5.0 inr

[Jackie]

I tested yesterday with INRatio 4,5, had to confirm at the lab 5,0, I take 5mg on Mon,Wed and Friday and 4mg the rest of the week. The Pharmacist had me lower by 2mg, so I took 3mg last night. My range is 2.5 - 3.5 , my INR has been on a upward swing for about a month now. Do you think that 2mg is enough of a decrease? I can't figure what is making it raise, I have not changed anything. Three months ago my Zocor was raised for 20mg to 40mg, that is the only change. Any help will be appreciated.

 

[Karlynn]

If you've been on an upward trend, I'd lower the weekly dose by 10% and see what happens. You take 31/week, so 10% is basically 3. So the pharmacist was in the ballpark, but if it were me I'd probably do the 10% at least.

 

[njean]

I'd follow Karlynn's advice Jackie & then re-check in a week. How often to you test?

Sometimes it's so frustrating when this happens because like you said, if there have been no changes in your diet, then what?? Has your level of activity decreased?

Also, since you were 5.0 yesterday, how much did you take last night or did you skip one dose?

 

[dick0236]

Jackie, my INR increased to over 4 shortly after my doc raised my Simvastatin (Zocor) from 20mg to 40mg. We decreased my Simvastatin back to 20mg and my INR returned to 3+. You may find that you will have to decrease your warfarin due to the Zocor increase. I chose to leave the Simvastatin at 20mg even tho my cholesterol might be a little higher than what some docs like. My PCP doesn't have a problem with my cholesterol being a little hi.

 

[Jackie]

I'd follow Karlynn's advice Jackie & then re-check in a week. How often to you test?

Sometimes it's so frustrating when this happens because like you said, if there have been no changes in your diet, then what?? Has your level of activity decreased?

Also, since you were 5.0 yesterday, how much did you take last night or did you skip one dose?

Thank your for the replies.I did take 3mg last night , I will .take 4 on Friday instead of 5, that will take care of the 10% My diet has not changed, activity is the same, I drink lots of water, have not been sick, have not changed meds. I have always been a medical wonder...... Thanks again for your help. At least this pharmacist does not go crazy with his changes like the previous, he is more conservative.Thanks again for your help.

 

[ALCapshaw2]

Jackie,

Since it appears that you are a "Self Tester", you would be wise to buy a copy of AL Lodwick's "Dosing Guide" from his website www.warfarinfo.com. It'll be the Best 5 Bucks you spend on yourself in terms of Peace of Mind and Guidance.

You might also want to look up the AAFP (American Association of Family Practicioneers) Guidelines. Do a Search on VR.com for "AAFP" and you should find several posts with the link to their website.

Here is AL Lodwick's advice for an INR of 3.6 to 5.0 for patients with a Prescribed INR Range of 2.5 to 3.5:

"Hold 1 dose (optional).
Decrease weekly dose by 10-15%.
Recheck in 2-4 weeks."

With an INR of 5.0, I'd be tempted to want to come down a little faster and perhaps drop down another 2 (or 3?) mg over the week, then return to a weekly dose of 28 mg (10% down from your previous dosing schedule). I'm not a big fan of Holding a dose for an INR less than or equal to 5.0.

You will probably want to test weekly for another 2 or 3 weeks to see how it goes, especially if this is a result of your change in dose for Zocor.

'AL Capshaw'

 

[Bina]

If you've been on an upward trend, I'd lower the weekly dose by 10% and see what happens. You take 31/week, so 10% is basically 3. So the pharmacist was in the ballpark, but if it were me I'd probably do the 10% at least.

I would lower by 10% also.....3mg split over 2 doses.

 

[Lynlw]

Am I thinking right here? If she origonally was take 5mg on Mon,Wed and Friday and 4mg the rest of the week.
wouldn't the easy way to lower by 3 be to take 4 everyday?

 

[ALCapshaw2]

Am I thinking right here? If she origonally was take 5mg on Mon,Wed and Friday and 4mg the rest of the week.
wouldn't the easy way to lower by 3 be to take 4 everyday?

Taking 4 every day would be the ideal long term schedule.

With an INR of 5.0, it is desirable to drop a little faster.
(Half a dose in one day, or 2 mg day 1, another 1 or 2 mg day 2... many of us don't like holding a dose unless OVER 5.0)

That's my (NON-professional) thinking anyway...

 

[Bridgette]

I was taking 8mg per day and recently I tested and my INR was 4.5. I didn't hold any doses or anything, just reduced my weekly dose by 10% - however I did it by reducing the 8mg per day to 7mg per day, so I did it the way Lynlw has described.
Tested a week later and my INR was 3.3, so within range.

 

[Karlynn]

Am I thinking right here? If she origonally was take 5mg on Mon,Wed and Friday and 4mg the rest of the week.
wouldn't the easy way to lower by 3 be to take 4 everyday?

Yes! But it will depend if she has the size of pills to get that dose. But good catch. I needed to raise my dose this past week from 10/ to 11/day (I did a 10% increase - I've started working out again.) I have 3's, 5's and 10's, but I don't have 1's. So I'm splitting my 3's in half and taking the 1/2's along with the 10's 4 days/week.

 

[Jackie]

Yes! But it will depend if she has the size of pills to get that dose. But good catch. I needed to raise my dose this past week from 10/ to 11/day (I did a 10% increase - I've started working out again.) I have 3's, 5's and 10's, but I don't have 1's. So I'm splitting my 3's in half and taking the 1/2's along with the 10's 4 days/week.

Thanks for the input I took 3mg on Wed and took 3mg last night, that would be 10% for the week. I have 2mg and 5mg tablets so spitting works good. If test is good next Wed, continue with 4 each day??????????