First time ever - forgot warfarin!

[DachsieMom]

its been two years since my surgery, and yesterday I forgot to take my warfarin. I self test but am managed by my Coumadin clinic. It was a hectic week - I forgot to do my usual self test on Thursday morning. I remembered Friday night, and tested. It was 2.3 (my range is 2.3-2.8). But then I forgot to take meds! (Just realized this tonight- Saturday night). They changed my dosage last week so I take 7.5 mg four times per week and 8.75 mg on Sunday, Tuesday and Thursday. I think if you miss a dose you just skip and not worry about it? Unfortunately I have to get on a plane Monday morning and will be gone until Thursday night (I wasn't planning on taking my home test kit, since I screwed up last week and tested Friday, thought I would just test a Friday again). I could test Monday morning before I leave. Or I could take 3.5 pills tonight, but not sure I want to? My coagucheck meter seems to be above lab tests by .2.

 

[dick0236]

I think I understand that it has been less than 24 hours since you missed your dose. I'd take the Friday dose now and take your Saturday dose at your regular time.

 

[Protimenow]

Personally, I wouldn't worry about one missed dose. Warfarin takes a few days for the full effects to show up. Doubling up on Warfarin is not a good idea. You probably don't need that half dose. This isn't like insulin - where if you miss a dose, you can get into trouble.

It's obvious for me to say this, but be sure that you DO take your daily dose from here on (which I'm sure you do, with one exception). I wouldn't stress about one missed dose.

 

[pellicle]

Hi

I'll echo the above ... your INR will drop low for a bit but recover well in a few days. If you self test it would be a good opportunity for you to take measurements and see what happens. Helps to build confidence when you've seen it rather than just worry about it.

Myself I've noted that taking half of the missed dose with the next one seems to reduce the time spent below level but to be hones its not a big deal and my (daily) self tests have shown that recovery is not significantly changed by that. So sometimes I do it, sometimes I don't

I missed a dose just last week because I failed to properly plan for a trip to sweden and I was away a day longer. My INR dropped from about 2.6 to 1.9 at its lowest and then just returned towards 2.6 (and god only knows where to from there really) by about the 4th day.
This thread from 2013 may be helpful for comfort / reassurance
http://www.valvereplacement.org/foru...ps-missed-dose

 

[Juli]

I use on my Iphone the Medisafe app which works great and always reminds me to take my dose. It also allows to enter a more detailed dose that might change day by day plus I track if I changed my dose after my INR self test. What is probably the greatest feature is that you can choose whether you keep or change your time when you travel and change time zones. Was just in Asia and are now traveling in Europe - no worries with (a) taking my Warfarin and (b) getting confused with the timing and dosis. Highly recommenden.

 

[Protimenow]

I just want to restate that warfarin is slow acting - it's not extremely time-dependent. It shouldn't make a lot of difference whether you take a daily dose at 6 PM or at midnight. You don't really HAVE to take your warfarin at the same time each day. As long as you keep it within a 10 (or so) hour window, there shouldn't be any real issues about taking it - although it certainly doesn't hurt to take your doses 24 hours apart.

 

[Superman]

Late to the party, but I would have taken your high dose Saturday and Sunday (maybe Monday too), then business as usual from there on out. An extra 2.5 mg over 3 days to recover from the missed dose should do it.

 

[Tappy]

I was told by my clinic to take the reg dose and 1/2 dose if I forget.to take one day

 

[Jamey T]

Again, my results missing a dose mirror what the more experienced posters have said, it doesn't affect me for more than a few days.

I would like to add that if I am within 10 or so hours when I realize I missed it, I take the dose and don't worry about it.

 

[DRG.]

I envy the people who are stable on Coumadin and can miss a dose with little effect. I drop like a stone when doses are missed or withheld as two Doctors have discovered. My range is 2.5-3.5 and twice I have spiked to 6. The first time I was told to stop taking it for three days then resume my normal dose and have a retest done in 6 days......in 6 days it was 1.4 and that was after taking my regular dose for two days. And to add insult to injury I was scheduled to meet with the head of the department that was managing my INR and he was the one who told me I was 1.4......he also said " I have a report here that says you are self medicating",,,,,,,,,,well I had not been. I had been following their dosing protocols exactly. That " self-medicating" "report from the ward clerk was the result of me questioning the wisdom of cutting me off for three days.

I was NOT impressed

After that, I asked my family doctor if he would take over my INR and he agreed. Five months later I spiked to 6.1.......there was no dietary reason for that spike and I had it retested at emerg that same evening and it was 5.3. My family doctor recommended I miss two doses and then retest. I reminded him what happened the last time and I told him I thought 1 day max would be better but he insisted this was the best course of action. Lab retest 2 days later gave a 1.3

Once again I was NOT impressed

The next day I bought a Coaguchek and I have been stable ever since and I am fully responsible for adjusting my doses as my family doctor admitted my suggestion would have been the better option. Every month I hand in a report of my dosing for the previous month and the highest it ever got was 4.0 once and I had it down to 2.8 within 3 days and it's been in range since

I have managed to miss two doses since then but I take one set of pills at 8am and the coumadin at 8pm so I never miss longer than 12 hours, The two times that has happened I take my Coumadin at 8 am then delay night time to after 11pm and I've never had the next INR reading go wonky.

The bottom line is, as the emergency room doctor told me.....everyone reacts differently and in my case, my body flushes it out rather more quicky than the textbooks say it should be