Coumadin Dosage Question for AL or others

[Martin_W_Riley]

Just a quick question about coumadin dosage. My INR from last Thu came back at 3.9 and the week previous 3.8.

I take 4mg each day and twice a week I take 6mg. My surgeon would like me to be closer to 2.5 than 3.5 and the "new" doc from the clinic also thinks 3.9 is too high. (new because my pcp is away)

So here is what he told me to do...

Skip my dose today and tomorrow - stick to 4 mg Wed and get tested again on Thu. So far this week I have 3 days at 4mg and one at 6mg.

Does skipping days sound smart? Isn't skipping two days a bad idea?

Why not skip today only and take 2mg Tue and 2mg Wed?

FYI: When I was taking 2mg per day, my INR was 1.9.

Any reason why they just don't keep me on 4mg everyday?

Thanks

Martin

 

[catwoman]

Martin:

Based on Al's algorithm chart, seems docs should be -- at most -- having you hold 1 dose, then reducing dosage by 10%. Which would put you at 4mgX7.
Another option would be for them to reduce your dosage to 4mgX7, then retest in 1 week, see what that does for you.

Any one else have thoughts? Am I thinking along the right lines? I've never done any self-adjusting. Been pretty steady at 3.4-3.6 for 8-10 weeks. KNOCK ON FORMICA...

 

[Johnny Stephens]

*Personally* I would feel more comfortable seeing you simply move to what the new dosage plan is now, and retest in a week. Skipping 2 days, changing a dose, and then testing the next day seems like a guarantee for a goofy reading, and many people seem to bottom out when they skip 2.

These seem like drastic measures for someone who isn't really dangerously out of range.

Standard disclaimers apply - not a doctor, etc.

 

[Ross]

No way should you skip 2 doses. I'd just reduce a little and test in a week. There going ballistic over nothing. No matter what they tell you, I like to stay higher, so I can have some play room with my diet. If I were to try to hold at 2.5 I'd never be able too and would be having dose changes every visit.

Case in point-On my normal dosing, I somehow crept out to 4.6. I decided to skip one dose and reduce the overall by 10% and retest in 4 days. I tested at 2.1 on day 4. If I skip even a dose, I bottom out very quickly.

 

[Martin_W_Riley]

Thanks

Thanks

I'm happy I ran this by you as I didn't feel comfortable with the new doc and his advise to stop the warfarin for two days.

Thus I will self medicate...

Based on your feedback, I'll try 2mg tonight and then hold 4mg per day thereafter and see with regular testing where that brings me.

I'll also talk to my cardio and see what his feeling is on the new dosage.

My "GUESS" with the new dosage, I will be at 3.5 this week and around 2.8 the next few weeks! I'll let you know if my guess comes close.

Thanks

 

[EVELYN]

Hi Martin.

I have to tell you.....when I hear a 3.9 and then I hear a "hold for two days," it certainly shivers my timbers!!!

Tyce has been on coumadin for two years---some of which were whacky dosages. However, we now follow Al's or Marty's I forget which, rule---Increase or decrease by 10% and test in a week. It has certainly worked for us!!!

I, too, agree with Rossman. I'm much happier when Tyce is about 3.5. This is a man who was as low as 1.6 to as high as 8 more than once. Our cardio has often told him to hold for two days----never going to happen in our house, especially if he's reading 3.8.

Good luck.

Evelyn

 

[Guest]

Translate your doctor's advice to I'd rather that you wrecked your valve or had a stroke than a bloody nose. You are better off with and INR below 5.0 than you are with any number below 2.3.

Holding two days should reduce your INR by about half so you can figure that you would be below 2.0 in two days.

 

[Martin_W_Riley]

Thanks

Thanks

Thanks folks.

I didn't listen to the new doc and I did not skip a day (or two) but instead only took 2mg on monday and have been at 4mg since. Test is tomorrow.

I'll let you know what the result is. My weekly total will thus be 30mg instead of 32mg and next week 28mg which should safely and slowly bring my inr back within 2.5-3.5 range.

What I think is scary is that anyone not informed about coumadin or unaware of this site or Al's would have listened to the new doc...

Ouch!

 

[Marty]

10 % Solution !

10 % Solution !

I never met a guy named Martin that I didn't like and I like you Martin. So follow Evelyns advice and consider the 10% solution when a dose change is being considered. This entails upping or lowering your weekly total dose by 10% spread as equal as possible over 7 days. Al sometimes advocates 15 or 20%.

 

[Martin_W_Riley]

survey says...

survey says...

INR came back last week at 2.9. Can you imagine if I had taken the new doc's advise!

 

[Georgia]

good going. I had a doc last year (oh, yeah - the same one who misdiagnosed me for years) who always wanted me to hold. When I disagreed with him he wrote me a letter and told me to find a new pcp. It was a blessing.

Rather than holding I cut dose in half; take half dose for two days if I'm really high (I've never been REALLY high - only up to 4.8). Of course, I haven't really out of whack with the new doc because he doesn't change the dosage every time I'm .1 out of range. Lets it resolve itself.

Be sure you keep track of all of this - a chart or something. It helps if you change docs or have problems later on.

 

[The Bionic Duo]

This sounds all too familiar. Bob tested at 3.5 this past Friday and when he called it in (he home tests) they called him back and wanted him to hold on Friday, take 2.0, for 4 days and 2.5 for two days. He has been taking 2.0,2.5 every other day for quite some time and he has been around 3.0 for most of that time. Bob usually tries to follow the Dr's orders, but this time he just looked at what he has written down and said that what he wanted didn't make any sense, and there was NO way he was going to hold for a day.

He tests every week but only calls the INR in when the Dr wants a reading, the last two times it has been at two week intervals. A few of weeks ago he tested at 4.0, (after a dentist appt and taking the antiboitcs), since he didn't have to call that one in he stayed on the same dosage and sure enough the next week he tested at 3.1. This is his cardio, and he seems to be fanatic about Bob staying within the 2.0 to 3.0 range and he seems to be happiest closer to 2.0.

Does this make any sense to you guy? It sure doesn't to me.

Joan

 

[Karlynn]

Martin,
My INR was 4.4 a bit over a week ago. If I hadn't been a member here, I would have freaked out. I used Al's algorhythm chart and lowered my dose by only 10% of my week's dosage. I didn't skip a dose, because my info here put me in fear of rebounding and going too low. A week later my INR was 2.4. My doc and I like to keep it above 3. So I'm back on my usual pre-vacation dosage and will test again in a week.

Pretty scary when you think of the advice doctors are giving. Glad it worked out for you.

 

[ticktock]

I will never skip two days again, I only skip one when I'm over 5. But then, I know my symptoms and handle a high INR pretty well. I find diet can get me down pretty quick, if I need to. Gina taught me this trick a few years back.

Mindy

 

[The Bionic Duo]

I guess these senerios just go on and on don't they. Bob did a slight adjustment (down) when he had a 3.5 reading, and the next week his INR was 5.8--on a lowered dose--go figure. So this time instead of calling the DR we sat down and figured out a plan based on what I have heard and read here. He held for one day and took 2.0 the rest of the week, which amounted to slightly more than a 10% reduction. Last Friday his INR was 3.1--hooray.

Bob has been in awe all week about that--just couldn't believe I knew how to adjust better than his Doctor. I told him to believe it--got to get him to do some reading on this site and see some of the things the rest of you have been through.

Joan

 

[Ross]

Joan when he had the high test after lowing the dose, did you have him check it twice? Sometimes you need to do that to verify the first reading. I've had a couple of wacko readings that would've called for adjustment in dosage, but turned out to be bum tests.