Missed Dose

[ALCapshaw2]

I'm wondering what others do when they miss a dose of their Coumadin?

I usually take my Coumadin just before going to bed, along with my other heart meds.

Last week, I fell asleep without taking my Coumadin. I realized my mistake the next morning and took half a dose, returning to my normal dose that night. My INR dropped to 1.8 at day 4.

Is there a recommended protocol if you realize you missed a dose within 12 hours?

AL Capshaw2 (VR.com did NOT recognize my old screen name on this new computer)

 

[Marty]

Missed dose?

Missed dose?

Al, I'll give you the benefit of my own experience. This is strictly anecdotal and non-scientific. I take my Coumadin in the AM at breakfast. If for some reason I forget and I remember before the next dose is due that day I take the full dose. If I miss the whole day I simply follow the regular schedule. I don't ever take a double dose to make up for a miss.Let things settle down for a few days and then test.

 

[Sunshine susan]

Al, that has happened to me several times. I normally take mine right before I go to bed. If I realize the next morning that I forgot, I take the whole dose then (just a few hours later and many hours before the next dose). If I don't realize it until it is the next night, I will spread out the missed dose (6 mgs) over 3 days, adding 2 mg to each of the 3 days. INR may vary some but most always still within range so it must work--at some level anyway. Hope this helps some! Susan

 

[Kim]

I think that sounds like a great idea! You would still get the same amount, but not have the bleeding risk of taking such a high dose at one time!

My cardiologist told me that if I miss my dose at night and remember first thing in the morning, to go ahead and take the full dose, but if I don't realize my mistake till the next evening at regular dose time, skip the missed dose completely. I was never comfortable with that advise becuase I am a high metabolizer of warfarin. I take 9 mg a day. Fortunately, I have yet to miss a dose.

Thanks for sharing!

 

[Guest]

What is worse than missing a dose? My aunt was setting up her weekly pill minder and talking to her husband. She absent-mindedly put the bunch of pills she had in her left hand in her mouth and washed them all down with a drink of coffee. When she went to put more in the pill minder, she wondered, "What did I do with those pills?"

She lived - no real ill effects.

But it wasn't warfarin...

 

[ALCapshaw2]

Thanks for everyone's response. I especially liked Susan's idea about spreading the missed dose as an increase over the next 3 days. Makes a lot of sense to me. What do you think Al (Lodwick)?

'AL Capshaw'

 

[Guest]

Patients have told me lots of things that they do and most of them seem to work.

I didn't see any posts on this that made me think, "Oh NO!"

 

[GregB]

Missed dose also

Missed dose also

Well folks it has happened to me now.

I have been a bit unwell for a couple of days with a stomach bug that has been doing the rounds here. Feelings of nausea and 2 bouts of fairly severe dioahreaha ( spelling??) Because this I took an early night and promptly went to sleep.
I normally take 10mg per day at 9:00 pm each evening and have an alarm set on my watch as a back up reminder. This night I slept through the alarm and realised I had missed a dose at about 2:00 pm the next day.
I also use a daily pill compartment box as a further check; and sure enough there they were, the 10 mg Friday night dose all bright eyed and bushy tailed waiting for me to turn up. Doh!!



The pamphlet I received from the hospital on discharge says:

"If you forget to take a dose and then remember within two to three hours, you can still take the tablets. If you forget for a longer time, do not take the tablets to catch up but take your next dose when it is due and tell your doctor or laboratory.

DO NOT TAKE A DOUBLE DOSE"

As I have a Coaguchek machine I tested and drew a 2.8.. in range for me.

By coincidence my doctor has requested some other blood draw tests and has added an INR to check against my self monitoring. I will have this done first thing Monday when the lab re-opens.

Am I correct to anticipate some drop in INR by Monday or Tuesday (3 days after the missed dose)?? There may be some variation also due to the illness I mentioned above and the loss of appetite and missed exercise associated with that?

I note from the above posts that some people have other ways of dealing with the missed dose. I will go with my manual and see what happens. Fingers and toes crossed for now.
Greg

 

[Ross]

You may test on the low side Monday. The combo of the missed dose and diarrhea should send your INR plunging. Time to keep a close eye on it, so Monday as a test date sounds good. Let us know what they find.

 

[GregB]

The missed dose

The missed dose

Well folks
Having missed a dose my doctor recommended no make up dose and simply resume the regular dose at the regular time the following night.

INR went as follows. Pls note the date format is reversed from the US format. That's the way we have to do things down here.

10/4 contracted stomach bug
11/4 missed nightly dose (10mg)
Did nothing and resumed normal dose 12/4
INR 2.8
13/4 INR 2.4
14/4 INR 2.0 on Coaguchek. Back up Lab test was 2.1
15/4 1.9 (ran out of test strips)
18/4 2.3 and back into the zone. Whew!

From this I deduce that if I miss a dose there is no need to panic unduly and simply resume the regular dose at the regular time and the INR should track back to the zone within a few days.

I am aware though that some people experience wilder INR swings so this will not work for all.

Yet another warfarin learning experience for me.

I am now a bit more nervous about missing a dose.

 

[Guest]

If the was a disaster every time somebody missed a dose there wouldn't be enough members on this site to make it interesting.

People who do not have a system for checking, probably do not even know when they missed.

 

[GregB]

Al,
I have to agree with your hard headed realist assessment.

However the lesson for me is that if I am serious about taking major responsibility for my own health (so far as that is possible) then I have to be constantly vigilant...and consistent. Enough can go wrong of its own accord without me adding to that through my own stupidity or forgetfulness.

Secondly, I did not enjoy my return to the below 2.0 INR zone. This is not a good place to be.
Someone wrote on this list (may have been you) that you can cross the freeway a number of times without being hit. I guess I made it across and back this time without mishap, but personally I plan to stay off the freeway as much as I can.

Thirdly my Coaguchek continues to hold up against the lab test results. At present I get no insurance rebate but the cost is well worth it for me.
Thanks for your interest.
Greg

 

[Guest]

Greg,

I agree with you 100%.

My point was, when you make a mistake do not spend too much time worrying about what could have been.

You could also say that if people on this site did not have the same level of concern as you, there wouldn't be enough left to make it interesting.

I wish all my patients shared your concern about their health.

I have a 30-something homeless, drug abuser in the hospital right now. He continually clots because he will not take his warfarin. The docotrs want to run a battery of tests costing many thousands of dollars on him to see if he has a clotting abnormality. I pointed out that whatever the tests show, the result will be the same - he won't take warfarin. I wish I could convince him, but he already is self-destructive. The really sad part is that his Mom is a patient too, and she is frustradted beyond belief because she manages her warfarin perfectly. His brother owns a business that I patronize and he will give his brother a job any day he wants. The only problem is that the younger brother will only show up for work a day at a time when he wants drug money.

 

[GregB]

Hmm You have your work cut out there. A sad case that must be completely frustrating for you and his family. I have noted in the past this list has counselled (heavily) some members who are non compliant. Perhaps we could all gang up on this poor guy and bring him around.
Then again perhaps not.
GB

 

[Christina]

Missed dose?

Missed dose?

I have also done that of course since I've been on Coumadin.
I started taking Coumadin at 4PM because the hospital started that. That was not a good time at all, so I changed it to 6PM after a while. (dinnertime)
Not too good a time either, because I would still forget at times, especially when I wasn't home and had forgotten to take the meds with me. When I would come home late I was out of schedule and wouldn't remember taking them. Then my dear friend Joni told me that she takes hers right away in the morning with her other pills. That sounded good to me so I switched to mornings too and find this time the best for me, as I also take my morning vitamins at that time. I have forgotten a few times mind you, but always remembered before the day was over.

 

[Joe777]

My advice, Dont miss a dose!

My advice, Dont miss a dose!

Short history. Aortic valve replaced 11 years ago with mechanical valve. Dr. said should last a lifetime. Its only 50% open now and will need to be replaced soon. What happened? What ive been told by doctors, now when its too late, is that when you miss your dose it creates a scum on your valve, from the clotting, restricting your valves movement overtime. The reason im sharing this is simple, dont make the same mistake as me. Remember your coumadin, its more important then you think. If any doctor ever told me this, I may not be in this situation again.
I dont consider myself to have missed a whole lot, I know the most i missed was 3 days in a row. Whatever the case, it sure made a difference.

As far as making up the dose. I was told that coumadin takes along time to go thru your body. In other words, it takes about five to seven days to make the changes to your inr, so if your trying make up lost doses its not going to happen. Hence, consistency is the key.
Good Health and a Happy Life to Everyone.
Joe

 

[Nancy]

Hi Joe-

Welcome to this site. My husband is also a Joe. You have made very important points. I am surprised that your cardiologists haven't ever mentioned to you how important it was to take Coumadin with a mechanical valve, and what can happen if it isn't taken. That's a shame, and now you find yourself in this position.

You have lots of friends here who understand all about valves and valve surgery. So we're here to offer you as much support as you need as you go down the road to another possible heart surgery.

There is so much information here, and I am sure you will give all of us the benefit of your help also.

Take care,

 

[Guest]

Hi Joe,

I used to live at Keeaumoku and Wilder in Honolulu. I worked at Queen's and my wife taught at UH Lab School.

It is not as rare as you might think for men (younger especially) to miss several doses and wreck their valves. I saw one today, in fact. I run a warfarin monitoring clinic. My website is www.warfarinfo.com

Al Lodwick

 

[LUVMyBirman]

Hi Joe,

Welcome. I am sorry to hear about your situation. Just reconfirms how important it is not to miss a dose.

Also, some members of the medical community being so laxed when it comes to removing you from the Coumadin so they can safley carry out an invasive proceedure. Have heard all sorts of stories about holding for 3 days or more. So your saying just missing three days gave you the build up on your valve? Al, can you tell us the story about your patient? Thanks

 

[Guest]

They are all about the same. They have this young guy thing that it real men don't need warfarin. Taking pills (at least prescribed ones) are for old guys. The second valve replacement surgery gets their attention that maybe they do need to take warfarin.

The range is from an attorney to the father of the some members of a local rock group that you can view at www.spinedown.com
However, do not click on this if you do not want to see satanic stuff.