INR What to do?

[Dave S]

I have a delema, I had my INR tested today, my doctor was not in, so one of the other doctors adjusted my levels, problem is I do not like the way he wants to go about it. what should I do?

My level today was 4.2 I have been taking 7.5mg per day seven days my last test was 3 weeks ago. I have never been in the right zone.

This is what they told me to do to adjust the level:
Skip meds for the next 2 days.
Then 4 days at 7.5mg
Then 1 day at 5.0 mg.
Then come back on Monday for a recheck.

Thanks Dave

 

[geebee]

I would NEVER skip a dose for a one-time 4.2 result (much less 2 doses). I would eat a large spinach salad or the like. I would test again in a few days and if it were still high, I would lower my weekly dose by about 10% and go from there. You will drop way too fast if you skip 2 days.

 

[jeffp]

Like Geebee said... I had a 4.2 early on and my PCP freaked (I wasn't all that concerned). Reduced me from 7.5 daily to 6.0 daily and I dropped to 1.6 the next week. I say exercise more and eat some greens to get it down that small bit rather than making alot of dose changes. You wind up "chasing your tail" to getin range. Just my opinion on the matter...

 

[ALCapshaw2]

Skipping for 2 days will most likely put your INR in the TANK !

When I hit 4.0 (after starting an antibiotic with only a slight effect on INR), my Coumadin Clinic Nurse told me to cut my dose for ONE day by 40% and then resume my normal dose since I was a tad low at the start. Following week I was right where I needed to be.

Bottom Line: For an INR below 5.0, a SMALL change is usually all that is needed, followed by another check in 7 to 10 days. I highly recommend that you BUY a copy of Al Lodwick's DOSING GUIDE ($5) from his website www.warfarinfo.com

'AL Capshaw'

 

[Karlynn]

Good for you in knowing that the doctor gave bad instructions!

When I'm getting a little high like that, I usually cut my dose that night by 1/2 and continue on as usual, testing again in a week. If it's still high a week later, then I cut my weekly dose by 10%, then test again in a week.

 

[Ross]

Drop the dose 10% or so.
Do like Mon 7.5 Tue 5 Wed 7.5 Thu 5 Fri 7.5 Sat 5 Sun 5 and eat a couple salads. I'll bet you'll be in range then!

 

[Guest]

Many times I will not even change the dose for a 4.2, depending on how the person feels about it. Most of the time the INR is back in range at the next test after doing nothing.

The dose the doctor changed you to is almost guaranteed to put you out of range. There is no logic to what you were given.

 

[MSG Morrissey]

My doc (CT) has my range 3.5-4.2 with the St Jude mechanical. Is this "normal".

 

[Karlynn]

My doc (CT) has my range 3.5-4.2 with the St Jude mechanical. Is this "normal".

The normal range for an aortic mechanical is 2.0 - 3.0. However, if you have other issues this may be the reason for your higher target. Not sure about the 4.2 and why he didn't just say 4.5? You can get a .5 variation in readings between machines.

 

[Ross]

My doc (CT) has my range 3.5-4.2 with the St Jude mechanical. Is this "normal".

If you thrown a clot or have a history of stroke, the range is 2.5 to 3.5. As far as I've read, anything beyond 3.5 doesn't offer any better protection, so I would question him on where he's getting these numbers.

 

[Marty]

In this case I would prescribe the "10% SOLUTION"

 

[Dave S]

Thanks for all the replys, I didnt think it sounded right, this is the kind of insructions I have been given sense starting all of this, and I have never been in the range more then 1 week.

I was reading everything on this site lastnight and fell asleep and forgot to take meds, that is a first for me, so I guess I skip one day and then go back on my normal dosing, and see what my level is next week.

Since I skipped a dose I went ahead and took meds in the morning, I wanted to switch to mornings anyways,easyer to remember, is it ok to do it like that.

Thanks so much
Dave

 

[Ross]

Sounds like it's time you find someone that knows how Coumadin works. Where your going now obviously isn't getting it.

If you completely missed a dose, make sure you let whomever know when your tested again or try to somehow divide the missed dose into the rest of the week.

Coumadin is so slow acting that switching shouldn't pose a problem. I take mine in the morning because I know I'll forget later in the day.