How much warfarin do you take to get to an inr of 2.5 to 3.5?

[pellicle]

I very much believe in diligent ACT but that does not mean I need to be a chemist or mathematician to successfully dose warfarin

agreed, which is why I developed a system where all you have to do is fill in the table each week and then if any change is needed read off the table as to what you should do.

write the date you took the test, write in the INR then write in the dose you wish to take as a result of reading your INR. Indeed most people now need to do something like this (enter numbers into a spreadsheet) as the most basic parts of any office job.

No maths is needed ... and the principle is as simple as writing it down on a spreadsheet instead of on a piece of paper.

KISSed

PS: please note, this is only for someone who manages themselves, if you are managed then its simpler: just do they tell you to do.

 

[Timmay]

You are being very argumentive, for I have been on warfarin for 22 years and counting. I have been more helpful on knowing the dosages and they come on 1 mg to 10 ng. Please realize that many of us have been dosing for many years here and know what we are talking about. And I do not take 4 mg every day. I take 5 mg four days a week and 2.5 mg three days a week. 100%. Be nice and stop trying to argue with us pros who know how this works.

You clearly didn’t read my post. That’s ok. I forgive you for being mean, cursory, argumentative, and distracted.

Now to correct your 22 years of experience.

First, No, they do not make 10 nanogram pills. They do however make 10mg (milligram) pills.

Second, You clearly don’t know what you’re talking about if you think that changing your dosage by LITERALLY 100% during a given week is completely fine. It is not. I was nice in my first post, but in this post I need to make sure that your destructive comments don’t seriously harm a new person coming here and trying to learn.

So to any new self-managers reading this thread: Increasing your dose by 100% regularly is unacceptable and extremely dangerous.

Last but not least Caroline, you made it a point to say “I do not take 4mg a day” and then described your dosing pattern again. I quite clearly read this in your first post, know this, and that was the reason for my initial kind post. Your comment makes no sense.

Please read before replying. Please take the blinders off. Open your mind to learning. Open your mind to facts.

 

[tom in MO]

You clearly didn’t read my post. That’s ok. I forgive you for being mean, cursory, argumentative, and distracted.

Now to correct your 22 years of experience.

First, No, they do not make 10 nanogram pills. They do however make 10mg (milligram) pills.

Second, You clearly don’t know what you’re talking about if you think that changing your dosage by LITERALLY 100% is completely fine. It is not. I was nice in my first post, but in this post I need to make sure that your destructive comments don’t seriously harm a new person coming here and trying to learn.

So to any new self-managers reading this thread: Increasing your dose by 100% is unacceptable and extremely dangerous. Please, for the love of all that is good and true, do not listen to Caroline.

Last but not least Caroline, you made it a point to say “I do not take 4mg a day” and then described your dosing pattern again. I quite clearly read this in your first post, know this, and that was the reason for my initial kind post. Your comment makes no sense.

Please read before replying. Please take the blinders off. Open your mind to learning. Open your mind to facts.

You might disagree about dosing strategies, but if a person stays in range, like carolinemc does, then their regimen works for them. Her reality of maintaining her INR within range validates her approach. The goal is to stay in range.

Warfarin metabolism is very much an equilibrium that cannot yet be fully controlled and as such it varies by a lot of things, such as person, diet, exercise, stress, GI upsets, illness... There is a significant time constant in warfarin metabolism that can smooth out variations in dose. This time constant probably varies by the individual.

 

[Timmay]

You might disagree about dosing strategies, but if a person stays in range, like carolinemc does, then their regimen works for them. Her reality of maintaining her INR within range validates her approach. The goal is to stay in range.

Warfarin metabolism is very much an equilibrium that cannot yet be fully controlled and as such it varies by a lot of things, such as person, diet, exercise, stress, GI upsets, illness... There is a significant time constant in warfarin metabolism that can smooth out variations in dose. This time constant probably varies by the individual.

Staying in range? TOTALLY AGREE. Don’t assume that she’s in range each and every day.

So many people say “I’m in range!” While testing once a month.

I test twice a week. I know more about me being in range than most.

 

[Gail in Ca]

I play music in a wind symphony 2 1/2 hours a week to forget small stuff and people’s comments which can be triggering to someone who had a husband with anger management issues for 32 years.
After my endocarditis and subarachnoid hemorrhage in 08, my cardiologist no longer wanted me to self manage. I had been through a lot so I was fine with letting the Coumadin clinic manage what I called in from self testing.
I moved 2 years ago to so cal and am managed by the Coumadin phd pharmacist at Cedars-Sinai.
I test religiously on Tues. My INR trends in the 3-3.5 range on the dosage I take of Jantovin. In the past 17 weeks, my range has been 2.6- 3.9. Out of range 3 times of 3.6,3.9,3.7
I’m fine with my dosage and knew when I posted some would have a cow!
La la. I’m going to hum a wonderful tune from The Planets by Holst, now!!

 

[pellicle]

Be nice and stop trying to argue with us pros who know how this works.

firstly on the being nice: sometimes being nice doesn't lead to good outcomes for the person.



secondly most professionals don't have a clue, they are nothing more than staff who have a tiny bit more knowledge than the patient (making them seem really knowledgeable when they really aren't).

 

[pellicle]

I’m going to hum a wonderful tune from The Planets by Holst, now!!

gonna have to put that on now, its been years since I last listened to that.

 

[Gail in Ca]

Yes, I hummed that lovely tune from Jupiter, the bringer of Jollity.
I was happy to sit in front of the Horns who also play that tune with the clarinets. It was heaven. We played all the movements in 2 concerts, and also played Mercury that same concert.
I realize that the person helping me with my dosage may not know as much as myself that has been taking warfarin since 2000. But, I also ask her questions. I can tell she deals with a lot of people that don’t test regularly like they are supposed to. In my case, I started with her at 7.5mg/ day. But, it had to be lowered since I wasn’t exercising like I had been before I moved. I think they like to keep it simple for people, like using what you’re taking and splitting it, especially as we get older. Anyway, I’ll stick with it because Medicare and supplement pays for my supplies if someone is managing my dose.

 

[3mm]

This discussion is educational, thank you everyone! Say a person takes 5mg warfarin on MWF, and takes 4mg warfarin the other 4 days (Sat, Sun, Tues, Thurs). The doses vary by 1 mg from day to day. Will the INR change much during the week? I am expecting the INR will only change by perhaps 0.2 during the week. Is this expectation reasonable?

When I get a meter I think I will test multiple times each week for a few weeks to see how stable my body chemistry is.

 

[dick0236]

Agreed. I have maintained a similar record since before I had a computer on a 7 column accounting pad (it is much easier now to have it on a computer). I also include a wider column for "notes".......for a note of any diet, medicine, illness or unusual activity that could have affected my INR for that period. This works well in explaining why my INR might have been affected. It also confirms what I've always suspected..........INR routinely changes for no apparent reason......and my doc agrees with me. He also agrees that a single pill can provide almost all of the needed "mg" strengths for INR maintenance.....from -0- to 1/2 to 1 to 1+ etc. Warfarin, in the USA, comes in 1,2,3,4,5,6,7,8,9 and 10mg strengths. Keeping multiple "mg" strength warfarin pills adds a level of confusion not needed in allmost all patients. If a patient needs very close dosing control that patient needs to be in close contact with their doctor and should not be "self-managing".....in my opinion FWIW. Those of us who have been on ACT for awhile should remember that most of the people viewing the forum are new, afraid and probably misinformed about warfarin and we should not add to their fears by making warfarin out to be "something I can't handle".

Somehow my posting above has been attributed to Pellicie. It is my response to his earlier post. As I've said many times......I am not very computer savvy and am unable to correct my error...........but gimme a break I am pre-computer........but taking warfarin has made it possible for me to still be here.

 

[dick0236]

This discussion is educational, thank you everyone! Say a person takes 5mg warfarin on MWF, and takes 4mg warfarin the other 4 days (Sat, Sun, Tues, Thurs). The doses vary by 1 mg from day to day. Will the INR change much during the week? I am expecting the INR will only change by perhaps 0.2 during the week. Is this expectation reasonable?

When I get a meter I think I will test multiple times each week for a few weeks to see how stable my body chemistry is.

Hypothetically, your dosing would be 31mg/wk. I would take 4mg 6days and 4mg+2mg 1day(6mg) mid-week =30 mg/wk. I doubt that the loss of 1mg spread over the week would make much difference........and you only have to stock 4mg tablets, not 4mg and 5mg tabs. Regarding your idea of multiple tests per week for a few weeks, that is a good idea to help you understand that INR is not an exact science. I also think you will find that twice/wk testing is "over-kill" in all but very unusual circumstances.

 

[Varago33]

carolinemc,
Why are you taking "5 mg four days a week and 2.5 mg three days a week" and NOT taking "4mg every day"?

This may work in your individual situation but for the benefit of others, especially newbies, the "ideal" regimen should provide the same dose, or as close to it, every day when possible except when a maintenance dose is required based on testing results.

WOW awesome post )

 

[3mm]

twice/wk testing is "over-kill"

I'm a retired aerospace engineer; it's only over kill if the aircraft is too heavy to take off!

Thanks for your suggestion on dosing. I'm leaning toward a mix of 4mg and 1 mg tablets. That makes the mix of 4mg and 5mg doses easy, or i can split the 1 mg tabs and do 4.5 mg every day.

 

[dick0236]

I'm a retired aerospace engineer; it's only over kill if the aircraft is too heavy to take off!

Thanks for your suggestion on dosing. I'm leaning toward a mix of 4mg and 1 mg tablets. That makes the mix of 4mg and 5mg doses easy, or i can split the 1 mg tabs and do 4.5 mg every day.

"Overkill" was probably not the correct phrasing. I meant that testing too often can, and does, confuse the tester since tests over a short time sometimes leads to illogical results.

I try to have only one Rx for Warfarin at a time and make use of pill splitting if possible. History has taught me that if I can make a mistake I will......and, in the not recent past, I have grabbed the wrong bottle........that is another great reason to have a pill-box for warfarin rather than opening two....or more warfarin bottles.

 

[tom in MO]

This discussion is educational, thank you everyone! Say a person takes 5mg warfarin on MWF, and takes 4mg warfarin the other 4 days (Sat, Sun, Tues, Thurs). The doses vary by 1 mg from day to day. Will the INR change much during the week? I am expecting the INR will only change by perhaps 0.2 during the week. Is this expectation reasonable?

When I get a meter I think I will test multiple times each week for a few weeks to see how stable my body chemistry is.

Your INR will not change by any perceptible amount. I take 3.5mg 3 days a week and 4mg the rest. I test every 2weeks and maintain a 2-2.5INR range w/o problem. Testing more than once a week is a waste of strips unless you need to adjust, even then you should wait at least 4 days before testing again to see if the adjustment worked.

 

[pellicle]

I'm a retired aerospace engineer;

being an engineer is not a skillset that will translate perfectly to biology, pharmacology nor laboratory work. Nature is not engineering and lab tests are not like engineering. Frequently in laboratory tests (yes, this includes your coaguchek) we use proxy measurements because on can not directly measure the unit. I recommend you read this at the very least:

https://en.wikipedia.org/wiki/Coagulation

Coagulation begins almost instantly after an injury to the endothelium lining a blood vessel. Exposure of blood to the subendothelial space initiates two processes: changes in platelets, and the exposure of subendothelial tissue factor to plasma factor VII, which ultimately leads to cross-linked fibrin formation. Platelets immediately form a plug at the site of injury; this is called primary hemostasis. Secondary hemostasis occurs simultaneously: additional coagulation (clotting) factors beyond factor VII (listed below) respond in a cascade to form fibrin strands, which strengthen the platelet plug.[1]​

also :
https://en.wikipedia.org/wiki/Prothrombin_time#Methodology
in the old days it was determined by being able to hold a standardised steel ball

we have since moved to electronic measurements in the 20th C

 

[Protimenow]

How do you KNOW your INR wouldn't change by 'any perceptible amount' if you only test on the same day 'every 2 weeks'? What you are doing is testing three days after a specific dose - any effect of the dose you took three days earlier won't be realized in your test results.

Testing every two weeks is not a healthy choice - although, unless you have a REAL problem of some sort in the period between the two week testing, you will probably be okay. I sometimes carelessly go 10 days to two weeks between tests and haven't had any problems, but I'm more comfortable with weekly testing.

Plus, the cost of the extra strips for weekly testing (about $125 or so) seems well worth it if, for some reason, your INR doesn't stay level and you're at risk of a serious problem.

 

[Protimenow]

Pellicle:

Your spreadsheet wasn't as easy as reading a times table. In my case, my M varies - not a lot - but it DOES change occasionally.

In other words, my constant factor ISN'T constant.

I'll probably stay with my primitive spreadsheet - date, time, dosage, results - and a comment field.

I'm not convinced that applying statistics (like SD and stuff like that (I took a LOT of statistics courses in Grad School)) apply particularly well to INR management. For me, looking at my INR, making minor adjustments if necessary, and keeping track of it all works well for me.

 

[carolinemc]

You clearly didn’t read my post. That’s ok. I forgive you for being mean, cursory, argumentative, and distracted.

Now to correct your 22 years of experience.

First, No, they do not make 10 nanogram pills. They do however make 10mg (milligram) pills.

Second, You clearly don’t know what you’re talking about if you think that changing your dosage by LITERALLY 100% during a given week is completely fine. It is not. I was nice in my first post, but in this post I need to make sure that your destructive comments don’t seriously harm a new person coming here and trying to learn.

So to any new self-managers reading this thread: Increasing your dose by 100% regularly is unacceptable and extremely dangerous.

Last but not least Caroline, you made it a point to say “I do not take 4mg a day” and then described your dosing pattern again. I quite clearly read this in your first post, know this, and that was the reason for my initial kind post. Your comment makes no sense.

Please read before replying. Please take the blinders off. Open your mind to learning. Open your mind to facts.

Honey child, you are very rude and condescending. I know as a lifelong patient. 22 years is from Aortic valve replacement. Was born with a birth defect, defect aortic valve 58 years ago and replaced 22 years ago. You are so rude and did not have to bash me here. You were not nice to me at all. So no need to respond since you cannot be respectful to me. PSH.

 

[pellicle]

Your spreadsheet wasn't as easy as reading a times table.

looks about the same to me ... but with a wider path down the diagonal.

¯\_(ツ)_/¯