Can't get my coumadin right!

[Karlynn]

Many of us do take a different daily dose, depending on the day. I used to take 9 3/days and 10 4/days for a total of 67/week. It's the weekly dose that is important. That is the number that you base any adjustments on. If you have a low INR and need to increase it by 10%, you figure that 10% on the weekly dose - not the daily dose. Once you arrive at the weekly dose with the added 10%, then you divide that by 7 and figure out what your daily dose will be. Obviously not all numbers will divide evenly by 7, and this is why some of us do not take the exact same dose every day.

When I was taking 67 a week, it would have thrown me way off to try and take either 9 all 7 days, or 10 all 7 days. Right now I take 10 every day. In 14 years of warfarin, this is one of the few times I have taken the same dose every day.

Differently daily doses is very common, and is one of the reasons people are told to have a few different sizes of warfarin.

If you tell youself you have to have the same dose every day, you aren't quite getting the concept of dosing.

 

[Ross]

I actually need about 6.25 per day, but I have only 5mg tabs to work with, so I'm taking 7.5 and 5 alternating days.

 

[RandyL]

Many of us do take a different daily dose, depending on the day. I used to take 9 3/days and 10 4/days for a total of 67/week. It's the weekly dose that is important. That is the number that you base any adjustments on. If you have a low INR and need to increase it by 10%, you figure that 10% on the weekly dose - not the daily dose. Once you arrive at the weekly dose with the added 10%, then you divide that by 7 and figure out what your daily dose will be. Obviously not all numbers will divide evenly by 7, and this is why some of us do not take the exact same dose every day.

When I was taking 67 a week, it would have thrown me way off to try and take either 9 all 7 days, or 10 all 7 days. Right now I take 10 every day. In 14 years of warfarin, this is one of the few times I have taken the same dose every day.

Differently daily doses is very common, and is one of the reasons people are told to have a few different sizes of warfarin.

If you tell youself you have to have the same dose every day, you aren't quite getting the concept of dosing.

So when you were at 67 a week, why didn't you just take 9.5 a day.That would equal 66.5 per week. I guess I don't see where a 1/2 mg per week would make that much difference, besides thats why we are allowed to be within a 1.0 range. I am not argueing with you, it's just that you have not made a believer out of me with your explanation yet and besides I have way less experience with this than you do and am willing to listen to anybody that will help me manage my dosage better.

 

[Georgia]

Randy - I alternate 4 and 4.5. When I took 4 every day my inr was 1.9. When I was at 4.5 daily my inr was 4.7. So sometimes you just can't win with the same daily dose.

 

[RandyL]

Randy - I alternate 4 and 4.5. When I took 4 every day my inr was 1.9. When I was at 4.5 daily my inr was 4.7. So sometimes you just can't win with the same daily dose.[/QUOT

Wow, so 3.5 mg increase per week more than doubled your INR. I didn't think it was that sensitive.Thank you I am learning more each day. Mine doesn't seem to work that way but maybe its because I take a lot bigger dose than you do.

 

[Karlynn]

We would probably have to have an Rx for every size of Coumadin if we were intent on taking the exact amount every day. Insurance companies will not allow that. You will find that it's much easier to have a few sizes and make your doses using them. There is no reason, other than ease of remembering, to take the same amount every day. Many of us use weekly pill boxes, some people write down each days dose when they take it.

I have 3's and 5's. It would be impossible to come up with 9.5 for a daily dose. Yes, small changes do make a difference for many of us. Quite frequently a 1 mg change is all that I need to get an INR in range if it's too high. And I take a lot of Coumadin.

Coumadin is a slow acting drug. It takes 3 days for a dose to register in your INR. So it's not important to take the exact same dose every day. It is your weekly dose that counts. This is why, when people miss a dose we suggest they split up that dose into 2 or 3 and add it on to the next two or 3 days dose, so that the weekly dose ends up being the same.

I think as you gain more experience in your dosing, you will begin to feel frustrated with trying to make each weekly dose fit into 7 identical days. And you will need to give yourself more freedom to tweak your dose when needed.

I think I make a poll to see just what people do as far as their daily dose.

 

[geebee]

I have been pretty consistent over the years (and we are talking over 25 years now) with alternating 5mg and 2.5mg. If I have to make a change it is only usually by adding or subtracting half of a 2.5mg per week. So, yes, a small amount can make a difference and alternating doses does not cause problems.

 

[Guest]

As you approach the goal range, small changes in the dose can have large impacts on the INR. Probably 90% of the patients that I see do not take the same dose every day. However, they are able to get the INR in range using just one strength of warfarin tablets. I usually have them take an odd dose on Mon and Fri or Mon Wed and Fri. That way they do not have to pay for two co-pays. Most are retirees on very limited income and an extra $20 would be a serious dent in their budget.

 

[Karlynn]

I have 3's and 5's. It would be impossible to come up with 9.5 for a daily dose. Yes, small changes do make a difference for many of us. Quite frequently a 1 mg change is all that I need to get an INR in range if it's too high. And I take a lot of Coumadin.

Woke up this morning and thought "Duh!" I could take a 3, a 5 and 1/2 of a 3 to get 9.5 a day. But too much pill splitting for me. Easier to do it the other way and use a weekly pill box.

 

[ccrawford]

Randy - another reason for taking different dosages on different days is that everyone doesn't have all the various pill sizes to get to a particular dose that would be the same for each day, even with a pill slicer. I keep 5, 2.5, 4 and 1mg so don't have much problems maintaining a uniform daily dose.

 

[Ross]

Woke up this morning and thought "Duh!" I could take a 3, a 5 and 1/2 of a 3 to get 9.5 a day. But too much pill splitting for me. Easier to do it the other way and use a weekly pill box.

Umm no, that would only be 8.5

 

[Karlynn]

Umm no, that would only be 8.5

No, it would have made it 9.5. 3+5+1.5=9.5. Your brain must be where mine was last night.

And here in lies the reason I don't like to do a lot of pill splitting.