UPDATE:
Incidentally, I put your drugs in the checker I provided for you, and it says that there is an “serious” interaction of increasing effects of warfarin when on Bactrim. Kenalog is supposed to decrease the effects of warfarin in a “significant” way. Tobramycin is supposed to “increase the effects of warfarin in a “significant” way. You may want to talk to your doctor about that right away, and your INR clinic. For Skyler, they switched him to Enoxaparin for the duration of his antibiotics this time (a 12 hour self-administered injectable).
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I don’t know what your first antibiotic if… Rifampin?
In any case, we find that INR generally incerease a little bit when Skyler is on oral antibiotics, but one of the IV antibiotics he’s on now practically nullifies the effct of warfarin. I doubt that the eye drops will have much of an effect since they shouldn’t get in your blood stream, but you never know. One thing you can check is to google a “drug interaction” web page where you can put in all your meds and see the possible interactions. In my experience, however, the effects posted are usually much higher than the doctors or effects seem to be, so don’t panic too much if it comes up “extreme”. Just call your doctor.
Do you self-test/dose? If so, and if you are concerned, you can take an INR in about 3 days time. This is when the full effect should be seen at the earliest. We find that the changes really aren’t as much as one would expect. I typical antibiotics (amoxicillin), Skyler’s INR typically goes up between 0.4-1.4 over 10 days. This means that periodically his INR might hit 4.0. His clinic says “big deal”, and they don’t really want to know about it unless it hits >5.0. So we simply adjust his warfarin dose a smidge for one day, and it’s usually back to normal by the time we test in another 3-4 days.
In fact, his clinic suggests that INR can change when on oral antibiotics and not to bother testing during that time because it will just worry you unnecessarily. Go figure. Personally, I’d rather test at day 4-5 after starting antibiotics and know if the change is significant or not, and to do a minor adjustment if they are until the antibiotics are over.
But then, we’ve been self monitoring and dosing for 12 years so it’s simply normal… Since we know very well how warfarin doses affect Skyler, we don’t mind playing with trying to maintain INR on the lower end of the range (2.5) rather than the higher end (3.5).
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I tried to counterbalance the antibiotics with extra veggies--must be working. Will just have to continue to do this for another week. Yes, I do, finally feel better. I have stocked up on yogurt, too. Thanks, again. When I have a question or problem, this is the first place I think of going. I'm not at all sure that I would get the right info from my doctor's office. For those who were asking--I lab test once a month or so and self test weekly in between. The lab tests are completely paid by my ins, but they will not cover the self testing--so I just do that on my own. My cardiologist is completely fine with it. I think the coumadin clinic just pretends they don't know I self test in between. So far, I haven't had to make any dosage changes--I guess I would call them in that case. The peace of mind from weekly testing--and not having to depend on someone else--is just amazing. Mary
