INR Adjustment Protocol

[BubbaHooska]

October 31 will be 5 years on warfarin. Initially, my cardiologist's office would tell me what to do when my INR tested out of range. If high, it was not unusual to hear "skip your dose tonight, then go back to regular dose tomorrow, and test again in three days." If low, I might hear "take an extra __ mg tonight, then go back to normal tomorrow, and test again in three days."

I found that this protocol produced problems. Skip a dose or take an extra dose, and INR would be out of range the other direction a few days later, and then we would repeate the cycle.

Eventually I started ignoring the cardiologist's office and began tracking pretty carefully the effect of any adjustments I made. Now, I only make small adjustments. I still get out of range if I do something stupid, but I find that I re-stabilize more quickly and effectively following my protocol of small adjustments. To his credit, after looking at my spreadsheet, my cardiologist told me to stick with what works.

I'd like to hear about the experiences and recommendations of others, if you feel like sharing.

 

[Ross]

The 10% solution. If it's low, increase by 10% or 15% depending on how low over the week and retest in a week. No hold on INR's 5.0 or less, simply half dose today, perhaps tomorrow as well, then back to normal and retest in a week. You may have to drop 10 to 15% depending on the circumstances. Pretty much all of us were educated by Al Lodwick and followed his dosing algorthyms chart. Doesn't sound like you need one, but if your curious, go to www.warfarinfo.com and click on publications and you can order one for $5.

 

[JimL]

I find that adjusting up or down 1 mg per week changes my INR a half a point or a whole point -- always assuming there are no other radical changes in lifestyle. 1 mg is for me about a 2-3% change.

 

[geebee]

What Ross wrote. - saved me from writing.

 

[Natanni]

So what to you all keep in stock supply of warfarin? We only have 5mg and 2.5mg tabs. Does everyone also have 1mg tabs also? Sorry, didn't want to hijack thread but didn't think this would warrent a new one.

 

[Freddie]

Natanni, - I have 1's , 3's, and 5's in my cupboard

Ross: I've got Al's chart. I really wish that Al and you could explain in lay-man terms exactly what 10% or 15% is.
To increase 10% is that like taking an extra 1mg for 1 day or for 3 days. Or does it mean to take 1/2 of a 5mg tablet for so many days.

For me to adjust my warfarin I'd like to how much more ( in mg) does one need to take.

This is not rocket science I know, but I'm no scientist. But its were my frustration starts.

 

[Bina]

Freddie, don't worry, you will adjust according to what your INR test shows.
Most times it will fine, no adjustment needed. Sometimes otherwise.

Bubba, I have 3mg and 2mg.
My dose is 2mg on Monday,and Friday, and 3mg on Tues,Wed,Thurs,Sat, Sun.
For a total of 19mg per week, so obviously I make very small adjustments.

 

[dick0236]

To: BubbaHooski

To: BubbaHooski

For the last several years I've done it pretty much as you are doing it. My goal is 2.5-3.5 but I am frequently out of this range. My normal dose in 35mg/wk (5mg/day). If I am in the low 2s I'll increase by 2.5 mg/wk. If I am in the +/- 4 range I'll reduce by 2.5 mg/wk. Recheck in two weeks. If under 2 or above 4.5 I'll change dosage by 5 mg/wk and recheck in one week. I have Al's chart and my way seems similar to his recommendation and it makes it easy for me to make my dosage adjustments using only 5mg tablets. My PCP pretty much follows the same guidelines so he and I seldom disagree on dosing. I "win some, lose some" with him.

To Natanni, I have kept only 5 mg tablets on hand for many years. The tablets are scored and it is permissable to break them in half. 5 mg tablets let me adjust from 0-2.5-5.0-7.5-10 mg using only 5 mg tablets.

 

[JimL]

I have a double prescription for 5s and 6s, which works well for me. I order them online, and get 90 pills of each. It is a one-year prescription for each: I get a three-month supply of each, with three renewals for each. Really, then, I have a prescription for nearly twice as much coumadin as I take -- but that insures that I don't run out.

 

[Karlynn]

I have 5's and 3's.

 

[Ross]

Natanni, - I have 1's , 3's, and 5's in my cupboard

Ross: I've got Al's chart. I really wish that Al and you could explain in lay-man terms exactly what 10% or 15% is.
To increase 10% is that like taking an extra 1mg for 1 day or for 3 days. Or does it mean to take 1/2 of a 5mg tablet for so many days.

For me to adjust my warfarin I'd like to how much more ( in mg) does one need to take.

This is not rocket science I know, but I'm no scientist. But its were my frustration starts.

10 to 15% of the total weekly dose that you take. Not daily. I'm taking 42mg per week to stay in range. So if increase by 10%, that's 4.2mg or 4 in this case, for a total of 46mg for the week or vice versa if I have to decrease.

 

[Freddie]

THANK-YOU ROSS!

 

[Ross]

Freddie this page will help you understand more. Look at the charts, THEN read or else you'll dumbfound yourself.

http://www.aafp.org/afp/990201ap/635.html

 

[aussie girl]

I was given 1mg 2mg and 5mg tablets when I left hospital ( 6 weeks ago ).

I was taking 5mg a day 35 per week and my levels went up so I checked with Al's chart ( it was the first thing I ordered when I got home from hospital ) and worked out that I needed to reduce by 3.5 a week. My local doctor rang later that day and told me to start taking 4.5mg a day 31.5 a week. It was so pleasing to know my doctor knew how to manage coumadin and that I had also been able to work it out for myself

Mary

 

[Bina]

Aussie girl/Mary, its great that you had some knowledge right from the start. I had not found VR.com at the time of my surgery and so was very nervous when my doc would not call me on time with results, etc.
Life is so easy now.

 

[kbheart]

Bubba,
I've only been on warfarin for a year but I learned early on that the nurses at my cardiology office didn't always give good advice. I ordered Al's pamphlet and now tell the nurses my plan for getting back in range. Last week the nurse actually admitted that I was "pretty knowledgeable". Thanks to Al and this website--I am! Luckily the nurses haven't balked at letting me take control.