New meds = high INR

[Gnusgal]

Okay, so back in August I started on a new med: aldactone. It's a potasium sparing diuretic. I also started taking lasix on a regular basis (used to be as needed). At the beginning of August my INR was perfect (in my opinion): 3.3 (my range is 2.5-3.5). The next time I checked my INR after starting the diuretics I came in at 4.3. I didn't worry too much, but the next time I checked my INR was 4.7 (I think I'm remembering that correctly). I decided it might be a good idea to lower my dose. So I went from 10 mg daily to 9 mg daily. I checked my INR and it was still in the 4's. So I lowered it AGAIN to 8 mg daily. Today I checked and it was 4.0... Closer to in range, but still high.

I don't want to lower my dose any farther if I can help it, but I am absolutely COVERED in bruises. I have 6 on my arms and 5 on my legs (and they aren't tiny). I look like I'm being abused (and yes, I've been getting questions. I have to answer "I'm a clutz on coumadin.").

I checked Al's site to see if aldactone interacts with coumadin... It IS listed, but doesn't give any info as to which direction. My bet is on raising INR...

Anyway, at this point I'm trying to figure out if I should lower my dose more, or if I should leave it where it is and work on eating more greens. What would you do? (I plan on calling my cardiologist on Monday, but wanted to get opinions before then.)

Thanks,

 

[Gnusgal]

Oh! I almost forgot. I've also been on antibiotics the last week and finished them yesterday... This MAY have effected today's INR (I didn't see it listed on Al's site, but you never know), so I'm wondering if I should wait for another check in a few days before making any adjustments.

 

[Ross]

What was the antibiotic? If you just finished it, I'd wait before making any further adjustments unless you go above 5.0 or are bleeding.

 

[Gnusgal]

What was the antibiotic? If you just finished it, I'd wait before making any further adjustments unless you go above 5.0 or are bleeding.

Omnicef.

I was figuring I'd probably wait at least until Monday or Tuesday before making any changes. But it's frustrating to have had a steady INR for more than 6 months, then having to make changes because of a new med added...

Thanks, Ross.

 

[Gnusgal]

I am absolutely COVERED in bruises. I have 6 on my arms and 5 on my legs (and they aren't tiny). I look like I'm being abused (and yes, I've been getting questions. I have to answer "I'm a clutz on coumadin.").

New assessment... I have now counted 9 bruises on my arms and 7 on my legs!

 

[Guest]

Hi Niki,

Aldactone is usually prescribed because you have fluid around the liver. Is your weight up several pounds? Fluid around the liver prevents blood flow through the liver as efficiently as normal. The result is that warfarin doesn't get carried through the liver as many times and therefore is metabolized less. So the INR goes high.

If Aldactone gets rid of the fluid then the INR usually drops.

I think that if your INR is around 4 and you are going to call your doctor Monday, then you are pretty safe in not dropping your dose further.

 

[Gnusgal]

Hi Niki,

Aldactone is usually prescribed because you have fluid around the liver. Is your weight up several pounds?

It was when I first started on it (which is why I started). Now I'm back to my base weight, but I feel some swelling in my ankles and fingers as the day progresses. I know that my card had been talking about prescribing aldactone even before I had the weight gain because they are trying to help my heart work more efficiently (my RV function is continuing to decrease).

Fluid around the liver prevents blood flow through the liver as efficiently as normal. The result is that warfarin doesn't get carried through the liver as many times and therefore is metabolized less. So the INR goes high.

That makes sense.

If Aldactone gets rid of the fluid then the INR usually drops.

That's what I would have thought. But my weight is down, I know that I'm getting rid of fluid (I pee like a race horse every day), but the INR is up... Doesn't make sense to me, unless my liver is having problems, like you said before. I'll certainly be talking to my card on Monday.

Thanks for your input. It's a lot to ponder.

 

[Persianlady05]

INR is delicate

INR is delicate

I understand about the bruses too.I am taking 3 mig mon-fri then on weekends 1 1/2 migs.I noticed my wrist near thumb it was sore and then began to get a lump there i have had a few hospitazations becaue of it being so high with bruseing all over my body and each time there was pain in the areaas before the bruses showed up this is becasue of internal bleeding in the tissues or musles i went to my cardio yesterday and took the INR it was 5.03 she called back later on in the day and said the dr said take 3 milgs each day come back in aweek i said excuse me I have a lump on my wrist its sore and brused so what dose to i go to al help please chris

 

[Mb]

GNUSAL:

I find it interesting that you jst started on the lasix on a regular basis. I noticed that you have a prosthetic tricuspid valve. My husband also has issues with the right side of his heart, and needs his tricuspid valve repaired or replaced. He has been taking 120mg of lasix daily for years now, in an effort to keep him "dry" so that the fluid overload doesn't make the condition worse., He also has reversal of blood flow to the liver from the regurg. - Did you take lasix before getting the new tricuspid valve?

Marybeth

 

[Guest]

Chris,
I don't know what dose would be best. You are too complicated for me to figure it out. From previous exchanges, I think that I could not do this without your complete history. I would have to charge for this large amount of time involved.

 

[Persianlady05]

I appricate you answer AL

I appricate you answer AL

I understand thank you for your time by what i have read about others having high INR I may skip one day dosages of warfarin 3mig its not easy living with this each time i have a bleed i am concerned i have 3 children two of which are grown and gone one at home they still need me as I need them i have been a divorced mother for 17 yrs im a bit overwhelmed and i have to vent somewhere that people have /are going through what i feel i get tired of it all but i am greatful to be alive thanks for listening everyone chris

 

[Guest]

Chris,

I understand and don't want to cut you off, but I just have too many things going right now to do long, detailed answers.