ACT Newb with Low INR

[Duff Man]

Thanks for the input Freddie and Al. My pills on hand are 5mg and 7.5mg tablets. My Target Range is 2.0-3.0.

The only other possibility I can think of for the fluctuation is that I drank 6 beers for Christmas. Anymore, drinking is rare for me at probably less than one beer a week.

I need to be more consistent with my diet... sometimes I randomly eat whole cans of mixed vegetables / beans / etc at a time, and sometimes I won't eat anything but pizza and hamburgers.

 

[Protimenow]

I'm with Al -- 3.9 is probably not considered all that dangerous. I'm also concerned about the pills you use to get to 7.5. I'm guessing that you may have 2.5s, and 10s that you split in half (or just 5s and 2.5s). The advice you got using 6s and 8s may have required purchase of new pills - at least a set of 2s (you can use a 2 and a 5 to reach 7, and 1/2 of a 2 plus a 2 plus a 2 to hit 8).

Your current dose is 55 - so reducing it by 5-10% can probably be done exactly as you were advised - or, if you're using 5s and 2s, perhaps on one day, instead of a 10, use a 5. Either way, you would be reducing your weekly dose by 5-10% and probably won't need to buy other pills that you may not really need if your INR bounces back down from 3.9.

 

[Freddie]

I have another thought, if it isn't the beers that is causing your higher readings, maybe it's your prescription. Are you on a generic warfarin?

JTIOT
After months of being on the famous roller coaster, I learned that company that made my generic warfarin had been shut down due to cross-contamination - and no one had been notified and these pills were still being distributed. After changing brands I've been so steady it's scary and I have probably I have the same diet as you.

But really, it's the season. Have a V8 and continue with your regular dose, retest, then see where your at.

 

[ALCapshaw2]

The Drug Manufacturer should be shown on the Prescription Label.
BARR (USA) and TARO (Israel) are well known High Quality Manufacturers of Warfarin.
I saw NO change when switching from Coumadin to Warfarin by TARO to Warfarin by BARR
(due to insurance company changing suppliers).

 

[Duff Man]

Interesting observations about the brand specifics. The main tablet I'm taking is the 7.5mg from Zydus Pharmaceuticals. I do have 20 or so 5mg tablets from Taro. In order to take the 10mg dose on tuesdays I was splitting the Taro 5mg tab in half and add it to the Zydus 7.5mg tab.

I got the Taro from Walgreens and the Zydus from Kmart. I like kmart because for some reason they'll fill an entire script for 90 or 120 or however many tabs are prescribed, but walgreens will only fill a 30 day supply. I would use walgreens every time if it weren't for that, even though they're generally slightly more expense.

I'll do some googling on zydus.. so far i've seen a couple scary remarks about them. In fact, this has me looking at all of my scripts for the manufacturer now.

 

[ALCapshaw2]

Several Pharmacies have Lists of Generic Drugs that they sell for $4/30 or $10/90.

I suspect that Walmart started this policy to attract customers.
MANY pharmacies have followed suit.
Walgrens has a similar list but will NOT let customers with insurance buy at those prices.
CVS has their own list with a required annual membership fee. It was $10/yr in 2010 but $15 for 2011.
CVS uses BARR to supply their Warfarin products.
You may want to check your other local pharmacies for prices and suppliers.
(I've never heard of Zydus before).

'AL Capshaw'

 

[OldManEmu]

Al, I have read some strange things about health insurance in the US and this certainly is strange.

Walgreens has a similar list but will NOT let customers with insurance buy at those prices.

So if I interpret this correctly someone in the insurance chain pays extra because of insurance, or the customer goes else where and buys cheaper without using insurance and Walgreens looses the sale.

 

[normofthenorth]

Anybody have anything good or bad to say about Mylan Warfarin? (That's the roller-coaster I've been riding!)

 

[ALCapshaw2]

Al, I have read some strange things about health insurance in the US and this certainly is strange.

So if I interpret this correctly someone in the insurance chain pays extra because of insurance, or the customer goes else where and buys cheaper without using insurance and Walgreens looses the sale.

My understanding is that Walgrns makes you file under your insurance if you have insurance.
(I don't use them because of their restrictive policy on generic drugs).

IF you bought a Prescription Drug Insurance Policy that has NO Deductible, it is my understanding that you just pay the Co-Pay set by the insurance company AND the Insurance Company Pays the remainder of the previously agreed upon price between the Insurance Co. and the Pharmacy.

IF you bought a Prescription Drug Insurance Policy that has a Deductible, it is my understanding that
you pay the same agreed upon price that the Insurance Company Negotiated with the Pharmacy.
(It took a LOT of calling / questioning of Both the Ins. Co. and Pharmacy to finally figure out where
the prices I paid before meeting my deductible came from !!!)

Walmrt, and several copycat Pharmacies, have a list of their own Preferred Generic Drugs that they sell to anyone for $4/30 or $10/90 or something similar. Whether you have insurance or not or a deductible or not. Prices for 2011 may be a bit higher at some. Some charge a small annual fee to participate in their generic drug program, some do not.

Every Insurance Company has a "Formulary" where they specify a "Tier" for the drugs in their different policies. Tier 1 is usually Generic Drugs with a low co-pay ($4,5,7). Tier 2 is Preferred Brand or non-preferred Generic ($35, 44, ??). Tier 3 is Non-Preferred Brand ($70, 75,...) and Tier 4 is Special High Cost Drugs that are typically sold at a Percentage of Cost (35% etc.). This system applies to Medicare Prescription Plans. I'm not sure how it works for Medicare Advantage Plans or Company provided Plans.

Several Pharmacies have computer programs where they can calculate your estimated drug costs if you give them a list of your "maintenance" drugs. The Tricky Part is to know how Specialty Drugs you "might" need (e.g. new AntiBiotics, or other new or specialty drugs) will be charged.

 

[watson524]

Every Insurance Company has a "Formulary" where they specify a "Tier" for the drugs in their different policies. Tier 1 is usually Generic Drugs with a low co-pay ($4,5,7). Tier 2 is Preferred Brand or non-preferred Generic ($35, 44, ??). Tier 3 is Non-Preferred Brand ($70, 75,...) and Tier 4 is Special High Cost Drugs that are typically sold at a Percentage of Cost (35% etc.). This system applies to Medicare Prescription Plans. I'm not sure how it works for Medicare Advantage Plans or Company provided Plans.

Company provided plans work basically the same way if there's an Rx component. The one drug I take each month (birth control) moved up a tier recently (from a $30 to $55 copay for a 28 day supply) because a generic of the brand I take came out on the market.