Can't seem to keep Inr above 2

[DachsieMom]

Just curious....how long did it take you to become consistent with inr readings? I am 12 weeks post ops and all over the map. This week, 1.7. I was 2 last week; most other weeks gave been 1.8 or 1.9. One week I was 2.4, but I think that had something to do with drinking cranberry juice). I must metabolize it quickly. I am pretty tiny but on 5 mg per day, now 7.5 mg twice per week (was once per week until last week). I test weekly at a lab, but hoping to start home testing soon.

 

[MrsBray]

Seems like I took about 6 months to settle down to a regular dose and reading. I take 7.5mgs 5 days a week, and 10mgs two days a week. I test consistently 2.7-3.1 I was all over the place last summer - 1.9-4.8! I was worried that I was going to be on such a high dose that I would damage something, but now I don't worry about. Like recovery, everyone is different. Food, alcohol, and exercise all factor in to INR. Mine was so low the week after surgery I was afraid I would have to get the injections. My nurse told me if I'm going to start anything new - different vitamins, exercise schedule, etc - to start about 6 days before my INR appointment, because it takes about that long for everything to make a difference. (Except vitamin K, I think that affects us pretty quick.)

 

[Freddie]

Took me a good three months. What is your INR range and why do you have to "metabolize it quickly"? Oh yea, have a little laugh; INR really stands for "It's Never Right"
Try using this to help you. Just fill in the second blue header "Continued Dosing" then click on "calc". It will give you a 7 day dosage chart. Hope this helps
http://www.pace-med-apps.com/CoumCalc.htm

 

[pellicle]

Hey there

Well 12 weeks post op and your body will indeed still be all over the shop. You have just had a major injury and been taking a bunch of new drugs.

I reckon that my INR didn't really stabilise for about six months.

I think its OK that you are under two and I think its even better that your clinic is not going nuts trying to push you too fast and set up a see saw effect.

Heaps of people kinda wanna be a bit under two anyway , so you are their envy

I sort of disagree with these irregular doses, I find that having everything even is better. So for instance I would think that six daily rather than your pattern of 5 and 7.5 would help make you regular

I know that my first year on warfarin was really frustrating. Mainly it was frustrating because the clinic did all manner of minor dose changes, I hated getting the vein samples every 1 , 2 or 3 weeks and felt like a victim not someone in charge of myself.

I was very glad to be able to say bye bye to the clinic and fully manage myself.

My blog post may seem a bit of an essay but hopefully you will find it a helpful resource to go back to

http://cjeastwd.blogspot.com/2014/09/managing-my-inr.html

 

[Protimenow]

Taking ONE pill ONCE a week is going to give you irregular readings. The half-life for warfarin is something like four days. So, the day after you take your dose, the INR will be high, the next day, it may be even higher, four or five days out, it'll be almost as if you didn't take it at all.

Whoever prescribed your dose didn't know what he or she was doing. Yes, the guidelines talk about a total weekly dose -- but this does NOT MEAN that you take it once and then expect the INR to be steady the rest of tthe week. If you want to get into rrange, you MUST take warfarin AT LEAST four or five days a week -- I take 7.5 mg EVERY NIGHT. In the past, I've alternated between 7.5 (on even numbered days) and 5.0 (on odd numbered days), but always took my dose every day. This is the only way you can get your INR in range and keep it in range -- and not be subject to some idiot doctor prescribing once a week doses depending on what your INR is days after you've taken it. WEEKLY TOTAL means exactly that --- not once a week, but the TOTAL dose spread out over 7 days.

Other than that, you're really asking for trouble.

 

[DachsieMom]

Ugh. I was 1.7 last week, so they had me take an extra 2.5 mg one day last week- and then this week I dropped to 1.6! They are having me take a few more pills on certain days this week (so 7.5 some days, 5 my other days). I am running quite a bit at rehab and tend to have a fast metabolism, but this is frustrating! I am not eating any greens. Hopefully it will pick up soon. I also take a baby aspirin. I am almost 13 weeks post op.

 

[pellicle]

Hi

Ugh. I was 1.7 last week, so they had me take an extra 2.5 mg one day last week- and then this week I dropped to 1.6! They are having me take a few more pills on certain days this week (so 7.5 some days, 5 my other days). I am running quite a bit at rehab and tend to have a fast metabolism, but this is frustrating!

indeed it is ... so how do you feel about an experiment?

I am going to suggest that you "disobey" directions and take 7mg all days and see where that leads you. As you are taking 7.5 anyway the worst that can happen is you go over 2 to something like 2.5 (which would be good right?) Even if (hard to see given your current experience) that your INR went to 3 that's not really threatening. This is exactly the sort of thing you'll need to be comfortable in doing if you self manage. Its one thing to gripe about how professionals are mis-managing you, and its another to choose to accept responsibilty for your own actions.

NOW (this is important) is there anything else you're not telling us? You know , like you are prone to this or prone to that, or diabetic, or ....


So, if everything you've reported is all A-Ok, then I'd say shoot for 7mg daily and see.

I did exactly this in hospital when they were failing to manage me and while I had a good ding dong with the head nurse when she found out what I'd done, she had to eat crow that I was actually right and accept that their process was flawed.

 

[pellicle]

BTW, there is nothing I've ever read to suggest your warfarin dose significantly effected by your body mass. A skinny person will just as likely require more warfarin to achieve INR = 2.5 than a fatter one

also, can you tell me *exactly* what your dose is ... what you take *each day* ... thanks

PS: I just put your numbers through my model (had to guess) and assumed a "metabolism" figure of about my upper range of "metabolism" and got a predicted INR of 1.72

 

[DachsieMom]

Wow! Thank you for the responses. As of today, I will now take 7.5 mg Mon,Tues, and Wed then 5 mg Thursday, then 7.5 Friday, then 5 mg Saturday and Sunday (I was on 5 mg all days, then they added one day (Wed) at 7.5, and last week a second day (Monday) at 7.5. I don't think there is anything else - not prone to anything....tend to be fairly low in iron and platelets, but never out of range. I am also taking a baby aspiring every day per my cardiologist. I am 99 lb, 4'9". I am running three days per week at rehab, fairly active on other days. I currently test at a lab each week, but hope to transition to home testing through Roche as soon as they can set me up. Right now, I have the 2.5 mg tablets. Generic.

 

[pellicle]

Hi

Wow! Thank you for the responses. As of today, I will now take 7.5 mg Mon,Tues, and Wed then 5 mg Thursday, then 7.5 Friday, then 5 mg Saturday and Sunday (I was on 5 mg all days, then they added one day (Wed) at 7.5, and last week a second day (Monday) at 7.5. I don't think there is anything else - ... Right now, I have the 2.5 mg tablets. Generic.

ok, well plugging your above stated doses and days into my model I get a graph like this:

I guess the first thing is that my assumption of M (what I call vaguely "metabilism") to be steady (and it isn't) at a bit over 8 (solid green line) your INR would sort of squiiggle around somewhere between the areas of the "Modeled INR" and the "two period average" of that ... but that number is dependent on the value of M which as yet we have no baseline for.

My own M varies anywhere between 6 and 10 ... and is effected by spike doses (such as you have been given.

Essentially its like trying to get a smooth surface on a pond when you are plunging something up and down (as you can see by the red line indicating DOSE)

I would want to sort that out to an even dose which I'd reckon on being 6.5 ... but as we know you want to elevate your INR above 2 I'd just go with 7 as my dose

Now, as you have 2.5mg tablets two of them is 5 but a third would be 7.5 ... so you could do 2 things:

split one of the 2.5's into 2 *(there is a line to make it easy) and then split those bits into 2 (I use fingernail clippers) and take 3 of those portions with the two 2.5's (which will be close to 7). Any inaccuracy in cutting will essentially be evened out over the days, but as long as you cut neatly you'll be fine.

OR

you could take 2x2.5mg (=5) + half a 2.5 ( = =1.25) = 6.25 and alternate that daily with the 7.5 This last secnario would model like this:

note that the smoothness of the INR will in reality never be like this as there are always other things pushing it up and down ... natural noise in the system so to speak.

If you did that it would be interesting to see what your INR is, it will be up but I'm expecting it will be below 3.

Myself I use a combo of the 5mg 3mg tablets as I can split a 5 to make 7.5 (5 + 2.5) or add a split 3 .... you get the picture

Its all your call, but if you can get back to me with what your measured INR was and when that was sampled so that I can put that into the model I'll post that and have a better idea of your M

 

[pellicle]

PS

Wow! Thank you for the responses. As of today, I will now take 7.5 mg Mon,Tues, and Wed then 5 mg Thursday, then 7.5 Friday, then 5 mg Saturday and Sunday (I was on 5 mg all days, then they added one day (Wed) at 7.5, and last week a second day (Monday) at 7.5.

I still think its a good thing you're moving up gradually. You don't want to have your INR shoot high and then have it waddle all over the place. High INR on starting can lead to some problems.

Also, they often try to simplify the doses (speaking to my friend the pharmacist) because (his words) people are often too dopey to be reliable in taking and taking the right thing. So that may be a factor. I personally would get a variety of tabs (say, 1mg, 3mg and 5mg) to make your dose level easy to obtain and day to day consistent.

 

[ajc1991]

The time that it takes for people to get the right dosage to have stable readings varies from person to person. I currently take 12 MGs three days a week and 10 MGs the rest of the days. My INR lowers when I am active so I had to make two adjustments when I started running again and when I went back to work, since with my job I am very active. I am currently 6 months out from when I had my surgery.

 

[DachsieMom]

So just an update - after being 1.7, they increased my dose by 2.5 additional mg per week, but then I dropped to 1.6! I was frustrated and concerned, with so many weeks below 2. They increased my dose again (4 days at 7.5, 3 days at 5) last week and this week I finally made it to 2.0! I was ready to celebrate! However, cardio wants me at 2.5-3 so now are increasing again this week - 6 days at 7.5 and one day at 5, retest next week. I still take baby aspirin every day as well. I am not eating any greens, no blueberries, etc. I must just metabolize these pills quickly!

 

[dick0236]

Your INR manager is adjusting you in a very sensible way......smaller adjustments until you get to your range. You will find that infrequent small adjustments will normally work to keep you in your range......but unless you just don't like 'em, I would not leave greens out of my diet. It may make it more difficult to maintain INR if you reintroduce greens down the road. The old saying is "dose the diet....don't diet the dose".

 

[pellicle]

Hi

So just an update... this week I finally made it to 2.0! I was ready to celebrate! However, cardio wants me at 2.5-3 so now are increasing again this week - 6 days at 7.5 and one day at 5, retest next week.

seems close to what I'd proposed above:

- 6.25 and alternate that daily with the 7.5 This last secnario would model like this

it will be interesting to see how close your final dose is to my estimation.

As dick said (and as I said earlier too) I think its good that your clinic is adjusting you carefully. Your cardio wants you higher, and you are moving higher ... rome was not built in a day and there is nothing worrying about your INR

I still take baby aspirin every day as well. I am not eating any greens, no blueberries, etc. I must just metabolize these pills quickly!

I agree with Dick, if you want to eat greens eat them. I'm quite sure its effect will be insignificant (well unless you ate 2 pounds of spinnache every day of the week).

the aspirin makes no measurable difference to your INR as it works on platelets

 

[Bonbet]

Are blueberries contraindicated if taking Coumadin? First I've heard that.
Bonbet

 

[pellicle]

Hi

Are blueberries contraindicated if taking Coumadin? First I've heard that.

you're correct ... its not ... as is often said here by those who are on warfarin, eat what you like. As far as "contra indicated" I'd doubt it

looking at this site:
http://ptinr.com/vitamin-k-facet-sea...1214&tid_1=All

Spinach, frozen, chopped or leaf, cooked, boiled, drained, without salt 1 cup = 1027.3micrograms
Blueberries, raw 1 cup = 28 micrograms

so you'd need to eat 36 cups of blueberries to equal one cup of spinach ... and as I eat spinach when the mood takes me (and have tested my INR) and found little difference then unless you're intending to gorge on a bucket of blueberries there will be no effect.

 

[Freddie]

So just an update - after being 1.7, they increased my dose by 2.5 additional mg per week, but then I dropped to 1.6! I was frustrated and concerned, with so many weeks below 2. They increased my dose again (4 days at 7.5, 3 days at 5) last week and this week I finally made it to 2.0! I was ready to celebrate! However, cardio wants me at 2.5-3 so now are increasing again this week - 6 days at 7.5 and one day at 5, retest next week. I still take baby aspirin every day as well. I am not eating any greens, no blueberries, etc. I must just metabolize these pills quickly!

You'll have to start eating an normal diet that includes green veggies otherwise your dosage is going to continue to swing.
I used the online Dosage Calculator with your old dosage (4 days at 7.5, 3 days at 5) and it calculated your dosage should be 7mg for 6 days & 6mg for one day.

With your new dosage according to the calculator, it looks like you may have to alternate days of 8mg & 7mg

 

[DachsieMom]

Stil trying to get adjusted...made it to 2.3. Cardio Increased me again to 7.5 mg every day because they wanted me at 2.5-3 (my surgeon prefers 1.8-2.5, with a goal of 2.2). With increased dose, I then went down to 2.2. Ugh!? So now they want me to take 10 mg twice per week and 7.5 mg the rest. I know some of you have said dosage doesn't relate to body size but I still can't believe I am on such I high dose - I don't even weigh 100 lbs. On the bright side, I started home monitoring (with my cardio regulating inr).

 

[pellicle]

Hi

Glad you are in range

Stil trying to get adjusted...made it to 2.3. Cardio Increased me again to 7.5 mg every day

That's good, that is about what I reckoned you would eventually settle on. It matters not a whip that you went down as up and down with a range is NORMAL.

They now need to stop tweaking your dose and give you two weeks on 8mg a day.

. I know some of you have said dosage doesn't relate to body size but I still can't believe I am on such I high dose

It doesn't . Check here and you will see some slender ladies are on 12. The dose relative to body weight doesn't matter . I know men who I drink under the table and chicks who I will not go shot for shot with.

Same thing.