Lasix & INR

[csutherland]

Does anyone know if Lasix (generic) affects INR? I mentioned in an earlier Small Talk thread that Jerry's feet, ankles & legs had been swelling and he started on 1 or 2 Lasix a day. Today when he had his routine INR test it was 4.6. He has to go back in a week. The Lasix is the only change we can think of in diet, meds, etc.

 

[njean]

Does anyone know if Lasix (generic) affects INR? I mentioned in an earlier Small Talk thread that Jerry's feet, ankles & legs had been swelling and he started on 1 or 2 Lasix a day. Today when he had his routine INR test it was 4.6. He has to go back in a week. The Lasix is the only change we can think of in diet, meds, etc.

I have been on 160mg of furosomide (Lasix generic) for more than a year now & I have not seen any interaction between it & coumadin. I've been on coumadin for 30+ years so I'm sure I could tell right away. So I do not think it could be the Lasix.

Has his level of activity increased/decreased that you can think of?

A lot of us struggle with unstable INR's from time to time & the causes can be very frustrating to try to pin down so I can relate to his confusion.

Did they do a dose adjustment for today or is he to continue on the same dose & then just recheck in a week?

 

[Lynlw]

Did he lose much water weight? Did they add Postassium with the lasix?

 

[csutherland]

Very little activity level change lately. He did have cataract surgery on one eye yesterday which slowed him down for one day. I don't think that would be anything significant.

The Coumadin Clinic said to not take any warfarin today, then cut back just a little the rest of the week until checked next Tues.

 

[njean]

Very little activity level change lately. He did have cataract surgery on one eye yesterday which slowed him down for one day. I don't think that would be anything significant.

The Coumadin Clinic said to not take any warfarin today, then cut back just a little the rest of the week until checked next Tues.

Had it been me, 4.6 is not that high so I would have just taken 1/2 of the usual dose & then continued on the regular dose & re-checked in a week but I'm not an expert either so do as the clinic says & we'll see how he is in a week's time.

 

[Lisa in Katy]

If he had cataract surgery yesterday, he probably had some kind of drugs injected, including antibiotics. A day later would be an awfully quick reaction, but antibiotics have a tendency to wreak havoc on the INR. BTW, if he skips a day and cuts back the rest of the week, he's probably going to be quite low at his next test. 4.6 isn't that high and more than a 10% adjustment is too much (IMO). I wouldn't do it.

 

[Ross]

He may have liver congestion and that may be the cause of the higher INR. It happens from time to time with us folks that maintain water. Follow the clinics advice until the next test and we see where he's at.

I'm going through a bout of it myself right now. Tested 4.1 today. My plan of action is skip tomorrows low 5mg dose and then resume normal schedule.

 

[ALCapshaw2]

I agree with the other comments that 4.6 is not so high as to need to HOLD a dose. Personally, I'm not a fan of holding a dose for anything under 5.0 (or even higher). Half a dose for one day seems appropriate (in my NON-professional opinion).

Again, in my non-professional opinion, I don't think Lasix per-se would cause a rise in INR. (Ask your Pharmacist - it's FREE and someone should still be available to take your call).

That said, if your husband lost a lot of Fluid because of the Lasix / Furosemide, that *might* cause the concentration of Coumadin / Warfarin to rise in his blood. That might be a good Question for you /him to ask his Coumadin Clinic or PCP.

'AL Capshaw'

 

[Cris N]

Hmmm.... interesting question. I take BP medication & dr changed my prescription- added hydrochlorothiazide. He warned me that itmight affect my inr - it did. Raised it from a fairly steady 3.5ish to 4.8 the first week. I had to cut my warfarin just a bit for the first 2 weeks - now it seems to have stabilized & I'm back to my regular dosage.

 

[Ross]

Hmmm.... interesting question. I take BP medication & dr changed my prescription- added hydrochlorothiazide. He warned me that itmight affect my inr - it did. Raised it from a fairly steady 3.5ish to 4.8 the first week. I had to cut my warfarin just a bit for the first 2 weeks - now it seems to have stabilized & I'm back to my regular dosage.

It wasn't the hydrochlorothiazide that caused the rise. I'm on Lasix, HCT, Aldactone and metolazone, all dieuretics and none of them affect my INR. It just depends on how well my kidneys are filtering waste and getting rid of water. If I'm water logged, my INR rises some. HCT will cause your INR to fall if anything.

1 potential interaction was found for the drugs you selected.
You searched for interactions between the following drugs :

Coumadin Tablets
Hydrochlorothiazide Tablets


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(Note: Not all drug interactions are known or reported in the literature, and new drug interactions are continually being reported. This information is provided only for your education and for you to discuss with your personal healthcare provider. )

WARFARIN SODIUM (in Coumadin Tablets) may interact with HYDROCHLOROTHIAZIDE (in Hydrochlorothiazide Tablets)

Blood clotting normally occurs in response to a cut or other types of injuries to protect the body from excessive bleeding. Many substances are involved in the clotting process including platelet cells and various proteins that are produced in the body. Water is one of the main components of the blood, along with red and white blood cells, platelets, and proteins. Hydrochlorothiazide promotes the removal of sodium and water from the body by the kidneys. When this happens, substances in the blood become more concentrated meaning that the same amount is now contained in less fluid. Because the platelet cells and proteins are more concentrated, the blood may be more likely to clot. Warfarin is generally used to prevent your blood from "coagulating" or forming blood clots. When these drugs are used at the same time, hydrochlorothiazide may diminish the ability of warfarin to prevent blood clots. If warfarin and hydrochlorothiazide are taken together, your doctor may want to monitor you closely for signs of a clotting disorder. Blood tests can be used to make sure that you are getting the right amount of warfarin. If you are experiencing problems, it may be necessary to adjust the dose of warfarin.You may want to ask your healthcare provider about this potential interaction if you think you are having problems.

This interaction is poorly documented and is considered moderate in severity.


http://www.drugdigest.org/wps/porta...blets^Hydrochlorothiazide+Tablets^&step=check

 

[csutherland]

It wasn't the hydrochlorothiazide that caused the rise. I'm on Lasix, HCT, Aldactone and metolazone, all dieuretics and none of them affect my INR. It just depends on how well my kidneys are filtering waste and getting rid of water. If I'm water logged, my INR rises some. HCT will cause your INR to fall if anything.

[/B

So....being water logged causes INR to rise? We didn't know that. Jerry has an app't on Tues with the cardio to see about his foot, ankle & leg edema, same day he has his INR rechecked.

 

[Ross]

It wasn't the hydrochlorothiazide that caused the rise. I'm on Lasix, HCT, Aldactone and metolazone, all dieuretics and none of them affect my INR. It just depends on how well my kidneys are filtering waste and getting rid of water. If I'm water logged, my INR rises some. HCT will cause your INR to fall if anything.

[/B

So....being water logged causes INR to rise? We didn't know that. Jerry has an app't on Tues with the cardio to see about his foot, ankle & leg edema, same day he has his INR rechecked.

Yes because the kidneys are not eliminating all the waste products, the effect of Coumadin builds up in the system. Once the water situation is under control, things should return to normal. I go through this about once every two months or so. You would think being diluted would drop the INR, but that's not what I've experienced.

 

[Cris N]

Thanks Ross... I didn't bother to check drug interactions... just assumed it was the HCT. Surprised, too, to find that it does the opposite of what you'd expect. But I did find this interesting:

Hydrochlorothiazide promotes the removal of sodium and water from the body by the kidneys. When this happens, substances in the blood become more concentrated meaning that the same amount is now contained in less fluid.

Does that mean that HCT is really a blood thickener???

 

[Ross]

Thanks Ross... I didn't bother to check drug interactions... just assumed it was the HCT. Surprised, too, to find that it does the opposite of what you'd expect. But I did find this interesting:

Does that mean that HCT is really a blood thickener???

Blasphemy!