Dosing thoughts?

[marc_kowal]

Ok, some I'm on Augmentin for the next 9 days ( I started it on 4/6 ) until this diverticulitis clears up, and I let my cardiologist know (they technically monitor my INR). I usually take 4.5 mgs everyday except Sunday is 6 mgs. My INR have been the following:

4/3- 2.0 home test
4/4- 2.2. Blood draw in hospital
4/5- 2.6. Blood draw in hospital
4/6- 2.5. Blood draw in hospital
4/8- 2.4. Home testing

My cardio's office wants me to reduce my warfarin to 3mgs on Sat, Sun, Tues, and Thurs. The rest of the week is 4.5 mgs. They are doing this in anticipation of my INR going up. Usually I feel comfortable with my cardio's choices but I'm a little concerned about such a big reduction when I'm already low and I'm also taking in less K then normal due to some short term food restrictions.

Just wondering what you guys recommend.

~Marc

 

[djacq]

Are you still on the Boost?

 

[pellicle]

Marc

...
My cardio's office wants me to reduce my warfarin to 3mgs on Sat, Sun, Tues, and Thurs. The rest of the week is 4.5 mgs. They are doing this in anticipation of my INR going up. Usually I feel comfortable with my cardio's choices but I'm a little concerned about such a big reduction when I'm already low and I'm also taking in less K then normal due to some short term food restrictions.

Just wondering what you guys recommend.

my thoughts coincide with yours: when your INR is low already don't bugger about with it. I can report that being on antibiotics has made zero change to my pre antibiotic levels of dose. NONE.

So it may be but they are pre-empting their decision. This just backs up my view that most clinics could not manage a billy cart let alone a race car.

My advice (what I would do) is to keep with your existing dose (aka lie to them) and home test a bit more frequently. I would test ever second day or every third at least. IF you see (note the capital in IF) a trend that goes out of range then and only then make small adjustments.

email me at gmail if you want my input in more details. (of course I'm pellicle right ... should be easy to figure out)

Best Wishes

 

[marc_kowal]

Are you still on the Boost?

Since my INR was at the low end, I've stopped taking it. It's gives a nice little increase to your daily K (about 48 micrograms), when you aren't able to eat what you normally do.

 

[honeybunny]

From my short time on this forum I would lean toward taking pellicle's advice for the reasons he stated. I have a tissue valve but I've read enough of his posts on dosing warfarin to put my confidence in him on this topic. Just my two cents.

 

[Elsie]

Antibiotics have never affected my INR. I wouldn't change a thing.

 

[marc_kowal]

So I didn't follow my cardio' advice and kept my doses the same. I checked my INR this morning and it's down to 2.2. I usually take 6mgs tonight, I wonder if I should bump it up to 7.5mgs.

 

[W. Carter]

I usually don't follow the a/c clinic recommendations if it doesn't sound right. The last time I had to bridge my INR wasn't coming up as fast as they wanted so they advised me to take 2 extra pills (2.5 mg each) with my regular dose. That seemed like a little too much to me so I only took 1 extra. The following 2 weeks I also added 1 extra to my weekly dose and my INR came up to 3.6. Then after 2 more weeks at regular dose I check it and it was 3.0. BINGO PERFECT! I just don't feel right adding 5 mg a week, that is over 10% (about 15%) and doesn't feel safe so I don't do it.

 

[Bina]

So I didn't follow my cardio' advice and kept my doses the same. I checked my INR this morning and it's down to 2.2. I usually take 6mgs tonight, I wonder if I should bump it up to 7.5mgs.

I'm glad to read that you kept your doses the same (despite your cardio) with your already 'low-end' INR readings.
And, YES, if it was me, I would bump up today's dose....

 

[Elsie]

My range is 2.5-4, and I adjust for anything under 2.5 because I'm prone to TIAs.

 

[pellicle]

Hi

So I didn't follow my cardio' advice and kept my doses the same. I checked my INR this morning and it's down to 2.2. I usually take 6mgs tonight, I wonder if I should bump it up to 7.5mgs.

I'd probably do a one off at 7.5 (to hit it up a notch) followed by a change to 6.5 for the rest of the week and test again in 4 days or a week.

 

[Fishing 4 Life]

I started testing my INR at home last year through www.AdvancedCardioServices.com I was able to finally get my INR under control! For an entire month I would test my INR every week and journal my medications along with food that I ate throughout the week and I was able to figure out that a combination of herbs I was taking and nutritional shakes I was drinking kept throwing things off. I've learned to be more consistent with my diet not and my INR has been stable for the last 4 months and my doctor doesn't need to change my dosage very often if ever. I like to know my numbers every week, even though I think it causes my doctor extra work but hey it makes me feel a lot better knowing if I'm in range or not.

 

[Superman]

Were I in your shoes, I would get a prescription for some 1mg's (which I actually have), and use those to make adjustments to my dosing. I would make smaller daily adjustments and base it on my weekly dosing rather than adding one randomly high dose almost double your normal.

6x4.5+6 = 33 mg weekly for you right now.

Based on running consistently low, I might want to get to 34.5 or 36mg weekly, which would mean taking your 6 mg tablet two or three times a week instead of just one.

So do like 4.5 / 6 / 4.5 / 4.5 / 6 / 4.5 / 6

I also wouldn't lie to the clinic. I used to play that game, since there were some people there who I was concerned would get defensive.

I've had more success since I started telling them what I elected to do and why, so they would have accurate records of my dosing history. I've had a better relationship with them since then. What can end up happening is you may be running a high INR, and their records say that you are still at 33mg, so they start telling you to reduce. Only, you have to come clean and tell them what you've actually been taking. It can get confusing for all.

I completely agree with not anticipating an impact and pre-emptively reducing. at 2.3, you have a lot of room to climb and still be in range. Your INR is not likely to double from Augmentin, but if it starts moving up - you'll have plenty of time to respond accordingly.

 

[marc_kowal]

Tested my INR yesterday and it was at 2.7. I'm glad it's finally back in range and I'll check it again tomorrow just to make sure it's still in range. I'll be glad once I'm done with the meds and off of this restrictive diet. On the plus side, I dropped about 10 lbs in a about a week since on this "low soluble" diet. But I am soooo missing eating a piece of fresh fruit right now!