Missed doseage

[Dennis S]

I have a question about a skipped warfarin dose. I have a new St Jude's aortic valve as of August 4th, this year. I self test for INR level. I take 7mg 1 day and 7.5 mg the next day. I test on Thursday each week. My levels for the last 2 weeks have been 2.8 and 2.4 respectively. My surgeon told me to stay between 1.8 to 2.5.

I forgot to take my dose of 7.5 on Tuesday evening, which I would normally take about 7:00 pm. I realized my mistake about 11:00 am this morning (Wednesday). At that time I took the 7.5 I should have taken Tuesday evening. In other words, the doseage was about 16 hours later than normal.

It is now 1:00 pm, 3 hours after taking the late doseage. I have the following questions: Should I take this evening's dose, (or some portion of it) perhaps late tonight? Should I do a self-test and factor those results into my decision concerning tonight's dose? How dangerous is it to forget to take the medicine?

 

[catwoman]

Dennis:

Why does your doctor have you in a range of 1.8 to 2.5? The accepted/recommended range for a mechanical in the aortic position is 2.0-3.0, and I'm sure many people aim for a little higher than 3.0 for "insurance" sake.
(I have a St. Jude in the mitral position and aim at 3.0-4.0, again for "insurance" sake. I'd rather be a little high than drop under 2.5 and throw a clot.)

Seems that others have a remedy for when they've forgotten a dose and I'm sure some will jump in here with their method of handling it. I take my dose at breakfast, seldom forget more than a couple of hours and seem it's always when my daily schedule is out of kilter.

 

[Natanni]

INR range

INR range

Can only offer comparison for INR range--Nathan has a Carbomedics mechanical valve in aortic position and his INR target range is 2.5 to 3.5; Someone will be by shortly to offer help on the missing dose!

 

[geebee]

Take half your normal dose tonight and the other half tomorrow (along with whatever you normally take on Thursdays) and you should be back on track.

 

[Karlynn]

Take half your normal dose tonight and the other half tomorrow (along with whatever you normally take on Thursdays) and you should be back on track.

I'll ditto that.

You might want to put off testing until next week, when your dose has leveled out again.

1.8 - 2.5 confuses me too. As Marcia said - the standard for aortic mech is 2.0 - 3.0. 1.8 is, in my opinion, getting into the dangerous territory. Since you are a ways from medical care, I'd shoot for 2.5 or a bit higher.

 

[Ross]

Someones Doctor does not follow established guidelines! 2.0 to 3.0 is the range for aortic unless you have other factors such as strokes, then it's 2.5 to 3.5.

 

[Guest]

People who take doses larger than 5 mg daily do so because they metabolize the warfarin very rapidly. When you miss a dose, your INR will probably drop dramatically. You did the right thing by taking the dose as soon as you noticed it was missed. I know that you self-test with Raytel and they will bug you if you do not do it every week on your scheduled day, so go ahead and test tomorrow. That will also help you learn what you should do the next time you forget a dose. The real world has lots of people forgetting lots of things every day. Taking the half-dose this evening makes sense, the test tomorrow will help decide what to do next. Who is your doctor - anyone in NM that I know? I know several in ABQ and Taos.

 

[Dennis S]

Thanks to all

Thanks to all

I followed the advice of Al, Ross Geebee and Karlyn about making up the skipped doseage. I decided to test today, which is my regularly scheduled day to test. I came in at 1.9 before taking today's dose, and feel a great relief. I am going to consider my range to be 2 to 3. I will try to have my errors at the upper end of that scale.

Thanks for the advice and education.

 

[Ross]

Try to sit as close to 3 as possible. This way, you'll have wiggle room. Don't spaze out if it's between 2 and 4.