How do we dose him now?

[cocoalab]

I'm reposting here and wondering what to do.

Andrew retested yesterday and is still a bit high 4.8 I think. We had dropped one dose and then did half doses 2 nights in a row but he did not do another half dose on sunday like he usually does. At least he doesn't think he did.

We would really like to drop down to 3.5. I had him skip last night and am waiting to hear from his nurse on what she would like him to do. What is the rule of thumb as far as how much percentage he should be dropping to get in his range of 3 to 3.5 if he is at 4.8 INR and took 12 mg and has dropped from an INR of 5.8 and was taking 19.5 mg of warfarin? Is there a rule of thumb? Should he return to his 3 mg every day and half dose twice a week instead of only once?

We discussed doing the half dose twice every other week and only once on the alternate week but have not gotten there yet. what to do what to do

 

[Ross]

Outside of divine intervention or someone over seeing that he's dosing and taking his meds as he should be, which obviously he is not, I'm not sure how we can help. It's constantly he's too high, then too low, then we hear nothing for a long time and the then the cycle is repeated. Someone has got to take responsiblility and oversee this kid.

There is no rule of thumb when someone is over their range. It's either hold doses until they're back in range, skip one dose and half the next dose, or half 3 or 4 doses. For 5.8 I would have skipped 2 doses and then restarted my schedule, providing the scheduled amount is correct. We don't know that his is. We don't know if he's even being compliant with what he's supposed to be doing. We cannot guess and make recommedations with the situation as it stands. It is not safe for us to even try. I suggest waiting for the nurses contact and suggestions. It appears they know more about this kids status then we do.

Have a look at this link and it may help you somewhat:
http://www.aafp.org/afp/990201ap/635.html

Sorry this is so harshly put, but this is occuring far too much.

 

[cocoalab]

I have to disagree. He is very compliant. All of his other medications- the ones he takes for heart failure and to keep his heart in rhythm are working just fine. He has occasionally forgotten a dose but he is pretty good and doesn't have a problem with taking coumadin. He has been on it for most of his life since he was 6.

I can understand that it looks like he does this on purpose but i had the same swings when I gave him the medicine myself when he was younger. He is 19 and does not drink doesn't drive and works full time along with going to Bible college. Give him a little credit. Everyone makes mistakes and forgets occasionally but his cardiologist is happy with his compliance and thinks he is doing fine.

i am waiting to hear from his coumadin nurse. Sorry if he is just too complicated.

 

[Ross]

What is his total weekly dose when he appears stable?

What was the total weekly dose when he hit 5.8 and were there any new meds added?

 

[cocoalab]

We were doing pretty well at 19.5 mg a week but he does tend to strart trending upwards so we were going to try dropping another 1.5 every other week. he does 3 mg every day but the one night he does 1.5.

He did get a flu shot and has dropped his Cymbalta. I don't know that it has affected it. Eating veggies is not always consistant though.

 

[escargome]

Wendy,
I won't chime in on your situation with your son's readings. I will say though that you should be proud of this young man. In a time when some young people seem to lose their way, he is trying to stay on task. I'm diabetic take oral medication and I can tell you that my blood glucose reading go out of whack just because I got up that morning. Try to hang in there and hopefully your nurse will be able to help you and your son get back on track. Give him a hug, I'm sure this situation is pretty stressful for him also.

 

[skeptic49]

He is 19 and does not drink doesn't drive and works full time along with going to Bible college

Wendy, he's a saint. I hope you can get the ACT thing sorted out.

Hugs,

JIm

 

[Bridgette]

Wendy, does your son home test? If not, is there a possibility you could start that and use Al Lodwick's chart as a guide?

I home test and sometimes I have been a bit over range - the other day my INR was 5.1 so I skipped one dose and rechecked in 24 hours - my INR was 2.5. Generally, the higher the dose a person is on, the faster the INR will fall when one dose is withheld. I was on 8mg per day. I restarted on 7mg then rechecked last night - still 2.5 so I upped the dose to 7.5mg because I want to get my INR up to 3+ - hopefully when I retest in a week it'll be around there.
What made it spike to above 5? I have no idea

Good luck
Bridgette

 

[Ross]

Try 18mg over the week Starting on
Sunday-3mg Mon-3mg Tues-1.5mg Wed-3mg Thur-1.5mg Fri-3mg Sat 3mg

 

[cocoalab]

Yes he is home testing. We had been using the lab for a while because the insurance had failed to pay. When he was about to lose his insurance, I asked if I could buy some strips and they sent me some.

His nurse was not feeling good about the machine because he would jump so much but we saw the same kind of results at the lab. She knows he has no insurance so is fine with him home testing. I have not bought the chart but probably should.

Totally off topic but I had to buy Andrew's first prescription without insurance and went to walmart to get his Nadolol. I thought it was part of their $4 list but his dose was 80 mg so it ended up being $24. If I had known I could have had the doctor change it to 2- 40 mg tablets for the $4 price, which is what we have done for next time. I told him Happy Birthday! What a gift huh?

 

[Bina]

I am on a similar dose to Andrew.....I take 19 mg per week.
For me, I don't like holding a dose, but I have taken a half dose once when I had an INR of 4.2
It's a great habit to use my pill box and mark down any changes on my calendar.
HOme testing every 2 weeks also catches any trends before ending up being too high or too low.

 

[Herb M]

Cocoalab, order the Algorithm Card. It costs $4.95 and will offer protection from bad doseage instructions your doctor or clinic may give.