Coumadin clinic

[mecretired]

Did you mean that you ARE comfortable splitting pills? Sorry, it’s 4 am, I may have missed something....

I also (briefly, thank god) had a Coumadin clinic that wouldn’t prescribe different dosages and insisted I add or subtract half a 5 mg pill a week depending on whether I was above or below range... I have since discussed this with a couple pharmacists who suggested that

1. Coumadin clinics are trained to think that you’ll get all confused if you have more than one dosage amount.
2. The 5 mg pills are more commonly prescribed than other dosages, so they are cheaper than say 6 mg or 1 mg.

Incidentally, I have spent 30+ minutes just waiting on the phone with a Coumadin clinic ‘technician’ while she tried to calculate what my new dose should be once when I was out of range. This when I was only allowed 5 mg pills... I wonder if a third reason for this difficulty getting other dosages could be the technician needing to think differently about calculating daily dosage?...

Maybe your clinic or cardiologist would be more supportive if you told them exactly how you plan to calculate a new dose when you’re out of range. (That’s IF that’s the plan - of course, they could still give you 1 mg pills to have on hand while ‘managing’ your INR for you (telling you how much to change warfarin dosage by when out of range) - but even if you want to rely on letting them tell you how much to adjust by, it might be good to calculate it yourself and then compare that to what they tell you.

I thought I would be able to rely on my Coumadin clinic, and guessed they’d be better at it than me (especially in the beginning); but I ended up having no choice but to self-manage after they NEVER called me back, on two occasions, to tell me the dosage change; and they were just generally too incapable, unresponsive and disinterested. It’s like someone else on this forum (probably Chuck C or pellicle) has put it - it matters more to YOU than to them because it’s your body and your life - your consequences if it’s not done correctly. Having said that, if they are capable and will prescribe 1 mg pills and you want to rely on them rather than self-managing, I get that too. We are all in different circumstances. I wish you luck.

I am definitely NOT comfortable splitting pills. I’m also NOT comfortable taking 7.5mg 6 days and 5mg on 1 day and expecting it all to come out. From everything I know, wouldn’t my inr be different depending on what day I tested?

 

[Protimenow]

This is 50 mg/week (if you figure it that way). You might be able to bet by with 7 mg/day (yes, 1 mg per week less). This is my daily dose.
I achieve it using one 5 mg pill and two 1 mg pills or 1/2 of a 4 mg pill. It keeps my INR more stable, no matter what day I test, and really isn't much more difficult than taking a single pill (7.5 or 5) each day.

If you can convince them to prescribe 5 mg and 1 mg, 2 mg (if they make one), or 4 mg, your dosing will be much easier to test against -- and your INR will be a bit more stable, too.

 

[Mister_James]

I find your comment almost amusing because I have on occasion self dosed and just lied to the Coumadin clinic about my inr and my dose. But you promised not to snitch. Currently I only have 5 mg pills and no script for 1mg pills. So she is in control right now. If I don’t hear back before my appointment on March 8 I will definitely have it out then.

I also have 5mg pills I break them up and I don't care how even the halfs are. I take 7.5mg and 5mg.
I have a testing company that reports and I lie everytime. I basically self manage. Last week I tested at 4.5. I reported 3.5 and skipped a dose. Nurse called me a day later and said doc reviewed your INR and keep the same dosage and I thanked them.

 

[pellicle]

I am definitely NOT comfortable splitting pills.

why not?

For instance if you split a 5mg pill slightly unevenly to have 2.45mg and 2.55mg and have one one day (with say a 5mg to make 7.45mg and the other the next day (to have 7.55mg) what difference could that possibly make?

If the pills were not intended by the maker to be split they wouldn't have a splitting line in them ...

These are:

• aspirin
• paracetamol
• ibuprofen
• 3mg (Marevan) warfarin

only the ibuprofen does not have a split line indicating it is not one intended to be split.

 

[Chuck C]

why not?

For instance if you split a 5mg pill slightly unevenly to have 2.45mg and 2.55mg and have one one day (with say a 5mg to make 7.45mg and the other the next day (to have 7.55mg) what difference could that possibly make?

If the pills were not intended by the maker to be split they wouldn't have a splitting line in them ...

View attachment 888351

These are:

• aspirin
• paracetamol
• ibuprofen
• 3mg (Marevan) warfarin

only the ibuprofen does not have a split line indicating it is not one intended to be split.

I'd also generally try to avoid attempting to split fish oil capsules.

 

[pellicle]

I'd also generally try to avoid attempting to split fish oil capsules.

I suck some out, leave it on the bench for tomorrow

 

[mecretired]

This is 50 mg/week (if you figure it that way). You might be able to bet by with 7 mg/day (yes, 1 mg per week less). This is my daily dose.
I achieve it using one 5 mg pill and two 1 mg pills or 1/2 of a 4 mg pill. It keeps my INR more stable, no matter what day I test, and really isn't much more difficult than taking a single pill (7.5 or 5) each day.

If you can convince them to prescribe 5 mg and 1 mg, 2 mg (if they make one), or 4 mg, your dosing will be much easier to test against -- and your INR will be a bit more stable, too.

Getting my cardiologist/Coumadin clinic to prescribe 1mg pills is my goal. I am willing to use ONLY 1mg pills if they don’t want to give me more than 1 strength. I will take 7 of them a day if that’s what it takes to make them happy.

 

[user 15848]

Difficult for a Split to be 50/50, but I use it for Vitamins and Natural supplements, things it does not really matter the %. For Warfarin i use:
1 , 2.5 and 3. And that works well for me. Sometimes it goes 1.0 above my range and then next day i take 1 mg; some times is in the lower end, and i also use that 1 mg again, It happens, in my case.

 

[carolinemc]

I am definitely NOT comfortable splitting pills. I’m also NOT comfortable taking 7.5mg 6 days and 5mg on 1 day and expecting it all to come out. From everything I know, wouldn’t my inr be different depending on what day I tested?

You should let the Coumadin(warfarin)clinic know your wishes as well as your cardio. I have split pills myself and no problem. But you do what you feel comfortable with. You are your own advocate with medication as you are to be with your medical issues. Good luck in getting them to listen.

 

[Unicusp]

Getting my cardiologist/Coumadin clinic to prescribe 1mg pills is my goal. I am willing to use ONLY 1mg pills if they don’t want to give me more than 1 strength. I will take 7 of them a day if that’s what it takes to make them happy.

Good plan. That's what I did from the start. 1mg tabs give you the most flexibility. Don't know why they would hesitate switching to all 1mg tablets. Demand it!

 

[KLS39]

I have always had 2mg tablets. It is easy to split them and allows me to change from 7 to 8mg. I don't have to think about what mg pill I am choosing as I fill my pill case.

 

[Brinntache]

I split my 2.5mg tablets pretty easily with my fingers. Just line up the line on the tablet and push. It's almost like they knew the tabs would get split.

 

[pellicle]

It's almost like they knew designed the tabs would to get split.

I'll take the liberty of changing your words to represent what I think is the case

 

[Protimenow]

I don't understand why any of you are angry.

Is it because I split the pills in the wrong place and temporarily hurt my dogs?

Is it because I criticized a fool at a clinic?

Please explain your response so I know why you're angry about my comment.

This is the first time I've seen this kind of response to my postings.

 

[Protimenow]

I'll take the liberty of changing your words to represent what I think is the case

Right. Designed so that they could be split. But they also knew that people would take advantage of the designs so they COULD be easily split.

 

[Protimenow]

Difficult for a Split to be 50/50, but I use it for Vitamins and Natural supplements, things it does not really matter the %. For Warfarin i use:
1 , 2.5 and 3. And that works well for me. Sometimes it goes 1.0 above my range and then next day i take 1 mg; some times is in the lower end, and i also use that 1 mg again, It happens, in my case.

There's nothing wrong with splitting warfarin. Although the dose IS sensitive, the few granules that may drop aren't significant and, as Pellicle said, if you're not exact one day, the next day will make up for it.
So - split away - just don't do it over the floor where a tiny dog might be walking...

 

[pellicle]

This is the first time I've seen this kind of response to my postings.

Things are a changing here ... Like the TV ads often say I use and recommend this product:

https://www.valvereplacement.org/threads/making-vr-that-bit-nicer.888377/

 

[mecretired]

Things are a changing here ... Like the TV ads often say I use and recommend this product:

https://www.valvereplacement.org/threads/making-vr-that-bit-nicer.888377/

I called my cardiologist’s office this morning and left a message (previous messages were online through patient portal). Anyway—“Martie” from my Coumadin clinic called me about 6 this evening. Cardiologist evidently didn’t get my online message but did get the message I left by phone. He must have read Martie the riot act We had a 30 min discussion/argument. But I am getting my 1 mg pills as well as my 5mg. If I ever have to split pills I will split 1mg pills. I checked my inr while we were on the phone. (I was shaking so much I almost couldn’t do it.). I will start taking 7mg tomorrow—which is what I was wanting to do. So, again, we have a truce. Bad news is my cardiologist (the head of a well respected cardiology group) is leaving. Thanks for all your support. This group has saved me multiple times.

 

[pellicle]

Hey there

I'd have loved to be a fly on the wall on that call ;-)

... Bad news is my cardiologist (the head of a well respected cardiology group) is leaving.

so, is it such that only a cardiologist can presecribe you the warfarin and manage your INR? Seems an odd system to me...

Thanks for all your support. This group has saved me multiple times.

I love the good new stories and I'm glad that you find support for the situations from here. I believe that any given person will not always agree with any other given person but we are all here to provide support (as well as learn).

Best Wishes

 

[Chuck C]

so, is it such that only a cardiologist can presecribe you the warfarin and manage your INR? Seems an odd system to me...

In the US, a doctor or nurse practitioner can prescribe warfarin. It does not need to be a cardiologist.