coumadin dosing

[nigella]

my mother is currently taking 2.5mg warfarin, everyday, except for Sun & Th, when she takes 2.0mg. I have asked her pharmacist if she could upgrade her Rx to just one 2.5mg pill, she has agreed and told me to have her take 2.5mg a day except for sun. when she will take half a pill which would be 1.25. her INR has been about 2.2 (her range is 2.0 to 3.0), and she tests every 4 weeks. {she has a jude's mech avr, 5-26-05). Should we expect a significant change in her INR? her old dose was about 16.5mg per week, and if she takes the 2.5mg per day except for Sun (1.25mg), that will be a total of 16.25mg, not much of adifference i guess? will this be ok, or will she have days when her INR is too low? Thanks for your input.

 

[geebee]

Since your mom is on the low end of her range, I would almost rather see her take 2.5 every day instead of doing anything to lower her dose. .25mg shouldn't really make that much difference but why take the chance. Adding 1.25mg/week will still keep her in range albeit mid to upper.
Just my 2 cents.

 

[Ross]

It shouldn't be terrible, but it really depends on how fast she metabolizes Warfarin and her diet. Personally, I'd rather see her go with a higher dose and higher INR. Cutting the dose at 2.2 is not a great idea because your on the fine line as it is. Judging by what she's taking, I'm thinking you could see 2.0 or lower with this dose, then again, maybe not.

 

[Guest]

In general, you are much better off with an INR near the upper end of the range then at the lower end.

 

[Blanche]

I agree with the other members and have some concern for reducing a dose when your mother is in range. I guess the question I have would be, why is the pharmacist changing your mother's dose? How is this pharmacist connected to your doctor. In my experience, pharmacists follow doctor's orders, they do not make changes....however small.

 

[Cris N]

I agree with the others... better to be at the higher end than the lower. I'd stick with the 2.5 daily. You say she's testing every 4 weeks... is she stable? I'm wondering if she's increasing her physical activity now that she's feeling better. If so, she might want to get test a bit more often if possible, since more activity increases metabolism of warfarin.

Cris

 

[chief911]

I know you have said that naproxin (alleve) is a good pain reliever that should not cause a problem with bleeding. Does this include napronex/naprosyn?

 

[ALCapshaw2]

Nigella,

WHO is managing your mother's Coumadin?

THAT is the ONLY person who should be adjusting her dose.

I agree with the others that maintaining her INR in the upper end of her range is preferable and it would appear that 2.5 mg every day *might* be a better answer. This would need to be agreed to by the person managing her Coumadin.

FWIW, many Coumadin Clinics are managed by PHARMACISTS, NOT Doctors, and in fact they seem to do a better job than doctors who only have a few patients on Coumadin. Note that AL LODWICK, our anti-coagulation guru, is a Registered Pharmacist and Certified Coumadin Clinic Director. The director of my own Anti-coagulation Clinic is a Pharm D (Ph.D in Pharmacy) with two Certified Registered Nurse Practicioneers under her. They have done an excellent job of keeping my INR stable with only minor (seasonal) shifts.

'AL Capshaw'

 

[Guest]

It does include Naprosyn but I don't know if there is another ingredient in Napronex or not.

 

[nigella]

thanks to everyone who responded .. the pharmacist at her provider's coumadin clinic is managing her dose. she's been stable ever since she got in range. she's always been at a 2.0. she tested this weekend and sure enough, she's at 2.0. she's been taking 2.5 per day with half a pill on sundays.. so it looks like the new regimen of 2.5 is pretty much the same as before... there was one time when her INR was at 2.6 which only happened once. her pharmacist said, " it's a little on the thick side today, so let's adjust the dose...." so i think they know what they're doing generally, but sometimes they "slip". i suspected , from what i've learned on this site, that if she took the adjusted dose, that her INR would probably go too high . by the time i got to the main pharmacist on the phone, she cut it down to 2mg less that what was originally ordered.
so anyway, is it better to be at 2.0 or 2.5? if the range is 2.0 to 2.5. if she takes 2.5mg a day, this might get her to more of a mid level INR. just curious, b/c i know the dosing adjustments should only be made by her MD or pharmacist. in her case, it;s her coumadin clinic.thanks again everyone.

 

[Guest]

There is no statistical difference between 2.0 and 2.5. My personal preference is to keep people on the high side. It is easier to treat a bleed than a stroke. (It is easier to get new blood cells than it is to get new brain cells.) Adjusting the warfarin dose for an INR of 2.6 when the upper limit is 2.5 is ridiculous. How would that pharmacist react if he or she were given a ticket for driving 26 in a 25 zone? That is about how sensible it is. Even setting a range of 2.0 to 2.5 just illustrates that the person who did that has very little knowledge about how warfarin works and its risks vs benefits.

 

[nigella]

thank you allodwick. your reply makes sense.