Warfarin: HeartDawg's been a bad, bad boy

[HeartDawg]

Ugh ... I went months without screwing up on my drugs. I have TWO alarms set on my watch and an alarm set on my cell phone to help me remember to take them ... (which gives you some idea as to how bad my brain is)

But, I've now screwed up TWICE in a week.

My INR has been very consistent for months and we have settled into a routine of 10 MG five days a week and 15 MG on Tuesdays and Fridays. I always take the stuff between 7 and 9 p.m.

So ... I wake up on Sunday morning and realize I forgot to take Saturday's dose. I didn't call anyone, and just took it right away, and then waited until later on Sunday night (11 p.m.) to take that dose ... figured I'd spread it out a bit.

So, that episode passed.

Now, I go to take my Wednesday dose and I see that Wednesday is GONE! Not sure what happened. My only guess is that I DOUBLE DOSED last night (it was a hectic evening).

Any thoughts on what to do? Do I need to report this to my Warfarin clinic? I actually got a flu shot today and had pretty much zippo for bleeding.

Otherwise, I was just going to wait until tomorrow night and go from there.

I miss being a regular here, but that's a good sign. You people were great to have before and after the surgery.

 

[Karlynn]

If you think you double-dosed - than just wait and take tomorrow's dose as usual. If you are unsure if you double-dosed, maybe take 1/2 a dose tonight. At 10 and 15 mg/day your INR will drop more quickly if you skipped a dose. You did the right thing by taking your dose as soon as you saw you missed it the night before. You should be back in line w/in a few days, so don't worry.

You can't tell how high or low your INR is by the amount you bleed for small punctures. There are times where I see my finger stick and think "Oh, it must be high" because the blood comes out easily and takes a little longer to stop, only to find it's too low. And there have been times when it's hard to get a drop of blood and I think it must be low, only to find it's high.

 

[HeartDawg]

I like your thinking ...

I like your thinking ...

In fact ... geez ... now I am sitting here thinking maybe I took my dose earlier tonight and just forgot. (Are you starting to see how bad my brain is?)

Thus, if I just take a 1/2 dose (5 MG) tonight, it will either push me up a little higher than I've been or keep me from falling a little lower ... and I've been sitting right nicely in the above middle category ...

Plus, I'm out of town for the next few days, so it doesn't work really well to go get my INR checked right now.

I'm going with that, and then we will see how the others think!

 

[Ross]

Your human. It will work itself out in the end. I wouldn't bother doing anything except resume normal schedule. If you did take it, you may be a high for a week or two, but it'll go back to normal. Same thing if you didn't take it, low for a week or two and back to normal.

 

[twinmaker]

Tom, this would be a good time to think about getting a home testing monitor for you INR. I noticed that you said you were out of town. If you had your own monitor, you'd be able to test anytime, anywhere. I love mine. I travel quite a bit, and it always goes with me. Just a thought! LINDA

 

[maestrorn]

Coumadin

Coumadin

I would recommend what they taught us in nursing school. If you miss a dose and don't realize it until the next day, don't double up and take the missed dose and the current dose. Instead, only take the current days dose.

You won't notice the change from a missed dose in your INR until 3-5 days later due to the long half life of coumadin. I would definitely look into getting yourself a home testing machine. They are spendy but you may be able to get insurance to pay for it as well as write it off on your taxes.

Hope this helps.

 

[ALCapshaw2]

I 'think' I remember AL Lodwick making a statement to the effect that taking a Double Dose ONE TIME 'probably' won't hurt you (it might be a good idea to check that out with him or a Knowledgable AC Provider).

Like you, I normally take my Coumadin / Warfarin before bedtime. I use a 7 day pill box AND a 31 day Data sheet to record ALL my medications. IF I discover that I missed a dose the night before, I simply take it at that time (usually the next morning), and resume my regular schedule.

I figure the sooner you take a missed dose, the LESS the effect. I'm also *assuming* that taking the next regular dose that evening is not going to have the same effect as taking a Double Dose so I don't worry about it.

Another option is to split the missed dose in two and spread it over the next 2 days. That way you never take more than 50% above a normal dose which 'should not' cause a problem. After a few days your INR should be right were it would have been if you had not missed a dose (since your running weekly total dose will be the same as normal).

'AL Capshaw'

 

[Blanche]

I've taken a double dose in the recent past and had no problems. I waited three days and tested on our monitor and found that my INR had increased by .06. While I was waiting, I enjoyed LARGE amounts of spinach...Yum.

I might suggest that you get one of the pill boxes that handle daily meds. It does take some of the guess work out of it. I also agree with the others, having your own monitor would solve this and any other concerns. We just love our new INRatio. We also used the ProTime Microcoagulation System for nearly 7 years. It's a good monitor too.

Kind regards,
Blanche

 

[HeartDawg]

Great advice

Great advice

As expected, you guys have lots of good insights ...

I had heard something like, "If you miss a dose, take it as soon as possible, but don't take it the next day" ... which isn't really all that accurate. Exaggerating to make a point ... what if you normally take it at 11 p.m. and forget to take it until 12:05 a.m?. Technically it is the next day. That's why I sort of felt ok playing catch up in the a.m. and then waiting until a bit later on that day's dose.

Darn, I really just need a personal assistant/nurse.

I also agree with the people around here that say I would rather lose blood cells than brain cells, so would prefer to error on the high side of things.

I'll think about that home INR. Just what I need ... one more electronic gadget. Does the new iphone come with the INR testing monitor built in??? Ha!

 

[HeartDawg]

Oh ... Blanche ...

Oh ... Blanche ...

SADLY ... I HAVE A BOX, and I STILL couldn't figure out what happened to Wednesday's dose!!! Ugh. I either double dosed on Tuesday (somewhere later in the evening forgetting that I had already popped the pills and then had in my mind that it was Wednesday) or I had already popped the pills on Wednesday and then forgot that I had done.

My brain is far more damaged than my heart.

And, like Al, I too have a spreadsheet ... which is on my computer ... but have been bad about keeping it to up to date since I have been on the same exact doseage for months.

 

[Bina]

I also have the little 7 day pill box. It stays on the kitchen table where I sit down to eat. Coumadin is taken with supper; should I somehow forget, it will be noticed when I take my late evening metoprolol.
So far so good.

 

[Ross]

SADLY ... I HAVE A BOX, and I STILL couldn't figure out what happened to Wednesday's dose!!! Ugh. I either double dosed on Tuesday (somewhere later in the evening forgetting that I had already popped the pills and then had in my mind that it was Wednesday) or I had already popped the pills on Wednesday and then forgot that I had done.

My brain is far more damaged than my heart.

And, like Al, I too have a spreadsheet ... which is on my computer ... but have been bad about keeping it to up to date since I have been on the same exact doseage for months.

Dude I did the very same thing last Thursday. I just went back to regular schedule, tested a little low this week, but I'll be back to normal next week.

 

[aussigal]

I too have had a week where I have done the same as you report, mucked up twice in a few days...apart from feeling silly and embarrassed about my useless memory I suffered no ill effects...I just resumed my regular schedule and my INR levelled itself out all on its own with no fiddly adjustments needed.