INR 4.1 - Miss Dose

[ajay_22_86]

Hi guys. My INR desired range is 2-3. I went to my clinic today and found out my INR is 4.1. It's been stuck around 3.8/3.9 for about a week now and I was taking 5mg warfarin. Today my nurse used INR computer software to calculate my next dose and it said to miss my dose today and then take 4mg/5mg (switching between the two to get 4.7 for the week).

I just wanted to check if missing a dose today sounds reasonable?

 

[Bina]

I would never skip a complete dose for an INR of 4.1 small changes spread out are more stable.
It helps to look at your doses and INRs for the past couple of weeks to see if you are trending upwards.
Anyway, You were taking 5mg for 7 days= 35mg weekly
If you were to reduce by 15% weekly, that would be 5.25mg over the week.
Or a reduction of 10% would be 3.5 mg over the week.

 

[Freddie]

Oh me oh my. Does this sound familiar, been there and doing that

I agree with Bina, don't miss a dose, it may cause you to get on a roller coaster ride.
Take half a dose tonight, that's right, cut a 5mg in half or take 2 - 1mg tables if you have them and start tomorrow with 4mg and alternate the next 7 to 10 days with 5mg and 4mg.

Try using this, it may help
http://www.pace-med-apps.com/CoumCalc.htm

 

[ajay_22_86]

Scary stuff for a newbie XD Thanks for the advice guys. I decided to just take 2.5 today and I'll see what my INR is like on Wednesday. Hopefully it hasn't gone up again!

 

[catwoman]

Scary stuff for a newbie XD Thanks for the advice guys. I decided to just take 2.5 today and I'll see what my INR is like on Wednesday. Hopefully it hasn't gone up again!

I'd ask about waiting at least Thursday or Friday for another INR test. It'll take several days for any dosage change to be reflected in your INR.

 

[Bina]

Testing on Wednesday this week may be a bit too soon if you are only changing your dose today.

 

[Freddie]

Can you wait to at least Friday to retest?
It takes 3 to 4 days for the dosage change to show a difference in your INR readings.
Going on Wednesday to too soon.

When there is a dosage change, 7 to 10 days before a retest is recommended. IMHO

 

[Ross]

Sounds like you have a real winner managing your ACT. I would not test for at least a week from the date of dose change. I concur with the others, for 4.1 take a half dose, but don't skip one completely.

 

[ajay_22_86]

Well the Wednesday appointment is actually to check my wound but I'm just going to get a check just out of curiosity. And then on Friday I can just test at home and then I have an appointment next Monday (I'm not officially a home tester as I'm just a month post-op)

 

[Freddie]

Don't be surprised or discouraged if there isn't much change come Wednesday.

 

[Ross]

4.1 now, skip half a dose and Wednesday you'll be around 3.7 or a little higher.

 

[Herb M]

I had a 4.45 INR on Saturday. My range is 2.5 to 3.5. My doseage has been 5mg per day. I decided to cut it in half on Sunday and Thursday. My doctor instructed me to skip a dose for at least 2 days and check my INR on Wednesday. I told the technician who called in the results that the change was too much. She said she will tell the doctor what I am doing.

I will probably have to go to jail for not listening to the doctor.

 

[Ross]

I had a 4.45 INR on Saturday. My range is 2.5 to 3.5. My doseage has been 5mg per day. I decided to cut it in half on Sunday and Thursday. My doctor instructed me to skip a dose for at least 2 days and check my INR on Wednesday. I told the technician who called in the results that the change was too much. She said she will tell the doctor what I am doing.

I will probably have to go to jail for not listening to the doctor.

Nope! I do this with my Cardio all the time. He's figured out that I do know what I'm talking about. In fact, I saw him today and he told me if I wasn't disabled and could function for a full 8 to 10 hours a day, he'd like me to become part of his Coumadin clinic. Of course, that means school so that I have a degree for something I already know without one, but hey, he knows. He and I have argued in the past about my dosing and he's happy with the results that I've achieved on my own.

Herb in your case, I would skip ONE dose, but no more then that and if you've been trending up, reduce the dose by 10% for the week.

 

[Bina]

Herb, some doctors like the "sledge hammer" approach....the INR is a bit too high and they want to whack it back down.
Most of us have found that an adjustment over a couple of days brings more steady results.

 

[Herb M]

Ross, I cut my dose by about 15% for the week. I chose not to omit a day.
I think a supplement that I started taking caused the rise in INR.

 

[Bina]

Sounds good to me.

 

[ajay_22_86]

Just an update for anyone interested - I checked my INR today and it was 3.0 so I'm happy with that. But just to complicate things I should bed that I'm currently taking antibiotics which might have impacted upon it.

 

[Bina]

ajay, 3.0 is very nice.
Keep track of what you are doing, including the antibs, it's good for future reference.

 

[Ross]

Just an update for anyone interested - I checked my INR today and it was 3.0 so I'm happy with that. But just to complicate things I should bed that I'm currently taking antibiotics which might have impacted upon it.

What antibiotic? Some do mess with INR, some don't.

 

[terodac]

Ross! Is it the legs you like? LOL!! I wonder if she knows anything about INR?

Sounds like you have a real winner managing your ACT. I would not test for at least a week from the date of dose change. I concur with the others, for 4.1 take a half dose, but don't skip one completely.