INR dropping after increased dosage

[halleyg]

My INR has been acting up the past 6 weeks or so. Had a pretty steady year before that, but then missed a dose and it was a little low, went back up was fine, then low and increased weekly dose from 10 mg 1x/week and 7.5 mg the rest to 10 mg 3x/week and 7.5 mg the rest (my current dose) Two weeks ago was at 2.8 which isn't bad, but I'm happier in the 3's and that's usually where I stay. Went today and I was 1.9 which is of course not in range at all. The dosing nurse who knows what she's doing was off today, and the other nurse told me to take 15 mg tonight and come back tomorrow. I didn't feel comfortable leaving being 1.9 and my afib had me up last night and had already been worrying about that. My cardio was there and he said I could go to another office and get a lovenox injection, which I did, and still take 15 mg tonight and come back in the morning. So just wondering what others might think of this. It seems like every other year or so I get way out of whack, usually around a holiday, too! But I have never seen my INR lower after increasing my dosage. Note: I'm a MV so my range is 2.5-3.5

 

[Protimenow]

Personally, I don't think I'd worry a lot about 1.9. Certainly taking 15 today and going back tomorrow seems like a waste of time -- you won't see the full effect of the 15 for a few days. What you'll see tomorrow will be a result of your dosage yesterday or the day before - plus your physical activity and diet.

It looks like your total weekly dose is 60 mg. Replacing 10 or 7.5 mg that you would normally take with 15 is pushing it beyond the recommended 5% adjustment, but may not be quite enough to start the roller coaster effect that drastic changes can bring on.

Although the advice given is probably not TOO wrong, expecting to see a change tomorrow as a result of a dosage adjustment today is just plain wrong.

 

[Philip B]

Time Factor

Time Factor

Keep in mind that it typically takes a couple of days for most of us to see changes in levels associated with dosage changes. Raising your dosage today and checking it tomorrow might not reflect much of a change.

-Philip

 

[ALCapshaw2]

MY understanding is that it takes 3 or 4 days for Coumadin / Warfarin to become fully metabolized so testing before 4 days after a change is not going to reflect the full effect of that change. IF you change doses again, based on a reading less than 4 days after a change, you will likely have a Spike in INR, then lower your dosing, and typically go into the infamous Roller Coaster Effect.

My Clinic typically waits 2 weeks before retesting after a dose change.
I'm more inclined to want to test after 1 week.

'AL Capshaw'

 

[halleyg]

Yeah, I do agree that testing tomorrow would be a waste of time and won't show anything. On the other hand the 1.9 worries me but guess with the dose increase tonight I won't drop further.

 

[tommy]

Personally, I don't think I'd worry a lot about 1.9. Certainly taking 15 today and going back tomorrow seems like a waste of time -- you won't see the full effect of the 15 for a few days. What you'll see tomorrow will be a result of your dosage yesterday or the day before - plus your physical activity and diet.

It looks like your total weekly dose is 60 mg. Replacing 10 or 7.5 mg that you would normally take with 15 is pushing it beyond the recommended 5% adjustment, but may not be quite enough to start the roller coaster effect that drastic changes can bring on.

Although the advice given is probably not TOO wrong, expecting to see a change tomorrow as a result of a dosage adjustment today is just plain wrong.

I agree with all of this......not to get too excited about 1.9......not to over react with the next dose.....don't expect results over night.....disappointment that testing the next day was even considered.

 

[catwoman]

Halley:

Since this is not the first time this has happened, consult your Coumadin diary to see what you did to get back into range -- what dosage you bumped up to. The holidays can be stressful, which can lead to disrupted eating habits/schedules, too much partying, non-stop shopping expeditions, etc.
If you're usually pretty stable on INRs, you should soon bounce back into range.

 

[Kathy McCain]

Hi Halley,

Sorry you are have some difficulties. I am sure eveything will turn out fine.

Take care

 

[halleyg]

Thanks all! Didn't get INR checked yesterday, am waiting till next week and trying not to worry! Happy Christmas

 

[ALCapshaw2]

Have you considered getting your own INR meter Halley?

Even If you stay with your current manager / clinic, it would be nice to have your own instrument for times such as this when you would like to 'keep and eye' on where you stand.

Keep the faith. I wouldn't blame you for getting tested sometime next week, maybe even Monday and Friday, just so you know where you are and where you are heading. Resist Large Dose Changes.

'AL'

 

[Bina]

Yes, Halley, you need a home monitor. I tested a couple of days ago and got a 3.7 so I know that I can indulge in
broccoli and asparagus this week with not a worry at all.