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View Full Version : Antibiotics and Coumadin... INR 1.6...!!!???



Deuce
May 9th, 2006, 08:07 AM
Well...I don't understand it. 2 weeks ago I was 1.8 on my home tester and 1.5 at the clinic. I admit ,I was eating a lot of salads and exercising a lot also.So we upped the dosage and I slacked off on the salads...10mg during the week and 7.5 on the weekends.Next test last Tuesday...2.1 ...better..and going up as it should.
Today...1.6 on my home tester...wondering if i should go to the clinic for a confirmation.:confused:
Here's the variable that was thrown into the mix on Friday...I had splinter in my finger that I couldn't get out last week ...By friday it was infected and swollen etc so i had to go to the doctor . She removed the splinter and thought it would be a good idea to put me on antibiotics because I was 10 weeks post OHS VR.
Now the QUESTION ....Is the antibiotic(cephalexin)counteracting the coumadin and affecting my INR ???
Or am I just some sort of freak ???;)
Does 10 days worth of antibiotic therapy for an infected finger sound a bit excessive(I should probably go to the dentist while I'm on these antibiotics)
Advice???
Thoughts???
Thanks ...Tim

Ross
May 9th, 2006, 08:13 AM
I'd test again with the home tester. No way could it have dropped that much unless you missed a dose or two.

ccrawford
May 9th, 2006, 08:23 AM
I agree with Ross. Typically the antibiotics tend to raise the INR because they kill the Vit K producing bacteria in the intestines. Also, all antibiotics don't do the same thing. Amoxicillin is typically used for pre dental work protection.

Deuce
May 9th, 2006, 08:50 AM
Thanks guys for your prompt response.
Ross ,I went ahead and retested and this time it was 1.5.:eek: I sure don't remember missing a dose .I guess I will have to finally break down and buy one of those pill boxes that has the days of the week on it. I recall being 6 hours late one time but not missing any doses.
Chris ,thanks for the clarification on the antibiotics.
What next ????Check into the hospital??....take an early dose of coumadin???
Where ya at big Al.??

Ross
May 9th, 2006, 09:28 AM
Your not living on 3 squares of spinich a day are you?

It's not bootleg pills?

Sudden increase in excercising?

What are you putting in your stomach?

Computec
May 9th, 2006, 09:29 AM
Well, Deuce...

I'd at least ascertain that the home tester is in good calibration.

With those two mechanical valves in there the INR is a bit worrying. Perhaps a trip to the clinic is in order. Take the tester with you and have them test at the same time as you do. Err on the side of caution.

And I agree that antibiotics tend to raise the INR for most people. Either that or it has no effect which, so far, is the case with me.

catwoman
May 9th, 2006, 09:52 AM
Thanks guys for your prompt response.
Ross ,I went ahead and retested and this time it was 1.5.:eek: I sure don't remember missing a dose .I guess I will have to finally break down and buy one of those pill boxes that has the days of the week on it. I recall being 6 hours late one time but not missing any doses.
Chris ,thanks for the clarification on the antibiotics.
What next ????Check into the hospital??....take an early dose of coumadin???
Where ya at big Al.??

Tim:

At 10 weeks post-op, you're still going to be unstable at times. As you recover, you'll become more active, needing more warfarin. So your INR will drop because your metabolism is speeding up.

I hated having to get one of the weekly pill boxes, because I thought it made me look like a little ol' lady getting it out at breakfast in a restaurant. Then I thought, Whattheheck? It keeps me alive.
Those pill boxes do come in handy. Much easier to know if you've taken your rat poison than to try to remember.

Deuce
May 9th, 2006, 09:56 AM
Exercise??? No increase but i did jog for a bit yesterday evening which i hardly ever do .
Put in my stomach??? I did have a nice Greek salad last night but as i said before i have slacked off on my salad/greens intake ...:confused: Ohhhhh BINGO.... I have been taking a protien supplement ...
EAS 100% Whey Protien... what do you think??? Whey protien isolate/concentrate. with acesulfame potassium. Branch chain amino acids . No vitamin K.
Do any of those sound like the culprits???
That has to be it . I just bought it and started using it last thursday.
Obviously I won't be able to take that anymore.
What do you folks think ??? Mystery solved ???
Advice,Thoughts,Comments.
Thanks .
Tim

catwoman
May 9th, 2006, 10:03 AM
Tim:

What are the exact ingredients in the drink? It's only going to list Vit K in the ingredients if it's an ADDED supplement. If something has spinach, broccoli, asparagus, etc., it's not going to have Vit K listed in the ingredients because the vitamin is not what's being added.

I'm sure that Al will check in when he has time. Don't know if he checks in during the workday while at work.

Deuce
May 9th, 2006, 10:29 AM
The ingredients :
Protien Blend(Whey Protien Concentrate and Whey Protien Isolate),Natural and artificial flavors,acesulfame potassium and sucralose.
Some supplement facts: (or i should say ...alleged supplement facts).
Protien 23g
Calcium145g
Iron< 1mg
Sodium 50mg
Potassium 170mg
Not a significant source of Vitamin A and C.

I seem to recall that soy products affect INR and I'm pretty sure this "whey protien" is derived from soy.
Comments,Thoughts.
Tim

Blanche
May 9th, 2006, 12:09 PM
We had a discussion about this some time ago.
I was of a mind to try it then, but didn't.
I may just do that now.
Hope this helps.










--------------------------------------------------------------------------------

Sharon:
Whey protein is protein from cows milk, which shouldn't be a problem for you. Actually, if you read some of the articles on the link left here, you might find that you have the potential for doing yourself alot of good with whey products. Apparently, the American Heart Association thinks hightly of whey too. I would be careful about the other ingriedents in protein shakes though. As others have stated, some shakes include soy as well as whey. I wish I knew all of the different names used for soy products. Perhaps someone can help on that. I have included a link that has some interesting materials under news. Hope it helps.
http://www.wheyoflife.org/
Blanche
PS Was little Ms Muffett eating cottage cheese? (curds and whey)

ccrawford
May 9th, 2006, 02:24 PM
Duece - Whatever is causing it needs to be counteracted. I'd bump my dose up by 10% and test again in 4 to 5 days. Gotta get you in range my friend.

Deuce
May 9th, 2006, 04:10 PM
Believe me Chris...I was tempted to go ahead and take my meds early... and an extra 2.5 mg at that...had 'em in hand and decided not to rush things ...just wait until the regular time...around 6pm.
So after conferring with my "coumadin manager" I took an extra 2.5 today(12.5 total) and will take 10 the rest of the week and test again on Friday.
I have an appt with my cardio on friday and they will start managing my coumadin there.
Thanks for the info on "Whey" Blanche.I should have known it couldn't be soy . They weren't into soy back in Ms. Muffets time ;) .

Karlynn
May 9th, 2006, 07:31 PM
Whether you are "exercising" or not, your need for more Coumadin will most likely increase some as you heal. Your body gets thrown for a loop with OHS and efficiently finds ways to back down from the usual pace in order to heal. I didn't have the energy to exercise for at least a year after my surgery, but my warfarin dose increase gradually for quite a while. I'm thinking you may just be at one of those times when your dose needs to be bumped up to the next level. You are taking a pretty large dose for someone 10 weeks post-op. Your metabolism may just be faster than most. Are you someone who has always been able to eat what you want without thoughts of gaining weight? (Just a thought.)

I agree with Chris - regardless of the reason for the low INR - you need to increase your dose.

LUVMyBirman
May 9th, 2006, 07:35 PM
My INR ALWAYS decreases with antibiotics. I will see a spike in the INR with consistant exercise.

Deuce
May 9th, 2006, 09:27 PM
Thanks Karlynn... I remember reading that a persons metabolism will affect INR and I've been trying to tell that to my coumadin mgr.I think I probably have a "fast" metabolism but I am also very concious of what I eat and my waistline:o .I also am very active for someone 11 weeks post op. I hike up Stone Mountain 3 to 4 times a week.I also ride my bike around it sometimes after I hike it (5 miles). I'm lifting light weights and I mow my lawn and lately... I've been using a shovel in the yard... .I'm not much for sitting still. Also my heart rate is still kinda high compared to what it was before surgery.Do you think I should slack up on my activities until i get back into range ??
So if i was taking 65 mg per week and I increase it 10 % thats going to put it at 71.5 mg a week. That seems like a lot. Are there many other folks out there that are taking that much? I just realized I've only been 3.0 once and every other time it has been low except that 2.5 the day they let me go home from that hospital.
I guess all i can do now is keep on keepin' on until Friday.
Thanks again
Tim

RandyL
May 10th, 2006, 06:03 AM
10 mg/day 70for the week here. almost 4 months post op

Ross
May 10th, 2006, 06:17 AM
As Al has said before, the proper dose of Coumadin is the one that keeps you in range. There isn't any such thing as a lot. Only whatever it takes.

catwoman
May 10th, 2006, 07:18 AM
I also am very active for someone 11 weeks post op. I hike up Stone Mountain 3 to 4 times a week.I also ride my bike around it sometimes after I hike it (5 miles). I'm lifting light weights and I mow my lawn and lately... I've been using a shovel in the yard... .I'm not much for sitting still.

Tim:

I'd call that EXERCISE.
No wonder you're having a struggle with getting your INR in range right now!
If you don't already have one, purchase one of Al Lodwick's algorithm dosing charts. You'll be able to tell how much to up/reduce your dosage based on INR results and your suggested INR range. Even if you never do home-testing, you should have one so you'll know if your warfarin manager has his/her head up their you-know-what.

Link for ordering dosing chart:

http://www.warfarinfo.com/publications.htm

Kathleen
May 10th, 2006, 07:55 AM
Deuce
Not sure how long you have been having these low numbers but I would think it is time to call your cardiologists office to let them know your numbers. I doubt with two mechanicals my cardiologist would let me keep upping my dose to get in range. There are injections to ease you to the range you need and perhaps it is time for that.
Kathleen

Karlynn
May 10th, 2006, 08:23 AM
Tim, I take 70/week. Ross is right, whatever dose you need to keep you in range is the correct dose.


Deuce
Not sure how long you have been having these low numbers but I would think it is time to call your cardiologists office to let them know your numbers. I doubt with two mechanicals my cardiologist would let me keep upping my dose to get in range. There are injections to ease you to the range you need and perhaps it is time for that.
Kathleen

Kathleen, your post is a bit confusing. There isn't an injection that helps you get into range in order to keep your dose lower. Maybe that's not what you meant, but your wording was bit confusing. There are Lovenox injections that help "protect" you from throwing clots when your INR is lower and some people will take these when their INR is low and are increasing their warfarin dose to get them in to range. But Lovenox and heparin do not register in the INR. INR measures what your warfarin dosage is doing. I'm thinking this is what you meant.

allodwick
May 10th, 2006, 11:42 AM
I have never seen cephalexin affect an INR and if it did, I can't imagine it causing it to go down.

It is probably just the usual drop that occurs when people recover from the surgery.

The only antibiotics that I can thinkof that cause the INr to go down are nafcillin, dicloxacillin and rifampin. None of these would be used for a splinter and are not likely to be mistaken for cephalexin.

ccrawford
May 10th, 2006, 12:16 PM
Duece - When we talk about bumping your dose, we mean the ongoing dose, not just for one day (unless otherwise specified), You were on 10mg five days a week and 7.5 for two days a weekfor a weekly total of 65mg. A 10% increase would be 6.5 more or 71.5 rounded to 70 or 10mg/day. I really would pick up a dosing chart because depending where you are, there may be differently solutions. Hope this helps :D

Deuce
May 10th, 2006, 04:17 PM
Yes , Thanks everyone. It is starting to appear that I too am a 70mg/wk guy. Maybe more. Whatever it takes. I'm sure it will eventually stabilize.I'm going to try not to worry about it. .I made it a point today not to do anything that would be construed or perceived as being "exercise". And definitely no salads or collards or anything of the vitamin K ilk for the time being.
Thanks again.

ccrawford
May 10th, 2006, 04:30 PM
Duece- Being on Coumadin doesn't mean you have to give up green veggies, exercise, or much else for that matter. What is called for is a certain amount of consistancy in what you do day to day. Go ahead and have that salad -just do it consistantly meaning have one most evenings. On another topic- you need to be aware that many other medications, even over the counter ones, can cause an interaction with Coumadin. Do a google search for "Coumadin interactions" and you will get a list of web sites to help you understand. Again, this doesn't necessarily mean you can't use these other meds, it just means you must use them consistantly, or be prepared to adjust your Coumadin dose when you do use them.This is the area I have had the most variability with. Hope this helps.

Deuce
May 12th, 2006, 10:25 AM
Thanks Again.
I do understand that I must be consistent with my intake of foods containing Vitamin K and with my exercise and/or related activities.
I felt that since I was so low on Tues (1.5) that I should slack up on the salads/greens and exercise/activities at least until I was in range or approaching range, And today i am testing at 2.4 on the Inratio machine. :)
They will call me later with the results of the PT/INR test that they took the blood on today.It would be nice if it was a little higher than the Inratio but every other time it was a few points less.
Oh yes ...they did confirm that the antibiotics may actually affect the INR but it would have been an increase instead of a decrease.
Thanks again folks.
Tim