Coumdin ?

[richie rich]

HI GUYS

I HAVE A QUESTION. I HAVE BEEN TAKING MY COUMDIN (3MG) PILL WITH MY OTHER MEDICATION AT DINNER TIME. THE BOTTLE SAYS THAT I SHOULD TAKE AT BEDTIME. I HAVE BEEN TAKING IT WITH MY OTHER MEDICATION SO I WOULD NOT FALL ASLEEP AND FORGET TO TAKE MY PILL.

I HAVE BEEN GETTING SEVERE HEADACHES EVERYDAY. I USUALLY WAKE UP IN THE MORNING WITH IT AND THEN IT GOES AWAY.

DO YOU THINK THAT THE HEADACHES ARE COMING ON BECAUSE I AM TAKING MY COUMDIN WITH MY OTHER MEDS AT THE SAME TIME RIGHT BEFORE I EAT DINNER?

RICH

 

[Ross]

To be honest, No I don't. What other meds do you take at the same time?

 

[richie rich]

HEY ROSS

I TAKE ENALAPRIL ( VASOTEC ) , METOPROLOL ( LOPRESSOR ),
PROTONIX AND DIPYRIDAMOLE ( PERSANTINE ) AT DINNERTIME. ZIPPER HAD MENTION THAT THE PERSANTINE MAY BE CAUSING THE HEADACHES. I WAS TOLD THAT I WILL PROBABLY HAVE TO BE ON IT FOR THE FIRST THREE MONTHS.

THANKS

RICH

 

[JimL]

It is recommended that you take coumadin later in the day only because on the days you get your INR checked, the doctor would like the opportunity to call you can tell you to change the dosage. Taking the coumadin at a time you won't forget is probably more important.

 

[Christina]

Hi,

I am taking my Coumadin first thing in the morning now, as soon as I come in the kitchen. I see the pill box so I don't forget. At first right out of the hospital I took it at 4PM because that's the time they gave it to me, and being scared I didn't want to change that. After a while I thought 6PM would be better for me as that was right at dinner time and I wouldn't forget. Even that time wasn't at all convenient. Many times when we would be out somewhere else I would forget because I would be "out of the routine".
Then I talked to a good friend of mine who said she takes all her meds in the morning, and that it is a lot easier to remember.
I took her advise and have been taking it in the morning and have not forgotten once, even when I was in Europe for three weeks. I take my HRT in the evening just before bed. Have the pillbox on my nightstand.

Hope this helps someone.

Christina
Tucson, AZ
Aortic Stenosis
AVR's 8/7/00 & 8/18/00

 

[alicia]

My docotors told me to take my Coumadin right before I go to bed. I have a big pill box organizer and include that with my nighttime meds. its the only way i can keep it all straight since Im now on 12 different meds. Hope your headaches go away soon. I get my level checked next week and they said I need to keep it at 2.5 to 3...

 

[wlaldridge]

I shifted mine to the morning for the same reason as Christina. With a drug that takes 3 days to make a change in the INR, it doesn't seem logical that it need be taken at a specific time of day, as long as you take it consistantly/regularly.


for what its worth.

 

[EVELYN]

Tyce does his warfarin in the a.m., too....every morning at 7 is his rule, with his yogurt or whatever he's having for breakfast at work. He puts it in a little plastic bag and puts it right in his lunch bag....I think what's most important is consistency. I don't recall any headaches as a result of the coumadin.

Ev

 

[richie rich]

i am going to see my surgeon this afternoon for my post op checkup. i will ask him about the headaches. i woke up this morning and i did not have the headache. go figure. i just can't wait to be off of the meds soon. 2 1/2 months and counting.

rich

 

[MarkU]

I got into the habit of taking my Coumadin and multi-vitamin at dinner time each evening. Seems to work okay for me.


Mark

 

[richie rich]

hi guys

so far i have gone 36 hours without a headache. i am going to take my coumdin wioth my other meds at dinner. easier to remember. my surgeon took me off of the persantine last nite. he also said that i can stop taking the coumdin on feb. 15, which would be 7 weeks post op. seems kind of soon but hey the less meds the better.

thanks to all who responded.

richie rich

 

[Christine]

so here's my question.. i didn't realize you could take coumadin in the morning.. i was told mainly that when I get tested it might make my reading higher.. I actually go at lunch to the clinic about once a month.. so if I were to switch to the AM.. how? what I mean is do I still take it at nite and then switch the next morning? I also have accuprill (BP) i take once a day which i just included in my 7pm doses.. but if I swap most of them, (except my beta blocker which is twice and pravacol which is bedtime) then i'd be happy, (take them all first thing and don't have to worry about it the rest of the day..)

thanks

christine

 

[wlaldridge]

Hi Christine,

I don't want to be here giving medical advice, though much of the advice on this forum is better than some ot the medical mistreatments we have seen in recent years. That said:

I switched to the morning just by taking that day's dose in the morning instead of at night. So, yes, I took a p.m. dose and the next day took an a.m. dose. The reasoning, as I mentioned before, is that they tell you to wait 3 days after a dosage adjustment before testing again, since it takes that long for the change to have effect. If that is correct, then the testing is not going to be confounded by a morning dose.

The p.m. dosing does allow them to make a dose change on the day they get results from the lab, but that only only delays the adjustment of a dosage by 12 hours and since the full effect is not in place for 36 to 48 hours, logic says that timing is not all that critical. If they feel you need to increase the dose that quickly they can just have you take extra that p.m. And it is probably more critical when raising the dose (since the too low INR is more likely to be catastrophic than having a slightly elevated one) than lowering a dose so the extra dose can be taken anytime.

If you read what Al Lodwick says, you will see that the combined weekly dose is what they manage, not just the daily dose. Many of us take different doses on different days to manage the total for the week. I take 7.5mg. on Saturday and Wednesday with 5 mg. the other days giving a total of 40mg per week. Other lifestyle issues such as dark green veggies or increased levels of exercise probably play a much greater role in the INR than what time of day we take the dose of coumadin/warfarin. I have had no ill effect from my switch and it makes remembering to take the stuff a lot easier.

Sorry for going on so, but wanted to be clear.
Good luck,

Bill

 

[Nancy]

Just wanted to add my comments to kind of mix up the pot a little. This is based on Joe's experiences.

First, let your doctor know that you have changed the time when you take your Coumadin. It might not have any bearing on things in an ordinary situation, but there are some real reasons to keep it consistent and probably in the evening. Most everybody takes it in the evening and doctors expect that this is the case. Every doctor we have spoken with has said that there is a lag time from the time you take Coumadin until it shows up in the blood, but there can be differences according to the individual and we have heard ranges from 24 to 48 hours, with 36 being the average. I guess it's how it's metabolized in your particular body.

Joe's spent a fair amount of time in the ER. Most of that time has started during the daytime hours, why, I couldn't begin to know. I can't think of one time when he's had ER type problems in the middle of the night. One of the first tests they do is protime. The reason for that is it might be necessary to do some sort of invasive test or other procedure which needs a lower INR. A twelve hour differential in this kind of scenario could make a difference. I know that if need be, they could administer Vitamin K to get the INR down, and Joe has had that done too. But the overall preferred method is to let it drop naturally and to start Heparin when it gets to a certain point.

I hope I'm making sense, I know what I'm saying but I'm not sure I have conveyed it the way I intended .

Now that I've said all that, in most situations, it wouldn't make much difference, but you guys are different. Stuff can happen unexpectedly.

Just another way to view it.

 

[richie rich]

i just spoke with my cardiologist's office. my inr was 1.6 and the nurse said that it was fine. it seems low to me. i thought i was supposed to be in the 2.0 to 2.5 range. anyone's inr usuallyu this low. also i woke up at 4:30 this morning with a nose bleed. it bleed for one hour and then stopped. has anyone expirienced this before?

rich

 

[JimL]

1.6 is definitely low.
There seems to be no connection between the INR and nosebleeds.

 

[richie rich]

at 1.6 should i even bother taking my coumdin. whats the point. i think i will just up my coumdin dosage on my own and see what happens. isn't it better to be higher than lower anyway? i have been walking 4 miles a day. do you think this is lowering my inr? i was taking 3mg a day (21 mg week). last week after my reading my cardio told me to double up twice a week (27mg). last week it was 1.6 also. if i take 6 mgs 4 times a week then i will go to 33mg. should i just do it w/out doc's consent. my surgeon also told me i should be in the 2.5 range.

rich

 

[Johnny Stephens]

Don't tinker with the dosage on your own unless you really know what you're doing. You're only a few weeks out of surgery, and as you get well your body will metabolize the Coumadin more quickly and bring the INR down. Your walking is definitely contributing to this as well.

The weekly dose I finally stabilized at was 50% above what I left the hospital taking.

 

[Nancy]

Richie-

Like Johnny said, don't fool with your Coumadin dosage. It's way to tricky for a neophyte to mess with. Your doctor should be doing this for you. Remember that it takes about 3 days plus or minus for what you do today to show up. In addition, as Johnny has said, it will be a little irregular for a while after surgery. Eventually it will get somewhat regulated. Messing with it yourself will put you into a wild swing of ups and downs. Trust me on that. Joe once had a doctor who didn't have a clue and that is exactly what happened. It never got well regulated until he switched doctors.

 

[richie rich]

nancy and johnny

so you think it is ok that my inr was at 1.6 two weeks in a row. i think i read a post that said it was better that the inr was higher than lower ( 2.0 to 3.0 range). thanks

rich