Holy Smokes Low INR

[rwsp768]

Checked my INR last week was at 1.9, should be between 2.0 and 3.0. Thought well I had been eating alot of greens. Last night ran a check and it was 1.6. Got to the doctor this morning and I was at .09. Best we could figure out was the warfarin I have getting through mail order from PPS, in Portland Or. were bad. Doctor had me go to Albertson's where I used to get it and double dose today and tomorrow, then start my normal dose on Friday and run a test Sunday. Pharmacist at Albertson's told my wife when she got the new warfarin that this is a big problem with mail order, you don't know how old the stuff is when you get it without sending to a lab to be tested as they take it from one bottle and put it into the one they send out. From now on no more mail order for me, now that my co-pay is the same at Wal-Mart or Albertson's as it is through mail order. So any of you folks that get your meds through mail order, I hope this information helps, the order before this last one I found a pill mixed in that wasn't warfarin.

 

[temp69]

wow, sounds scary

wow, sounds scary

except i wouldn't worry so much about your inr being low, as I understand it fluctuates -- so if you're around 2 or so, then drop a little below, you're still "thin" as it were. just keep monitoring it and adjust your dose to how you want to eat.

good luck!

 

[Karlynn]

I'm assuming it was generic? If so, what company makes it? I had an issue with a generic causing me to go too high. Most people have no issues with generic. Maybe it's old - but the expiration dates for most things are dated well before they actually expire and lose effectiveness. Was it a change in generic companies?

The only other thing I can think of is any change in your eating - such as eating prepackaged South Beach meals or other low-carb packaged meals. They get a lot of their protein from soy, which is high in K. Also protein bars - many use soy as their protein source. This was how I found VR - I had been using a daily protein bar and couldn't figure out why I couldn't get my INR in range. I kept increasing my dose and it kept getting lower. If I'd been smart and read the ingredients, it would have hit me right away - soy.

 

[njean]

My doctors have always insisted that I take coumadin and not the generic, warfarin. I know it's cheaper but I've always demanded the coumadin too.

Good luck & I hope you get your levels up soon! Take care.

 

[ALCapshaw2]

I've had NO problems with Generic Warfarin made by either TARO (first mail order company) or BARR (second mail order company - my insurance company changed providers).

OTOH, there was an interesting TV News Documentary about COUNTERFEIT DRUGS, usually supplied by Foreign Providers (I think China was implicated in at least one case). It might be worthwhile to see if your provider or pharmacy or the FDA might be interested in doing an analysis to see if those mail-order pills were actually Warfarin that had deteriorated because of age or if they were out-and-out counterfeit drugs with NO medicinal properties.

There have been several cases of counterfeit Cancer Drugs which are quite expensive. Unfortunately, the patients aren't aware of the problem until their disease has worsened and suspicious Doctors have investigated their drugs. The drugs were made to "look like" the real thing and even the packaging was duplicated.

'AL Capshaw'

 

[Cooker]

I have always been on generic and I have always been stable

 

[Karlynn]

I have always been on generic and I have always been stable

You make things way too easy - so I won't even comment.

I'm thinking that the problem with GOOD generic might not be getting and staying in-range, but switching around companies or going to Coumadin for different pills. My 3's were the generic that made me go high. Had I only used 3's I could have adjusted my dose and continued using the pills. However, I also use 5's in Coumadin, so that would have been a little more of a pain to figure out what dose I really needed with combining the 2.

 

[catwoman]

Checked my INR last week was at 1.9, should be between 2.0 and 3.0. Thought well I had been eating alot of greens. Last night ran a check and it was 1.6. Got to the doctor this morning and I was at .09. Best we could figure out was the warfarin I have getting through mail order from PPS, in Portland Or. were bad. Doctor had me go to Albertson's where I used to get it and double dose today and tomorrow, then start my normal dose on Friday and run a test Sunday. Pharmacist at Albertson's told my wife when she got the new warfarin that this is a big problem with mail order, you don't know how old the stuff is when you get it without sending to a lab to be tested as they take it from one bottle and put it into the one they send out. From now on no more mail order for me, now that my co-pay is the same at Wal-Mart or Albertson's as it is through mail order. So any of you folks that get your meds through mail order, I hope this information helps, the order before this last one I found a pill mixed in that wasn't warfarin.

How could you have an INR that was .09? That's only 10% of the anticoagulation level of someone who isn't taking warfarin..... Are you sure that number is correct?
Are you sure you haven't forgotten a dose or two? Are you have to take 2 tablets to get a correct dosage (such as a 5 & 2 to get 7mg)?

I've done mail-order (Medco Health) for 3 years w/out any problems and I take the generic, rather than Coumadin. My PCP wrote new Rxes today for me to take to Wal-Mart to get filled for $36 for 90 tabs of 3 strengths. It would cost me $60 through Medco for the same amount.

 

[Ross]

If the pills crumble easily in your fingers, they are bad. Sometimes it happens. Very rarely, but it does. I've had one bad batch before.

 

[rwsp768]

Holy smokes INR low

Holy smokes INR low

These are the generic. The reading at the doctors office was .96, which the doctor indicated was someone not on coumidan. They sent the blood sample to the hospital lab and they got a reading of 1.69. Yes they crumble easy in the hand. If you recall I said one of the pills in the last dose bottle was something else. During the night I woke up and it dawned on me that it was probably a good warfarin pill that had turned gray. That would indicate that it was a old pill, past its prime.

 

[ALCapshaw2]

Counterfeit Drugs

Counterfeit Drugs

The following is some supporting documentation on counterfeit and unregulated / uninspected drugs from China posted the first week of November by BobH (aka TobagoTwo) in the Heart Talk Forum.

'AL Capshaw'

=======================

Buying Imported or Internet Drugs?

---------------------------------------------------------------

You can look this up at http://www.nytimes.com

This is from a service:

Chinese Chemicals Flow Unchecked to Market

The New York Times reported that pharmaceutical ingredients exported from China are often made by companies that are neither certified nor inspected by Chinese drug regulators. The Times identified at least 82 Chinese chemical companies that said they made and exported pharmaceutical ingredients, yet not one was certified by the State Food and Drug Administration in China, records show.

The Times also found that these companies were negotiating deals at a pharmaceutical show in Milan, where suppliers wooed customers with live music, wine and vibrating chairs. Since the chemical companies are not required to meet even minimal drug-manufacturing standards, there is little to stop them from exporting unapproved, adulterated or counterfeit ingredients. The substandard formulations made from those ingredients often end up in pharmacies in developing countries and for sale on the Internet, where more Americans are turning for cheap medicine.

Just be careful...

Best wishes,
__________________
Bob H

 

[lance]

counterfeit drugs, toothpaste, etc

counterfeit drugs, toothpaste, etc

This is becoming serious. Recently here in Ontario counterfeit toothpaste was sold in the "dollar" stores that was importeds from China and contained a harmful substance.

So it makes me wonder could bona fide pharmacies be buying the ingredients unknowingly.

I'm going to start a thread about food issues under another heading.

 

[Lynlw]

These are the generic. The reading at the doctors office was .96, which the doctor indicated was someone not on coumidan. They sent the blood sample to the hospital lab and they got a reading of 1.69. Yes they crumble easy in the hand. If you recall I said one of the pills in the last dose bottle was something else. During the night I woke up and it dawned on me that it was probably a good warfarin pill that had turned gray. That would indicate that it was a old pill, past its prime.

Did they put you on Lovenox? That really is scarey.I'm glad you caught it.

 

[catwoman]

These are the generic. The reading at the doctors office was .96, which the doctor indicated was someone not on coumidan. They sent the blood sample to the hospital lab and they got a reading of 1.69. Yes they crumble easy in the hand. If you recall I said one of the pills in the last dose bottle was something else. During the night I woke up and it dawned on me that it was probably a good warfarin pill that had turned gray. That would indicate that it was a old pill, past its prime.

How long had you had these tablets? If not more than a month or two, I'd contact the mail-order pharmacy about the tablets. I'd go up the food chain -- whatever regulatory body inspects pharmacies where the mail-order outfit is located + the FDA, if it's not the same regulatory body.

Could be there are others in the same boat as you!

 

[Lynlw]

How long had you had these tablets? If not more than a month or two, I'd contact the mail-order pharmacy about the tablets. I'd go up the food chain -- whatever regulatory body inspects pharmacies where the mail-order outfit is located + the FDA, if it's not the same regulatory body.

Could be there are others in the same boat as you!

That's a really good point, and others may not know if they don't test that often. These things have me so angry, with counterfeit drugs and all the dangerous toys, it can be pretty scarey