Warfarin training

[Old clicker]

Does anyone know where I can go, here in Ontario, to get some doseage training so I can make my own changes to my INR. My Inr was 4.1 on Friday. My GP called on Sunday, and wants me to not take any thing for 2 days, then start back at 2.5 mg per day. I am on 5 mg per day now. I don't think its right.

 

[Bina]

Oh good Lord....no dose holding for an INR of 4.1

 

[Bina]

If you are on 35 mg per week, you can take a half dose today only, then continue on your 5mg and test in one week.

 

[dick0236]

My GP called on Sunday, and wants me to not take any thing for 2 days, then start back at 2.5 mg per day. I am on 5 mg per day now. I don't think its right.

I agree with you. If you have been on 5mg for awhile and in range and suddenly got a 4.1, I would probably cut 2.5mg for a day or two and then stay on the 5mg and test in a week or so. If I understand your post, stopping 5mg for two days and then going on 2.5mg because of a 4.1 INR seems WAY TOO EXTREME.....and will put you on a roller-coaster. Is there any other reason that he suggested such a dosage change?

 

[netmiff]

www.warfarininfo.com if memory serves me right.

any changes in meds, or anything else, to cause a jump like that? how long since your last test? Do you self-test?

 

[Old clicker]

I was off my multi vitamins for 2 days, I dont recall else anything changing in my meds.
I don't self test, it was a lab test.

 

[Bina]

You can check the label on your vitamins.....some have K.

 

[Ross]

Get Al Lodwicks dosing chart http://www.warfarinfo.com/publications.htm

and in the mean time, use this online calculator.

http://www.pace-med-apps.com/CoumCalc.htm

Decrease dose 5 - 10%, check INR 7 - 14 days

 

[KristyW]

I was off my multi vitamins for 2 days, I dont recall else anything changing in my meds.
I don't self test, it was a lab test.

Clicker,

This is one of the big things that people overlook. Anymore, most multi-vitamins have Vitamin K in them. (about 30-50% of the RDA). If you take a multi-vitamin with Vit K it is important keep taking them. This is how our dosing can really get messed up. If you're going to continue taking the vitamins, get back on them soon, and then continue with your regular warfarin dose. If you're not going to continue taking them, you'll probably have to adjust your dose down a bit. Another thing to remember is once you settle on a vitamin, try to stay with the same brand and formulation (but check the label each time to make sure the Vitamin K is the same.)

Remember our mantra about consistency.

 

[terodac]

Good Lord that does not even sound right. Thanks Ross for the online info and the chart is very helpful. Some of these medical people do not know what they are talking about when it comes to dosage on INR. Trust me, I have a so called specialist NP that thinks she knows it all. I have now taken over and doing fine! with my home test and chart!

 

[dick0236]

Clicker, my cardiologist mention the Vit K content of multi-vitamins to me a few years ago. They suggested Kroger One Daily-Essential to me. It has no Vit K. It has helped me keep my INR very steady. Before their suggestion, I bought whatever was on sale, without looking closely at the contents, and I did experience some volatility in my INR. Simple things like this,seemingly, can an do, affect INR.

 

[Old clicker]

I should have thought about the vitamins, because when I was going to go on them we discussed it here. We decided that I would take the ones with Vit. K, and change the warfarin dosage, and that worked well.

 

[Jkm7]

What are you going to change about your dosing?
Are you doing what your GP instructed?

 

[Old clicker]

I skipped Sunday
Took 2.5 mg last night
Going to take 4 mg per night the rest of the week, and test in 1 week.
If I'm back in my range I will tell him I didn't follow his instructions.

 

[ALCapshaw2]

Tell your Doctor to Read the CHEST Guidelines.

It sounds like he Slept through most of the Lecture on Coumadin Management and only heard the "Discontinue for 2 days for a (dangerously) high INR" and applied that caution to ANY slightly high reading. IDIOT.

 

[Bina]

I skipped Sunday
Took 2.5 mg last night
Going to take 4 mg per night the rest of the week, and test in 1 week.
If I'm back in my range I will tell him I didn't follow his instructions.

Last Friday your INR was 4.1

So your dose on Saturday was 5mg, Sunday....0, Monday 2.5, then 4mg for 4 days.
That makes your weekly total.....23.5......a huge decrease from your previous 35 mg.
Did you find out how much vitamin K is in those vitamins?

 

[ALCapshaw2]

Personally, I would NEVER Skip a Dose for an INR under 5.0, or maybe even 5.5 or 6.0

My usual adjustment for something like a 4.1 would be to make a ONE night reduction of no more than Half a Dose and retest in 4 to 7 days.

My Cardio likes a narrow range at the high end. Personally, I don't get excited about anything that is between 2.5 and 4.0. I figure that is 'close enough'.