Request for assistance.

[IanH]

I've been on coumadin for two years since my valve replacement surgery. I self test/dose and have been able to maintain my range of 2.5-3.5 with very little playing around. I usually alternate between 6 and 7 mgs/day.

Last week I had a bout of diverticulitis and the Dr. put me on two very strong antibiotics. I was warned that my INR would probably go up and to monitor it closely. I was fine until Wednesday when my INR reading was 6.0. My doctor advised to skip two doses and resume again today. I did another test today and my INR was down to 3.

My question to all the experts out there is what dose do you think I should be on until I finish my antibiotics? (2 more days worth)

Thanks in advance.
Ian

 

[ALCapshaw2]

Good Question.

Who writes your prescription for Coumadin / Warfarin?
Is his/her office still open?
If so, give them a Call NOW.

IF your pharmacist is knowledgable about Coumadin dosing and antibiotic interactions,
that may be another person to ask.

Be sure to ask your Doctor and/or pharmacist if either of those antibiotics have an 'extended action' characteristic. Some do.

I would also suggest testing often (every 2 or 3 days?) just to see where your INR is going.
I won't speculate about what to do once you know though. Sorry about that.

Or hopefully one of our more knowledgable self dosers can supply a more specific plan.

'AL Capshaw'

 

[bigsidster]

I just went through the same thing(being on antibiotics) and my INR went from 2.6 to 3.0 then 3.9. My doc wanted me to miss a dose at 6mg then take 5mg a day.I did not miss a dose.Instead I took 5mg for 2days,down from 6mg,then got retested and dropped from 3.9 down to 2.8.The doc wants me to stay at 5mg until next test a week from now but I am going to alternate 5mg and 6mg the next day and back to 5mg until the week is up because I think if i stayed at 5mg all week I would fall to 2.0 or below.

 

[Protimenow]

If you've already skipped two doses, you should be heading well below 3 (and 3 isn't a bad number to have). Resuming your previous dosing sounds pretty reasonable - especially if you're now off the antibiotics and your diverticulosis has resolved. (The loss of fluids diverticulitis can cause might also push your INRs up, because you may have become somewhat dehydrated, so the warfarin may have had less of you to work against). If you're back to where you should be, it wouldn't be surprising if the previous dosing protocol brings your INR where you want it.

 

[dick0236]

I was fine until Wednesday when my INR reading was 6.0. My doctor advised to skip two doses and resume again today. I did another test today and my INR was down to 3.
Ian

If I understand, you held 6mg on Wed. and Thurs and tested on Fri at 3.0. I doubt those recent changes would be fully reflected in the Fri test. Usually takes warfin 2-3 days to metabolize. If you have been taking 6mg for some time, I would go back on 6mg, test on Sun and see where you are. By then those earlier changes should be fully metabolized. This is one of those times that you need to stay in contact with your doc.

 

[Bina]

Hello Ian,
I have the same recommendations as Dick. Since you have already held 2 doses, you could go back on 6 mg and test again on Sunday. Isn't is great to be able to self test?

 

[IanH]

Thank you everyone for your advice. Unfortunately the Dr. that prescribes my coumadin finished at noon today and is not available for the weekend. That's why I turned to this forum and you didn't disappoint. Self testing is great. I'm surprised how few people know about it (even Doctors) here in Victoria.
Ian

 

[Protimenow]

Yes, it's disappointing that most doctors either don't know about it or pretend not to. One thing that we might consider is the fact that many doctors (I know of a few) have financial interests in some of the labs. If the patient goes to the lab for a blood draw, the doctor makes some money. If the patient does a home test - nothing comes to the doctor (unless he can charge something for the 'consult').

If everyone taking warfarin chronically (rather than just for a month or two) could get a meter and do self testing, and if those who ARE able to self manage CAN self manage, the costs of meters and strips should fall to levels where this large population can actually afford to do self-testing and self management. Although the economics differ a lot from that for blood glucose monitoring, having a large enough population of self-testers SHOULD bring the prices of meters and supplies down to more affordable levels. This wouldn't drop the doctors out of the equation - but it SHOULD help to produce a population of patients who are more often within range than those who occasionally travel to labs for testing.

This is a Public Health issue -- and I'm hoping that it will eventually be addressed.