Has anyone had Covid interfere with Coumadin and INR levels?

[Gator Chief]

I tested positive for Covid 8 days ago. The Doctor prescribed amox-clav 500mg a day for 7 days and zinc. I tested day before yesterday and my INR has dropped to 1.5. Today it was only 1.6. Increased my dose from 12.5 to 15 tonight. Last week it was 2.3 and has been steady at 2.3 - 2.5 before this Covid infection. I thought antibiotics would enhance the anticoagulation if anything. I not comfortable with 1.6 at all. I’m calling the doctor tomorrow about stopping the antibiotic and see if my goes back to normal. I thought I read somewhere that Covid was causing blood clots in some people. Has anyone experienced this while having Covid infection?

 

[pellicle]

Increase your dose by 50% once (I see you did a little less, that'll do) and then resume your previous dose. Test again in 3 days and follow up here. @ mention me so I don't miss it.

Antibiotics will commonly cause a dose change requirement, which will cease when you cease the course. It's common with these things, so always test a couple if days after you commence a new medication.

Always

 

[brijeshb]

My INR also dropped to 1.7 from 2.5 range during Covid and I had to bump my dose to get back to 2.5 range . It took couple of days for me to get INR up .

 

[Gail in Ca]

Mine was complete opposite.
INR went to 4.8 two days into paxlovid. Then after stopping a dose of jantovin, went higher. It’s been out of range high for 3 weeks now at 3.7, even though I’ve gone to 1/2 tab one day per week. Now I’ve been advised to take 1/2 tab twice a week, and full tab 5 days.

 

[pellicle]

Mine was complete opposite.

did you take antibiotics? Also did you feel like COVID was a hammer blow?

 

[carolinemc]

I tested positive for Covid 8 days ago. The Doctor prescribed amox-clav 500mg a day for 7 days and zinc. I tested day before yesterday and my INR has dropped to 1.5. Today it was only 1.6. Increased my dose from 12.5 to 15 tonight. Last week it was 2.3 and has been steady at 2.3 - 2.5 before this Covid infection. I thought antibiotics would enhance the anticoagulation if anything. I not comfortable with 1.6 at all. I’m calling the doctor tomorrow about stopping the antibiotic and see if my goes back to normal. I thought I read somewhere that Covid was causing blood clots in some people. Has anyone experienced this while having Covid infection?

It can raise the INR up very high and very low with the use of certain antibiotics. Be careful on the dosing. Hope you got to go into the Doctor's office. Hope you all feel better soon.

 

[carolinemc]

Mine was complete opposite.
INR went to 4.8 two days into paxlovid. Then after stopping a dose of jantovin, went higher. It’s been out of range high for 3 weeks now at 3.7, even though I’ve gone to 1/2 tab one day per week. Now I’ve been advised to take 1/2 tab twice a week, and full tab 5 days.

They made you feel like a yoyo with the antibiotics. My mother had problems with infections due to her RA years ago and she said all the switching on the antibiotics made her feel like a Guinea pig.

 

[Gail in Ca]

I didn’t take antibiotics, only started Paxlovid the day I tested positive. That 1st day I had 103.7 fever. I took rapid release acetaminophen and it went down to 102.1.
I felt pretty bad those first days. The Paxlovid has a horrible after taste that made me nauseous. I ate soup and crackers mostly. I lost 4 lbs.
I used my pulse oximeter often but luckily my oxygen level stayed in 90’s.
I was afraid of COVID because of my multiple surgeries and lingering pre existing issues. I felt so tired long after the 10 days of isolation. My cough still hasn’t gone away. But this week I finally didn’t need a nap every day, so things are looking up!

 

[Beach77]

Glad you're doing better! Sounds rough!

 

[skier]

I've got COVID and started Paxlovid yesterday. I found this paper that discusses Paxlovid and warfarin interaction:

https://ashpublications.org/blood/a...blood.2022017433/1925093/blood.2022017433.pdf
In this small study, Paxlovid lowered INR by .4 to .5.

"Comparing INR pre-NMV/r administration (days -1 to -33) with the first post-treatment INR, the median INR decrease was -0.40 (Wilcoxon signed rank test p=0.18). In the period immediately following the 5-day NMV/r course (days 5-14), the measured INR was significantly lower when compared to pre-NMV/r (median INR decrease -0.50, Wilcoxon signed-rank test p=0.026, Figure 1a)."

 

[skier]

I could use some help with my INR testing strategy. I've been testing at home weekly and in range (2.4-2.9) for the last couple of months.

Unfortunately, I'm down to two test strips. (Of course, when I need them!) I ordered more, but they may take a week.

My symptom onset was Friday night. I started Paxlovid on Sunday night, and it's currently Monday night.

Any thoughts on when should I use my two test strips?

 

[Superman]

If you’re testing weekly, personally I’d just stick to that. If you’re every other week, add a test at a one week interval.

 

[Gail in Ca]

My doctor wanted me to test 2 days after starting paxlovid. My INR jumped to 4.8.
Maybe it was the virus and not the drug?

 

[skier]

Thanks for the feedback! I was worried, so I went ahead and tested a little early. Good news, my INR is 2.6. I'll test again in a few days.

 

[skier]

My INR is down to 1.9 today. I'm 6.5 days post-COVID symptom onset and 4.5 days after starting Paxlovid, having just taken my last pills.

Looks like I'm seeing an INR reduction similar to the study I posted above.

My normal warfarin dose is 10mg daily, and my target INR is 2.5. Any suggestions on how much to increase it? I haven't needed to do this before.

@pellicle, would you recommend I do similar to this?

Increase your dose by 50% once (I see you did a little less, that'll do) and then resume your previous dose. Test again in 3 days and follow up here. @ mention me so I don't miss it.

 

[pellicle]

My normal warfarin dose is 10mg daily, and my target INR is 2.5. Any suggestions on how much to increase it? I haven't needed to do this before.

if you're normally at 2.5 and prefer that I'd increase it by 10% for one dose (round it either way to make pill splitting more convenient). I'd check again in a week to see if it just needed a boost once to get it in range (where it'll stay there) or if its down to 1.9 again (meaning you'll need to adjust the dose up a little more. Perhaps to 10.5mg daily.

reach out if you want to discuss getting a sheet and instructions on using it.

 

[skier]

My INR is down to 1.9 today. I'm 6.5 days post-COVID symptom onset and 4.5 days after starting Paxlovid, having just taken my last pills.

After testing two days ago, I bumped my dose from 10 to 11, then took my usual 10 mg yesterday.

The doc wanted me to test frequently, so I tested again today, 8.5 days post-COVID symptom onset and 4.5 days after starting Paxlovid.

My INR is down to 1.8 today.

I increased my dose to 12 mg (from my usual 10mg) today to reverse the downward trend and plan to test again in two days.

Any thoughts? Is that enough or too much? @pellicle?

 

[pellicle]

Hi

After testing two days ago, I bumped my dose from 10 to 11, then took my usual 10 mg yesterday.

ok ... and just to be clear what sort of INR would you normally have on the dose of 10mg? Do you normally just take 10mg (and not do much tweaking or do you often change from 10 to something else?

Have you changed brand of warfarin?

I'm going to say that one needs to follow the INR numbers nothing else and so I'm going with take 15 once and then resume on 10.

The doc wanted me to test frequently, so I tested again today, 8.5 days post-COVID symptom onset and 4.5 days after starting Paxlovid.

as do I ... can you test? Say, every second day for a little while? Just to get the hang of what this thing is doing right now? Especially as:

My INR is down to 1.8 today.

I don't like just blurting out numbers without data ... I know that's what "the bar is set to" by clinics but its not my way. I lean on data and knowing doses and making INR measurements are the only way to provide that.

I recommend working on a sheet for a little while at least (as I offered earlier)

I increased my dose to 12 mg (from my usual 10mg) today to reverse the downward trend and plan to test again in two days.

Any thoughts? Is that enough or too much? @pellicle?

 

[skier]

ok ... and just to be clear what sort of INR would you normally have on the dose of 10mg? Do you normally just take 10mg (and not do much tweaking or do you often change from 10 to something else?

Have you changed brand of warfarin?

I'm going to say that one needs to follow the INR numbers nothing else and so I'm going with take 15 once and then resume on 10.

Thanks. I took 14mg today (I took 11mg two days ago) and will resume 10 ms tomorrow and test again in two days. I"m happy to test as frequently as needed.

No change to the brand of warfarin. I'm stable with an INR between 2.4 and 2.9 on a 10mg. I haven't needed to adjust the does for several months, so I"m assuming this is all COVID and Paxlovid related.

Where can I find your spreadsheet, or happy to make my own?

 

[pellicle]

Where can I find your spreadsheet, or happy to make my own?

as I said, reach out by message and I'll hook you up with one, I'd prefer to guide you through starting
perhaps also we should chat about this (you now, mouths and ears not fingers and eyes ;-)