Missed Dose

[a4wanman]

My AVR was on April 26 and I'm working on finding the right dosage for me. My warfarin tablet is 5mg and my weekly dosage is:

5, 2.5, 5, 2.5, 5, 2.5, 5

Last Thursday, my INR was 2.6 and will have it checked again tomorrow.

Last night (Tuesday), I forgot to take my night time meds. I didn't realize it until I was going to take my meds this morning. :frown2:

I took the 5 mg this morning based on readings from this site that you consider the weekly total dosage. (As a side note: my GP wanted me to do the whole, half, whole, etc. I talked him into always starting a whole on Sunday so the weekly total dosage is the same and does not change every week.)

I also took my Wednesday night dose (2.5)

So the big question is: did I do the right thing?

Question #2: Is it imperative to take the warfarin at the same time each night or does a few hours difference matter?


Scott

 

[Bina]

I would have done the same thing as you.
Take the missed dose (5mg) if you discover it within about 12 hours, then take your regularly scheduled 2.5 tonight.
Most of us find that taking the med at around the same time every day establishes a good routine and keeps your level consistent. Mine is taken with dinner, and if somehow I forget it, then I will see it there in my pillbox when I take my nightly Metoprolol dose.

 

[Philip B]

Missed dose?

Missed dose?

I've never missed a dose, but if I did I'd simply resume my normal dosage and see where it tool me. You can always adjust up or down as needed.

-Philip

 

[Ross]

You did fine. You can either take the missed dose, take half of the missed dose over the next two days, or completely forget it and go back to normal schedule. It all works out in the end.

Warfarin is so slow metabolizing that you can take it pretty much anytime you want too.

 

[ALCapshaw2]

Whenever I discover that I missed a dose, I take the missed dose IMMEDIATELY.
I figure the longer you go without taking your dose, the Lower your INR will drop.

If the missed dose was less than 12 hours ago, I just continue my usual (evening) dosing schedule.
If it was more than 12 hours, I split the NEXT dose in half, take 1/2 dose on schedule and the other half the next morning.
This avoids double dosing and gets the weekly dosing back on schedule within 2-3 days.

FWIW, my (well trained) Coumadin Clinic CRNP is OK with this protocol.

'AL Capshaw'

 

[catwoman]

When I forget a dose and then compensate for it, I wait at least 3-4 days after the last compensated dose before doing an INR test. No one's told me to wait before testing, but I figure that it would give the warfarin enough time to be back in my bloodstream at the usual amount.

 

[prdraper1]

My doctor assures me that if I miss a dose it will not do any harm. If, like me, you take your dose at night and discover that you have forgotten one morning then forget it. I looked into this myself when I first missed a dose and the next INR was unchanged from normal. I take 6,5,6,5,6,5 etc. and have an INR getting on for 2.5 which is fine.
I am now 22 weeks post op and the main thing I have found is that I tend to be over concerned at any new effect, either aches or medication wise. It is far better to trust what the doctors and surgeons advise, go with the flow and don't worry about things. It is hard to do but necessary. This forum generally has all the answers from others who have had similar experiences but there may be some effects that are unique to you as we are all different while being the same.

 

[Ross]

It is far better to trust what the doctors and surgeons advise.

Sorry to say, but over here, our doctors and surgeons are not on the same page and are usually responsible for total mismangement of a Coumadin patient. It's sad, but true.

 

[prdraper1]

That speaks volumes for the U.K. National Health service, I have found that my doctor, surgeons and specialists work well together, even today I have had a notice from a different specialist to find out the cause of my aneamia last November, I certainly show no signs of it at present but it shows that the information on me is shared to my advantage by the various specialists and doctors.
I must admit to be being a little surprised at the thoroughness shown. I certainly cannot praise my surgeon, Mr Guvendik, high enough as he has done such a brilliant job and given me a life.

 

[Jkm7]

That speaks volumes for the U.K. National Health service, I have found that my doctor, surgeons and specialists work well together, even today I have had a notice from a different specialist to find out the cause of my aneamia last November, I certainly show no signs of it at present but it shows that the information on me is shared to my advantage by the various specialists and doctors.
I must admit to be being a little surprised at the thoroughness shown. I certainly cannot praise my surgeon, Mr Guvendik, high enough as he has done such a brilliant job and given me a life.

With all respect......

Does it bother you to get a notice today about anemia from last November?
That is 7+ months ago.

I would be very uncomfortable in that situation..... but, perhaps, that is just me.

 

[Ross]

That speaks volumes for the U.K. National Health service, I have found that my doctor, surgeons and specialists work well together, even today I have had a notice from a different specialist to find out the cause of my aneamia last November, I certainly show no signs of it at present but it shows that the information on me is shared to my advantage by the various specialists and doctors.
I must admit to be being a little surprised at the thoroughness shown. I certainly cannot praise my surgeon, Mr Guvendik, high enough as he has done such a brilliant job and given me a life.

They may appear to be, but if you were to ask them about Coumadin dosing, I bet you'd get a completely different answer from each one asked. It's that bad.

 

[prdraper1]

I have had several checks for anaemia since then and it has improved as I have recovered. I was very ill before my surgery and could not eat for about 8 weeks. I'll keep you posted but no I am not bothered as I was due for a check up anyway.

 

[ALCapshaw2]

My doctor assures me that if I miss a dose it will not do any harm. If, like me, you take your dose at night and discover that you have forgotten one morning then forget it. I looked into this myself when I first missed a dose and the next INR was unchanged from normal. I take 6,5,6,5,6,5 etc. and have an INR getting on for 2.5 which is fine.
I am now 22 weeks post op and the main thing I have found is that I tend to be over concerned at any new effect, either aches or medication wise. It is far better to trust what the doctors and surgeons advise, go with the flow and don't worry about things. It is hard to do but necessary. This forum generally has all the answers from others who have had similar experiences but there may be some effects that are unique to you as we are all different while being the same.

Skipping a dose has NO affect? !!!

I find this hard to believe. A frequent recommendation by Doctors when patients have an INR over 5.0 is to Skip ONE Dose, then resume normal dosing an retest in a week.

How long did you wait before testing? It can take a few days for dose changes to register on an INR test.
High metabolizers tend to drop faster than slow metabolizers.

'AL C'

 

[prdraper1]

I was on weekly INR tests at the time and the test was 5 days after I missed a dose, I MISSED IT BECAUSE OF BEING SICK and not knowing if they came up, about 15 minutes after taking them. The sickness was an unrelated bug. You may find it hard to believe but this is what I have been told from several sources. I do have a fast metabolism.
Sorry about the capitals!!

Patrick

 

[Ross]

It did work out in the end did it not?

 

[Cris N]

Quote Originally Posted by prdraper1 View Post
My doctor assures me that if I miss a dose it will not do any harm. If, like me, you take your dose at night and discover that you have forgotten one morning then forget it. I looked into this myself when I first missed a dose and the next INR was unchanged from normal. I take 6,5,6,5,6,5 etc. and have an INR getting on for 2.5 which is fine.
I am now 22 weeks post op and the main thing I have found is that I tend to be over concerned at any new effect, either aches or medication wise. It is far better to trust what the doctors and surgeons advise, go with the flow and don't worry about things. It is hard to do but necessary. This forum generally has all the answers from others who have had similar experiences but there may be some effects that are unique to you as we are all different while being the same.

Skipping a dose has NO affect? !!!

I find this hard to believe. A frequent recommendation by Doctors when patients have an INR over 5.0 is to Skip ONE Dose, then resume normal dosing an retest in a week.

How long did you wait before testing? It can take a few days for dose changes to register on an INR test.
High metabolizers tend to drop faster than slow metabolizers.

'AL C'

Al, thanks for bringing this one to the forefront... it's been bugging me since I read it. If I skip a dose my INR drops like a rock. I had to reduce my INR a couple of years ago for a minor surgery... doc said 2.0 would be okay. I was at 3.5ish, skipped just one dose and was at 2.2ish same time the next day - a drop of approx. 33%. If I had started at 2.5 and lost 1/3 third I would have been at 1.6.

We should all remember that while it may take 3-4 days for the FULL effect of warfarin to be acknowledged by the body, some tests have shown that approximately 1/2 the dosage it metabolized in the first 24 hours. So, telling someone it's okay to skip a dose & not worry about it may have serious consequences. I don't like the idea of being unprotected.

 

[Ross]

Al, thanks for bringing this one to the forefront... it's been bugging me since I read it. If I skip a dose my INR drops like a rock. I had to reduce my INR a couple of years ago for a minor surgery... doc said 2.0 would be okay. I was at 3.5ish, skipped just one dose and was at 2.2ish same time the next day - a drop of approx. 33%. If I had started at 2.5 and lost 1/3 third I would have been at 1.6.

We should all remember that while it may take 3-4 days for the FULL effect of warfarin to be acknowledged by the body, some tests have shown that approximately 1/2 the dosage it metabolized in the first 24 hours. So, telling someone it's okay to skip a dose & not worry about it may have serious consequences. I don't like the idea of being unprotected.

Come to the darkside. We have cookies!

 

[olefin]

I'm another that skipping a dose or even cutting back drops my INR like a rock.
I've never missed a dose but have skipped couple days several times when INR got to 6 and above.

Recently wanted to lowered INR a little due to upcoming dental surgery. INR was 3.3, cut dosage 5%, 6 days later on day of surgery, INR 2.2.
Control 2.5 to 3.5.

 

[a4wanman]

Forgot to update people: (my GP uses the Coaguchek XS)

I know it takes a couple of days for dosage changes, but last Thursday (1 1/2 days after taking missed dose - how's that far a saying, similar to our southernisms: such-and-such turned up missing), my INR was 2.9. I'm scheduled for another INR at 1:00 PM on Thursday. I'll try to remember to post the results. I did eat a kid's size helping of turnip greens at Cracker Barrel on Sunday, but I doubt that will change anything.