Aargh. INR at 5.4 and I am going back on Antibiotics

[RobNDenver]

Date 25-Aug 16-Sep 29-Sep 12-Oct 16-Oct 24-Oct 14-Nov
Dosage 4.5 4.5 4.5 4 4 4 4
Lab INR 2.7 3.5 4.3
Home INR 5.5 4 4.4 4.3 5.4

This table shows a little history but I am worried. I have had a persistent sinus infection and was on Levaquin for two weeks in the middle of October. Have been off since the beginning of the month. Last week I took XS Aleve several times due to some pain in my hips.This weekend I noticed that my gums were bleeding, my home monitor results were 5.4 so I immediately held a dose on Nov 15 and will hold my dosing tonight.

The rub. . . Sinus infection is back, my PCP wants me on Bactrim, which has a strong interaction with Coumadin. I talked it over with the nurse who follows me and she suggests (agrees) that I should cut my Coumadin dose to 2mg a day when I am taking the Bactrim and test every two or three days to make sure that I am not trending too far either way.

Seem reasonable to you all?(Sorry about the misaligned text in the table, I couldn't figure out how to make it format correctly.)

 

[Freddie]

Oh my, I find Bactrim very hard on the stomach. Have you had it before?
There has to be different antibiotic the doc could have given you.

 

[Rich]

Rob,
I have taken Levaquin for diverticulitus a few times, and it was tough on me(not to mention very expensive(.
I have also taken Bactrim for sinus infections a number of times.
In each case both of these meds had a significant impact on my INR.
What I have done a number of times during these episodes is really up my intake of vitamin K.
In my case my wife makes a big batch of her cole slaw which I really like. It helped keep me in line a lot.
You are lucky to home test so keeping an eye on things is a lot easier.
Hopefully you will be back on track soon.
Rich

 

[RobNDenver]

Rob,
I have taken Levaquin for diverticulitus a few times, and it was tough on me(not to mention very expensive(.
I have also taken Bactrim for sinus infections a number of times.

Thanks Freddie and Rich. . . I was Levaquin a few weeks ago and said I would never use it again. I am allergic to penicillin so if they want to use the big guns it has to be one of the sulfa drugs. . .

Sheesh.

Thanks for the advice. I will be checking my INR's frequently.

 

[catwoman]

Rob:

Here's some interesting things about antibiotics I found in a search. It lists some meds good for those allergic to penicillin:

http://adam.about.com/reports/000062_7.htm

I've had a sinus infection since Nov. 7. Couldn't get to my PCP last week (my only co-worker was on vacation most of the week) so I started amoxi 500mg Nov. 9. Also took generic DM cough syrup during the day, a codeine syrup I was Rxed last December for the same exact illness that segued into bronchitis. I also bought some Mucinex, never tried it before.

My infection seems to be getting much better (thank heavens! darned tired of the barking cough & headaches).

BTW, in case you ever need to fly and take cough syrup: You don't have to check your bag containing cough syrup, even if it's over 3oz. Just put it in a bin with your zipped baggy containing shampoo, toothpaste, etc., when going through security.

 

[terodac]

Levaquin will do it every time! It makes your INR go up, it is very strong and it makes me sick to my stomach. You really have to watch your INR when taking this.

 

[Ross]

We know your INR will rise, so in a sense, it's probably prudent to do as she said, though I'm not one to drop anything until I know exactly what my INR is. Still far better to be too high then too low. I think 3.5mg under normal circumstances would be your ideal, so maybe 2mg isn't such a bad idea either.

 

[RobNDenver]

This morning after holding two days (8mg) my INR is at 2.6. I will be starting the Bactrim today, so I think I ought to test again on Thursday.

Thanks for the help and advice everyone.

 

[ALCapshaw2]

Last time I was on antibiotics, my Coumadin Clinic CRNP had me reduce my dose and she "Nailed It", right in the center of my Range!

FWIW, I'm not a big fan of Holding, but for ONE day with an INR of 5.4, that seems appropriate. TWO Days seems excessive to ME and I would bet your INR will TANK if you do hold for 2 days. Let us know how it goes!

The only way you can maintain a rigid format with Text is to use a print style that assigns a FIXED width to ALL characters, such as Courier. Variable width formats will screw up the formatting Big Time, Every Time.

'AL C'