INR level at 5.0

[ejonbry]

I went in to the coumadin clinic today, 1st time. I had been having a blood test done, ordered by my surgeon, each week. My dosage of Coumadin started at 7.5, last week my INR had gone up to 3.2 and I was told to half my dosage for 2 days, then back to normal dosage. Now today, 1 week later, INR is at 5.0, was told to skip dosage tonight, take 1/2 tomorrow, whole Sat, 1/2 Sun, whole Mon, and retest on Tue. Does this sound okay? I am still very new to this.

Thanks,
Eric

 

[Bina]

what dose of pills are you using.....5mgs?

 

[ejonbry]

I using 7.5mg

 

[Bina]

In my first 4 weeks, until I got stable, I kept 2 different doses of pills on hand to make it easier for adjustments and calculations.
You don't want to get into the pattern of a swinging INR from holding and halving doses.
(I bet you would end up being fine on 5 or 6mg per day).

 

[ejonbry]

Thanks for the advice. I am just a little unsure about holding doses completely. The Pharm D seemed to know what she was talking about, but I don't know her well enough to completely trust her.

Eric

 

[Bina]

with an INR of 5.0 you can hold one dose quite safely....don't worry.

 

[ejonbry]

Thanks Bina, that makes me feel better.

Eric

 

[Ross]

What is your total weekly dose for the week? 7.5x7?

52.5 - 20%= 10.5 = 42mg

It should be 7.5 5 7.5 5 7.5 5 5 =42.5mg

You need to get 5's to work with.

 

[ejonbry]

52.5mg total for week. 7.5mg/day. changed last week to 45mg. 7.5mg/day x 5, 3.75mg/day x 2.

Eric

 

[Ross]

Did they let you go a full week before testing after the change to 45?

 

[ejonbry]

Yes, before the change to 45mg, my INR was 3.2. After the change and 1 week, 5.0.

Eric

 

[Ross]

If it were me, I'd take 5mg daily and no more for one full week and then retest. I think your going to find your a 35 to 40mg a week person, at least for a little while. As you start feeling better and getting more active, your going to need to increase the dose some.

 

[ejonbry]

Cool, I guess the less rat poison the better. Thanks for your help Ross.

Eric

 

[Ross]

On things for sure, it's better to be too high then too low, so your doing fine thus far.

 

[ejonbry]

Yeah, I know 5.0 isn't extreme, just don't want to continue the trend.

Eric

 

[ALCapshaw2]

Personally, I don't like the idea of Holding a Dose for an INR of 5.0 or Less.

I'd rather take half a dose and test in 4 to 7 days.
It may take a bit longer to get exactly where you want to go,
but it reduces the likelihood of INR 'swing'.
In other words, it's a conservative move in the right direction.

I have 2 different dose tablets, 1mg apart, which allows me to control my weekly dose over a 7mg range in 1mg increments taking only one tablet per day. I also spread them out symmetrically thorughout the week. This makes for a very small (1mg) change day to day and helps maintain a more stable INR.

I hear that several pharmacies now offer 30 day supplies (some pharmacies allow any dose, some are still just 5mg) for $4 (and some are offering 90 day supplies for $10).

'AL Capshaw'

 

[ejonbry]

Thanks for the info Al. I'm still new to this, so I appreciate any advice I an get. Hopefully I'll catch on pretty quickly.

Eric

 

[Ross]

This really is simple. If your too high like you are now, decrease the dose by 20% and retest in a week. If you'd of been 4.0 a 10% adjustment may have been all that is needed. Once your in the house, 5% tweaks now and then.

 

[Lisa in Katy]

I would never hold for a 5.0. Actually, I never hold at all. I had a 6.9, held a day, tested 3-4 days later, dropped to 2.0.

My last 3 monthly tests were 3.9, 4.0, 4.9. My doctor sees the 4.9 as a fluke and he'll retest me next week when I have my annual check up. I figure it's related to my diet because I forgot to hit the produce section the last time I went to the grocery store! So I'm going to eat some green veggies and retest next week.

 

[Bina]

Once I had a reading of 4.2, so I took half a dose and resumed regular dosing.
Oh, and no running with scissors!