How Much and When should I?

[Blake777]

Hey guys. I finally got all that dental work done. I am in the process of trying to stabilize my INR. Now before my teeth extractions my INR was a yoyo and I don't think I ever made it to 2.5 when I was trying to adjust it. Well now I am trying to get it up and it has been in the 1's for too long, like 8 days. I have been taking 5mg but it won't come up, when I tried 7mg it over shot a few weeks ago so had to get it down and it's been low every since. I usually take it in the evening, but getting worried maybe I should take some now and then some in the evening as well. Or should I just take like 7mg this evening? So worried because with the heat and all this dental work and pain meds it is not stabilizing.

 

[JimL]

Everything affects INR, including (and perhaps especially) worry. Don't worry. Relax. Calculate how much coumadin you are to take per week, then divide that out among the days. For example, I took 35 mg coumadin last week, and my test was low (2.2), so this next week I'm taking 37 mg. If I adjust closer to 10%, I'll overshoot way too high. If you overcompensate for a low INR, it will go high every time, then too low again, then too high, etc.

 

[Lynlw]

Just take it 1 time a day, do not break it up. The best way to increase it, is figure out the total oyou are taking for a week and increase that by a certain percentage. Instead of taking 5 every day or 7 every day, since 5 (35 for week) is too low & & (49 for the week) You will probably need somewhere in the middle 5 some days and 7 others.
They will be able to help you, but they need to know how much you took and what that INR was.

 

[Blake777]

Well I normally take 5mg a day, I already tried to take 7.50mg and over shot one time when I did this a few weeks ago. So I skipped two days and it dropped too low, so I tried to take 5mg again and it just would not get up and has not been since. But of course I did go off the coumadin for a bit to get teeth pulled, but back on it now. But it was never stable before the dental procedure, so hopefully it is not something wrong with my valve. I will try to take 7mg tonight because I did overshoot the last time I took 7.5mg. This I think will put me right on the mark, but how do I keep it there? Besides eating the right foods and staying out of the heat.

 

[Lynlw]

With out knowing a little more, what your INRs were when you took the different amounts, it is hard to help. When you say you "overshot" when you took 7.5 how high was your INR, unless it is VERY high, a 2 day hold would drop you too low.
What was your last INR on 5 for the week?

PS what size pills do you have?

 

[Blake777]

When I over shot it went to 5.4.

 

[Blake777]

I have 5mg, 4mg, and 2mg pills. So I will take 5mg and a 2mg tonight. Last time I took a 5mg and a 2.50mg and it took me to 5.4.

 

[Blake777]

Forgot to mention I am at 1.4 and I was at like 1.9 before.

 

[ALCapshaw2]

Blake -

I *assume* that you have your own Finger Stick INR measuring instrument and are Self Dosing.
Being under 2.0 for 8 days is NOT Wise.
As you (hopefully) learned, Holding 2 Doses makes your INR Drop Like a Rock.

Do you report your INR's to a Doctor?
With an INR under 2.0, many Doctors will put you on Lovenox Injections to protect you until your INR is back in range.

Do you have an INR Guideline or are you just "winging it" with your dosing ?

'AL C'

 

[Ross]

What happens if you take 5mg daily for 7 days for a total of 35mg for the week?

It's sounding to me like your testing too often and changing the dose too soon.

 

[Bina]

Take your Coumadin once a day and mark down on a calendar or paper what dose you take each day. It is the only way to keep track of what is going on. You can't "wing it". And don't keep changing doses, let it ride for a few days, but get tested. You may end up on 6mg per day or alternating with the 7mg.
Mark it down: doses and test results. It becomes easier, don't worry.

 

[Blake777]

Well if you look at my other posts you will know that the 2 doctors and a dentist had me to get completely off my coumadin to have extractions. People here told me to keep on it but I did not want to go against the doctors or dentist so I stayed off it. I am kind of glad I did because he had such a hard time getting the teeth out and I had to have a lot of stitches. I am not back on the coumadin and tested 1.4. I was at 1 before I started it back up, but didn't take enough to raise it up a little more. So I just took 5mg for two days and tested again today to see where it was....(1.4). So I will just try to take 7mg tonight and see what happens. I am trying to to over shoot because I still have my stitches and don't want to start bleeding again.

I am on a coumadin study and that doctor told me to get off too for the procedure, so it was a total of 3 doctors and a dentist who requested it. I know, I know, I should have stayed on, but with me what can go wrong will every time.

For the record I do my own testing and I write it down and call in my INR. I usually call my doctor but I have found out I know my own body better than him and know how much will usually get me there. Just these last few weeks have been yoyoing. But I guess I was really asking if anyone has taken like a half dose in the morning because you were so low and then your regular does in the evening. But I got that answer already. But thank you all so much for being here and for your advise.

 

[Blake777]

Oops, meant to say I am back on coumadin and tested 1.4 this morning. Have been back on it for two days now.

 

[Bina]

That's great that you have a tester and have an On-X valve.
My doc would recommend getting a Lovenox shot with an INR of 1.4 though.

 

[Freddie]

I have 5mg, 4mg, and 2mg pills. So I will take 5mg and a 2mg tonight. Last time I took a 5mg and a 2.50mg and it took me to 5.4.

So, your planning on taking 7mg tonight - you do know it will take at least 3 days for tonight's dosage to show up in your INR and ideally you should be testing 5 to 7 days after a dosage change.

Increasing the dosage by 5% is the best way for me to adjust my dosage and now find myself taking 6mg for 3 days, 5mg for 1 day, then another 6mg for 3 days = 41mg for a 7 day period.

Baby steps I feel is the best way to adjust, although I do wonder if your magic dosage would be 6mg?
6mg x 7days = 42, might be too much - just a thought.

 

[Blake777]

Yes I fear Lovenox shots. My doctors never mention them at least not for this procedure. They just said normally when we do a medical procedure we bridge with Lovenox. I know, I know, what the hell are they trying to do kill me. It is just a no win situation being on coumadin, they say you might bleed to death and then they don't give me anything and I still could die.

Maybe I will just do 6mg tonight and test in 3 days and see what happens. He normally have me test every 2-3 days if I am not stable. Usually I only test every 7 days, but I have to get this stablized before I do end up in the hospital.

Been feeling really yucky yesterday and today, mostly dizzy and faint, but I just ate my first real meal in 4 days, so I guess that is expected with all the pain meds too.

 

[Cris N]

Just a suggestion - you say you're going to take 6mg tonight... that's good but make sure you take that tomorrow, etc. You need to get a good pattern of dosage & test results. On any given day your results could vary widely too - so don't be too quick to change dosage. Your best bet is to check back in here and report your results.

 

[ALCapshaw2]

So, your INR today measured 1.4 How Many Days in A Row have been under 2.0?
Be sure your Doctor is aware of that number.

I'm glad you have an On-X Valve since they claim the lowest propensity of producing clots.
That is especially important in the Mitral Position which is more likely to have clot formation that the aortic position.

As you are learning, balancing the Risk of Bleeding versus the Risk of Stroke can be a 'difficult dance'.

 

[Blake777]

Hey Al. Yes, it is 1.4. It has been there for like 8 days, well, it was 1.6 Wednesday and then when I checked it Friday it was 1.0, yesterday it was 1.4. I was told to check it every two days if unstable, by my surgeon's assistant. But I just took 6mg and I will wait and check it Wednesday, but in the mean time should I keep taking 6mg because my regular dose was 5mg?

Thanks everyone for your advice.

 

[Lynlw]

Since you've had your valve a year, what were you taking BEFORE you stopped for your teeth? Whatever dose had you in range then probably is what you need.

I also would be very nervous with an INR 1.4 for about a week and no lovenox to protect you