Missed a dose. What do you do?

[Superman]

Went away for the weekend celebrating 22 years of wedded bliss with Wonder Woman. Realized about 2 hours down the road that I forgot my drugs. That’s what soccer games and dance and setting the kids up for a decent weekend before we leave will do.

Took my usual Saturday morning before we left. Couldn’t Sunday morning since we were gone. Got home Sunday night and took the usual right away. Resumed normal dose and time today. Tested today as well and right at 2.5 so no worries.

If it was a longer trip, I guess I would seek a local pharmacy. Have to travel for work this week. Hope I remember for this trip.

In short, if you’re consistent and consistently in range, one missed dose is no cause for panic. Just resume as soon as you can.

 

[pellicle]

great to post this again (to keep it fresh)

Since the topic appeared to have a question, (probably like you(, I've done this enough to have tried the various options

• take half the next day
• take half the next day and the rest the day after
• take all the next day (if you dose in the PM and you discovered in the AM)
• do nothing

by weeks end its all about the same (both in INR monitoring and in my model) so its just as easy to not worry about it and just continue.

 

[tom in MO]

Not really a missed dose, but a late one I've missed a dose and split it between the next two days w/o impact.

 

[drleng]

Good topic for discussion (the following is advice from my INR clinic - makes sense):
If you manage to take your missed dose within 8 hours of the usual time - take your usual dose.
The next day, take your usual dose slightly later than usual time.
The following day, resume normal.

I don't even bother to check my INR during such times. No problem!

 

[Protimenow]

In my case, I don't do much of anything after missing a dose.

I've had my INR reduced for minor (or more major) procedures. After my procedure, I began taking my normal dose. In 3 or 4 days, my INR was back in range. The few days that my INR was below 2.0 didn't provide risk of clot formation, and I just waited the few days until my INR returned to where I wanted it.

Warfarin has a half-life in most people of 3-5 days. For me, my INR is affected by the dose I took 3 or so days earlier. I don't see much difference whether I take Warfarin at 10 AM or at 10 PM. I don't think the time that you take your dose makes a significant difference in your 'steady state' INR.

What DOES make a difference is if you don't take the same dose every day. THEN your INR may fluctuate, based on your different doses the days before your test.

 

[almost_hectic]

In a pinch… without Coumadin on hand would taking something like Ibuprofen be a good idea?

 

[Superman]

In a pinch… without Coumadin on hand would taking something like Ibuprofen be a good idea?

Or a glass of cranberry or grapefruit juice? Cranberry sends my INR up.

 

[almost_hectic]

Or a glass of cranberry or grapefruit juice? Cranberry sends my INR up.

I knew to avoid grapefruit juice, wasn't aware of cranberry juice

 

[sharky7]

Not really a missed dose, but a late one I've missed a dose and split it between the next two days w/o impact.

YES....for sure....did that one time, i figured where i was and added 1mg to my dose. I own a machine, am MALE/68yrs/2.5-3.5/saint jude mitral valve. And am on right now, WARFARIN-4mg/s everyday cept-tuesday and thursday-2mg/s! Two days ago, I was at 2.4, took my regular dose, next day i was at 2.5, right where, I think, i wanted and needed to be. being i was at 2.4, i needed to know if i was staying at 2.4, going up or down. so next day when i got the 2.5 i was very happy. i was eating salads, etc., and knew my INR was doing something, but i did not know what, last INR test, by me, was 2 weeks ago. VA test is on 28th/OCT/2021, so i am right now planning on it to be where I want and need it to be, about 3.1/3.3 or so. AND BTW, does anyone here also do tests also with the VA and in the USA??? asking for friend.
AND is there others that also use a pill container, and calendar, and magic marker to help keep track???

 

[pellicle]

is there others that also use a pill container, and calendar, and magic marker to help keep track???

myself I do this:

• pill box labelled in day
• alarm on my phone set for 7pm to tell me to take my pill
• the location of that pill box where I put my phone adding a visual check (wait, its tuesday, why isn't mondays taken)

I never end up looking at paper calendars ... well not since about 1991 when I got my firs Sharp Organiser (then Palm device, then Google calendar and my phone ...)

simple and reliable little fellow it was too ... backed up onto my PC weekly in case of "you never know what"

 

[sharky7]

That helps alot, and i guess doing it the way that I do, and I admit I am an old timer. using CELL is a very good idea, and perhaps I should and need to at least consider it? and that is good, "paper calendar", lol! ya just made me feel much older........heeehehehehehe. And yes to that, incase anyones even cares, i usta also own one of those SHARP devices.

myself I do this:

• pill box labelled in day
• alarm on my phone set for 7pm to tell me to take my pill
• the location of that pill box where I put my phone adding a visual check (wait, its tuesday, why isn't mondays taken)

I never end up looking at paper calendars ... well not since about 1991 when I got my firs Sharp Organiser (then Palm device, then Google calendar and my phone ...)
View attachment 888191
simple and reliable little fellow it was too ... backed up onto my PC weekly in case of "you never know what"

 

[sharky7]

Or a glass of cranberry or grapefruit juice? Cranberry sends my INR up.

You bring up a very good point there, if it is possible to get a higher INR drinking those, why are we even messing with WARFARIN? just a dummy asking a question that I havent even a clue. I happened to be a lover of grapefruit juices.

 

[pellicle]

... I admit I am an old timer.
... "paper calendar", lol! ya just made me feel much older.

well I'm probably not that far behind ya looking at dates on the calendar ;-)

 

[pellicle]

You bring up a very good point there, if it is possible to get a higher INR drinking those, why are we even messing with WARFARIN? j

I'm not sure I understand what you mean.

firstly however yes its not only possible its certain
http://cjeastwd.blogspot.com/2021/05/grapefruit-and-warfarin.html
as I mention in that blog post, if it tastes so horrible that you have to add weight for weight sugar (also bad for you) why the hell do people claim to love it (let alone put that bitter crap in your mouth) ... still people do drink vinegar for "health".

 

[drleng]

You bring up a very good point there, if it is possible to get a higher INR drinking those, why are we even messing with WARFARIN? just a dummy asking a question that I havent even a clue. I happened to be a lover of grapefruit juices.

I think I understand your question. Grapefruit or cranberry by themselves don't make us bleed easier. It's only mixing with warfarin that does that. They inhibit the body's ability to metabolize warfarin, hence increasing the effect of warfarin

 

[Protimenow]

I wouldn't use Ibuprofen. I wouldn't use Aspirin. I wouldn't use ANY NSAID unless I was on a desert Isle that has a drug store with only NSAIDs and no Warfarin.

The problem is that NSAIDs work differently, making platelets more 'slippery' and making clotting take longer than it does without the NSAID. There are a few problems: you can't really tell how much these will effect your clotting time - you can't really tell how much to take - and if you take enough to have a significant effect, you may wind up with a gastric bleed.

If you miss a dose, don't panic. Aspirin or Ibuprofen would probably not provide much benefit - just take the next dose at your usual time (or even earlier on the next day). The issue with a missed dose is that you won't see the effects (lower INR)) for a few days. Taking an INSAID when you first realize that you've forgotten your Warfarin is NOT going to help -- the effects disappear before the effect of a missed dose will be reflected in your INR.

As far as Cranberry or Grapefruit juice (yuk) are concerned, these may have no effect on your INR UNLESS you are taking warfarin. These probably interfere with your body's rate of absorption of warfarin, and it's the effect that these have on warfarin metabolism that causes shifts in your INR. On their own, they probably don't effect INR.

Personally, I wouldn't take an anticoagulant that doesn't provide some level of predictability and that can't be monitored for the level of effectiveness (like an INR test).

 

[pellicle]

I think I understand your question. Grapefruit or cranberry by themselves don't make us bleed easier.

the bit that eluded me was the bit about "why are we messing with warfarin" ... I think it suggested that "maybe we should be using something else" ... now that's a rabbit hole!

 

[pellicle]

I wouldn't use Ibuprofen.

I was also so advised, but I did some digging and found that it was life changing when I badly hurt my back (in Feb this year). I monitored INR and monitored my stools and found that all it did was take away the pain.

By pain I mean confined to the floor, bed or using crutches type back pain for 2 months.

https://www.valvereplacement.org/threads/ibuprofen.887853/

 

[Critter]

I take celecoxib when I overdo it for a few days to help with pain. Haven’t had any adverse events. It is contraindicated but not an absolute contraindication.

 

[carolinemc]

If I am few days from doing INR, I generally go to the next dose and if it is closer(three days) to INR, I will eat a little salad. It works.