INR 5.0 Dose Adjustment?

[BDMc]

My range is 3-4. My weekly dose is 82mg, 12mg 5 days, and 11mg the other 2. Tonight's dose would be 12mg. How much should I reduce it? Seems easier to email results with a reasonable plan to my doc, as he may not respond until tomorrow. Thanks, Brian

 

[Ross]

Have you been consistent at 82mg or has it been creeping up? If it's been creeping up, lower it by 10% or 8mg and take 11mg everyday then retest in a week.

 

[Karlynn]

I like Ross's plan. For those of us that take a lot of Coumadin, our INR can go down too much if big adjustments are made. My INR tested at 4.2 (my machine) and 4.7 (my card's machine). My range is 2.5 - 3.5. I'm not doing anything this week. If it's up next week, then I'll make a 10% adjustment.

 

[Guest]

I don't like to lower warfarin doses for INRs of 5.0 and below. I'd probably wait a week and restest before doing anything.

 

[BDMc]

Thank You!

Thank You!

I don't think it's been creeping up: 3.2, 4.6 3.9, 2.7, 3.4, 3.3, and now the 5.0. Sounds like I should just continue, and retest next week before adjusting. Thanks, Brian

 

[Ross]

I don't think it's been creeping up: 3.2, 4.6 3.9, 2.7, 3.4, 3.3, and now the 5.0. Sounds like I should just continue, and retest next week before adjusting. Thanks, Brian

That's what I would do and Al confirmed my thoughts. I thought maybe it had been creeping up on you, so offered the other choice.

 

[mtkayak]

I don't think I would adjust it quite yet either, if you do make it a very slight decrease. Wait another week and test. My Dr. usually gives it a week as long as it's give or take .3 above or below my target before he adjusts it, my target is 3.0-3.5. Actually, I don't think he would adjust it until it's 2.5 or 4.0. I'm starting to get a pretty good handle on what to adjust it too myself. I'm taking 5mg a day and it usually drops to 2.7 and when I take 5mg for T,T,S,S and take 7.5 mg for M,W,F then it's in the 3.8 range so if I take maybe an additional 3mg a week on top of my 5mg daily then I'm in range.

I just got my own Home Kit!!!!!! It's awesome, I only have to go to the Dr. once a month now!

 

[Marty]

10% solution

10% solution

I really hate to disagree with Al and Ross but if my INRatio gave me a 5.0. I'd reduce my
weekly dose 10 % and test weekly till I found a dose that stabilized the INR in the recommended therapeutic range, 2.5 to 3.5. Then ,I'd go back to testing every two to three weeks. This is easy for us to do ,that self test and self dose.This course of action was recommended to me by a hematologist I met at a national meeting a few years ago and has worked for me.

 

[Granbonny]

If you are not going to adjust your doseage...Try drinking a couple of V-8 juices..some coleslaw...or a few good salads this week. ..See if that lowers it? bonnie

 

[RandyL]

Now that sounds like a great idea!

 

[Ross]

Bloody Mary's and brussel sprouts.

 

[Georgia]

I've heard of celery in bloody mary's, but brussel sprouts? Do you stick them on a toothpick?

 

[Guest]

I had a patient come in today who seems to love coming to the clinic for some odd reason. (Even Bob Uecker has a stalker.) Her excuse for today was that she thought her INR would be low today because she had Chinese food on Sunday and there were two pieces of broccoli in it. For the past 7 visits her INR was in - in - low - in - low - in and today low. All on he same dose. Since there was no clear pattern to indicate what to do, I just told her to stay on the same dose. I heard her complaining loud and long to my office manager. I kept hoping that she would get mad enough to quit coming but I doubt that I could get so lucky.

 

[Ross]

I had a patient come in today who seems to love coming to the clinic for some odd reason. (Even Bob Uecker has a stalker.) Her excuse for today was that she thought her INR would be low today because she had Chinese food on Sunday and there were two pieces of broccoli in it. For the past 7 visits her INR was in - in - low - in - low - in and today low. All on he same dose. Since there was no clear pattern to indicate what to do, I just told her to stay on the same dose. I heard her complaining loud and long to my office manager. I kept hoping that she would get mad enough to quit coming but I doubt that I could get so lucky.

The bad thing is, I believe it!

 

[Karlynn]

Al - you have a groupie!!!!!!

 

[BDMc]

Sunday INR 5.0, Tues. 2.6

Sunday INR 5.0, Tues. 2.6

Well gang, I maintained my ususal dosing last week, and Sunday tested 5.0. So I reduced my dose for that night to 10mg (from 12) and took 11mg last night. Now I'm at 2.6. Do you think one of these tests was off/bad? My diet has been very consistent this past week. I did have about a tablespoon of cranberry sauce Saturday with dinner. I can't believe that would effect my INR that much. My PCP is on vacation, so I'm turning to you veterans for dosing advise. I was taking 82mg per week. I plan on taking 12mg tonight, and will be interested in your advice for the rest of the week. Thanks, Brian

 

[Guest]

If it does anything, cranberry is supposed to raise the INR. If a tablespoonful of anything affects the INR that much, I wouldn't be doing warfarin because everyone who took it would be dead.

This is another example of why I keep saying to not do anything for an INR of 5 if you have nbeen having good results with this dose. Tinkering with the dose just screws things up down the line. My experience is that if you do nothing but retest in another week or two the INR is almost always back in line.