt to test the day after your meal, but I wouldn't obsess about being below 2.0 for a day or two. The effects of Vitamin K wear off pretty quickly.

 

[catwoman]

Being below 2.0 for a day or two will NOT make you throw a clot, according to some of the studies that I have seen. Increasing your warfarin in advance of a meal that may be high in Vitamin K is not the way to deal with this.

I agree -- do NOT adjust your dosage beforehand. What would happen if you did NOT eat the liver & onions? Best to adjust based on a test, not on what might or might not take place.

 

[Superman]

What I find frustrating about the clinic is when they try to make a permanent dose change based on what I know to be a one time or infrequent dietary change. I've had many consecutive weeks at 2.7 INR. My clinic thinks I'm on one dose, and I've stopped correcting them. I take 5 a day. They, for some reason, insist that I take a 7.5 on Friday's because I made a one time correction based on a low read due to a dietary impact (vacation, all you can eat salad bars for a week!). I knew I wouldn't be getting all you can eat greens at home, so when my next test was back in range I told them I'd be going back to my old dose. Which I did, and I've stayed in range ever since. So every week they leave a voice mail regarding my test results to continue with 5 mg daily and 7.5 mg on Friday.

Confession time. I have done what the OP discusses on occassion. Had a lot of greens with dinner (and leftovers for a couple days) and took a 6. No problem. Stayed right in range three days out (ready for lectures). I would be less inclined to do this if I were already at the high end of my range, but I prefer to stay at the low end of a 2.5 - 3.5 recommended range. No logic to it - just passes the sleep at night test. I figure even if I'm wrong - a 1 or 2 mg adjustment on a weekly 35 mg dose won't throw me out of the high end. Kids, don't try this at home.

 

[Protimenow]

You might ask your clinic why, if they want you to have 37.5 each week, you shouldn't just take 39 MG on Friday, and 1 mg every other day? They should know enough to try and spread your dosing out for a week, so that your daily doses are almost equal. It would make more sense to have you take 5 mg EVERY DAY, and an extra 1 MG on Monday through Friday than it does to take 7.5 one day and 5 the rest. Your INR would change, based on the day that they run the test.

I'm amazed that some doctors and clinics still seem to not realize that a ONE TIME change won't have an effect 5 or 6 days later, and that making daily dosing almost even, day after day, is a more logical way to manage INR.

As for taking 6 mg one day and 5 the rest -- this is really a pretty small change, if you compare it to a 7.5 one day and 5 the rest -- if you didn't eat greens or suspect that your INR may have dropped because of dietary changes - the worst that this would do would be to put you near the top of your range (which is probably still a pretty safe place to be).

Personally, I don't mess with my daily dose unless my meter shows a real problem (and it seldom does). If I'm below 2 for a day or two, or around 4 for a day or two, I just rely on my body to adjust its way back.

(I had a TIA - aka STROKE - in April, but this was because I wasn't testing as frequently as I should have (I was running out of strips and couldn't afford more), and because I was relying on my meter to be accurate (a 2.6 on the meter was actually below 2.0 in the lab). But - being below 2 for a day or two shouldn't be an issue, according to some recent studies)

 

[Freddie]

Superman, you know that if you were to aim for a higher INR within your range, you'd have more room to enjoy the higher K foods without any worry of dropping below 2.5.

JM2CW

 

[mecretired]

Protimenow, I certainly agree with your last post. I have gone round and round with my coumadin clinic about taking an "even" dose each day. I take 10mg 5days/wk and 7.5 the other 2 days(65mg/wk). I just CANNOT believe it doesn't make a difference. If the daily dose didn't matter (only the weekly total) why not take 59mg 1 day and 1mg on the other 6 days? I see my cardiologist next month and will take it up with him? It seems, to me, that there is a big difference in the 10mg and the 7.5mg.

 

[Protimenow]

I think that it only makes good sense to take your total weekly dose and divide it by 7, so that you can take the SAME dose daily. With the many different dosages available - from 1 mg pills that you can split in half, to 2, 2.5, 5, 7.5, and probably others, it shouldn't be too difficult to tailor your daily dosing to be almost the same every day. With generic warfarin available at about a dime a pill, the cost of taking two pills (or two half pills?) a day isn't that high.

OTOH -- the scenario that you describe - taking 5 mg five days and 7.5 mg two days isn't that terrible, either. If you do the 7.5 three or four days apart (maybe Monday and Thursday or Friday), the effects should be fairly balanced all week. In the past, I've done something similar, taking one dose on days with at 'T' in their name, and another dose for all the other days. The idea is to try and do the same dose every day - but to try and keep it simple (or to use a weekly pill dispenser to keep track).

(One thought -- in your specific case, when you're taking 60 mg/week, why not take a 7.5 mg plus a 1 mg every day? Getting to 59.5 this way is awfully close to your target of 60 and is easy to do, and may be even easier to remember because you're taking the same dose EVERY day. Plus, this will balance out your dosages a lot more evenly. If you MUST have 60 mg, you can always break a 1 mg pill in half and add it one day during the week).

 

[dick0236]

I avoid keeping more than one strength of Warfarin on hand in order to avoid a potential dosing mistake. I learned years ago that my normal 5mg tablets gave me the options of -0-, 2.5,5.0,7.5 and 10mg using only 5mg....plus using a seven day pill box to put a few days between changes, when necessary. There are many strengths of warfarin available, from 1 to 10mg. Once your "usual" dose is establiched, you should be able to "cover the waterfront" using a combination of your "usual" dose. Warfarin does require careful attention, but it does not require "micro-management".

 

[Protimenow]

One of the good things about the way Warfarin is packaged is that a different color means a different dose. If you're taking two pills (perhaps a 7.5 and a 1), you should be able to tell just by looking at your day's dose that there are TWO different pills. This makes it somewhat more difficult to take two of the same pill. A 7 day pill box can also be a big help.

I know that, in the past, when I believed that my life was hanging in the balance, I was fairly careful with my dosing. (What nailed me was misplaced trust in a meter that I didn't realize was ALWAYS higher than the lab).