High INR and Generic

[Karlynn]

I've been having higher INR issues this past month and am wondering if it has anything to do with the generic warfarin I've been using since the beginning of August.

Here's my stats:

8/5: 73/week - INR 3.4
8/19: 73/week - 4.4
8/25: 70/week - 4.2
9/1: 67/week - 3.7
9/8: 67/week - 5.0

I've been taking doses of 10 and 9. And here's the confusing part. I ran out of 5's a few weeks ago (waiting for my new Rx via mail order) so I've been making 10's out of 2 of the the generic 3's (Taro) and 1 Coumadin 4. That's 4 days a week. The 3 days I take 9 it's been 3 of the Taro 3's.

Discovered this too late to call my card with the question today. She has been totally against generic. So I was a bit surprised I got an Rx from her (via fax in to Rx company) for the 3's in generic form. My last Rx for the 5's was Coumadin. So I'm thinking the generic was a mistake on her part or her office person. But I thought, what the heck, let's give 'em a try. Probably didn't check the "do not substitute" square. I should be getting my 5's any day now, so I'm a bit confused as to what to do.

Would you hold tonight and continue with regular dose, assuming that in a few days those 4 days of 10 will be made up of 2 Coumadin 5's?
Or -
reduce X % for the week. (I have 3's and 5's)

I really want your collective opinions because I'll call my card tomorrow and feel she may flip over the generic 3's. I feel like a teenager that got caught drinking and smoking.

Not to get real graphic - but I tested because today has been a hellish "that time of the month" and it made me go hmmmmm.

 

[Ross]

I would do what you normally do to reduce your INR. I've mixed and matched all types of warfarin and never saw any difference in INR. Some people swear they do, but not true in my case. I don't think it has anything to do with Generic or Brand, I think your just running one of those up spike cycles.

 

[jeffp]

I've been using generic warfarin (Barr Labs) and having no real problems. My PCP did have me on Coumadin 6mg vs the generic and my INR dropped from 3.8 to 1.6 in a week. Stopped and went back to the generic and took 3 weeks to get it back up (the INR - gimme a break Ross ). Maybe one of the many factors that can play with INR was coincidental to the switch, but I have not been comfortable to try that batch of tabs again. (they're still sitting in the bottle, I should just toss them). Again, probably just a coincidence for us both, but who knows for sure. Some folks' systems absorb the active ingredients better or worse depending on the "inert" pill binder formulation...

 

[Ross]

Well if you folks insist that there is difference, how about going to Jantoven?

http://www.jantoven.com/patient/index.html#

 

[ALCapshaw2]

Karlynn,

Before making any more changes, I'd take another INR reading, just to be sure the last one was not a 'fluke', then decide on a course of action.

'AL Capshaw'

 

[Georgia]

I've mixed and matched generic and coumadin ever since I started taking it - the only time I get coumadin is when I can snag some freebees from the doc. It's just never made any difference in my inr.

I just think it's all Rain's fault.

 

[Guest]

The whole country of Israel switched to Taro warfarin. It didn't seem to make any difference.

I'd keep looking for another cause.

 

[Cris N]

You home test don't you? By any chance, did this spike occur with a new batch of test strips?

Cris

 

[Karlynn]

You home test don't you? By any chance, did this spike occur with a new batch of test strips?

Cris

Hmmm - it may have. The fortunate thing is that I have 2 batches because they sent the wrong # the first time around. I'll test again with the 2nd and see if there's any difference.

 

[Karlynn]

Cris - you may have found the culprit. Just tested with the other batch of strips and it was 3.7. Last night it was 5.0 and then 4.8 on a retest, but both times using the first batch.

 

[ccrawford]

Hi Karlynn - If I remember correctly, there have been at least three past threads re the uniformity of generic warfarin and the concensus has always been that there is no difference. I've got Coumadin, Barr, and Jantoven currently and I consider them interchangable. My cardio was initially reluctant about the generics, but I think I've convinced him. Hope this helps, Chris

 

[Hank]

Jantoven

Jantoven

I use Jantoven..

Generic price - brand name quality.

It has worked perfectly consistent for over 6 months.

 

[geebee]

I think brand name vs generic is right up there with the valve choice issues. It may be hard to change someone's mind.

I used to feel I would never take generic but then I got to the point where I simply couldn't afford the brand and took the plunge. I now mix Barr and Taro and have been as consistent as I was with Coumadin. Maybe even more so now that I home test.

I still have occasional spikes but I think that is due to diet or hot weather. I am rarely on the low side.

 

[Karlynn]

Must of had a bad batch of strips. Thank goodness I had 2 batches to choose from.

Just for grins I did a test today. INR = 3.0. (took 1/2 dose on Thurs. after 5.0 reading) I'm going back on the dose I was on prior to the 4's and above.

 

[geebee]

Must of had a bad batch of strips. Thank goodness I had 2 batches to choose from.

A little scary tho don't ya think? Glad you figured it out before you reduced your dosage into stroke territory. Hope things even out and this never happens to you again.

 

[Karlynn]

I'm also thankful that I didn't mix the 2 batches together. I almost did that since I keep them all in a little bin in the refrigerator.

Gina, it is scary to think about isn't it. I'm going to call the company on Monday and let them know about it. They should be able to know what batch was bad by looking at the shipping details.