New meds wreak havoc on inr level!!!

[COLLEEN S]

:confused2:
Hi all, I haven't been around, but I need some guidance before I call my over aggressive cardiologist.
I started last week on a new med for fibromyalgia called SAVELLA (milnacipran). Before starting it I checked on drugs.com for the interactions with Warfarin. I also started 2 nights ago on a new sleep med for me, Lunesta. The SAVELLA info I read said there is a contraindication of Savella with Warfarin in that higher INR results may occur. They used a fancier name, but you know what I mean. Well I felt like my pulse was racing, so I took the INR today and it was 5.0
Should I ...
1. Call cardio, let her dose me and make me make a 2 hr drive so she can confirm results with a million year old PT machine and dose me wrong?
2. Decrease my dosage by 20% and retest in 2 days.
3. Go to bed and put the covers over my head and pray.

Seriously, any help is appreciated.

 

[barbwil]

xxxxxxxxxxxxxxxxxxxxxxxxxx

 

[COLLEEN S]

Please keep on topic, this is important.

 

[Freddie]

Hi Colleen, long time no hear.
Here's my 2 cents worth: if you don't have confidence with your cardio don't bother taking the 2 hour drive. Skip todays dosage, take 1/2 dosage tomorrow (Wednesday) and use your monitor on Thursday to see if your treading downwards. Remember it takes at least 3 days for your first adjustment in dosage to effect your readings.

 

[catwoman]

Colleen:

What was your INR previous to starting the new med?
Since you had AVR, I would take a half dose today, reduce dose by 20%, then retest about Sunday or Monday. That would give the halved dose and reduced dose enough time to be fairly accurately reflected in your INR.

For someone who had MVR (like me), I would probably suggest reducing dosage by 20% and not recommend halving the current day's dose.

 

[Ross]

For 5.0, I'd hold one dose and lower the dose by 10 to 20% for the week.

 

[Bina]

Hi Colleen, whether you take 1/2 dose tonight or skip a dose, you will need to see what the new med is doing to your INR.
Fortunately you have your own Coaguchek and can test again in 2-3 days just to make sure the INR is not rising.
Otherwise, you know that testing and making changes that often is not necessary.
Best wishes.

 

[Maryka]

Good luck with that! It is really great you can test at home. That is something I might look into when I get back from North Carolina. FYI, I have changed cardiologists to Dr. Kelleman in Columbia, MD. He has another office which may be closer to you. He is directly affiliated with Johns Hopkins. My friend Carol has gone to Kelleman for many years. He stays on top of things.

 

[COLLEEN S]

Thanks!

Thanks!

Hey Thanks so much guys!
I was thinking the same thing...halve it and then reduce by 20%. And retest in a couple days. Thanks for the good info and confirmation on the dose. Thanks Maryka for the info on the doc. Let me know what you think of him after you've had a couple visits with him. That might be a good way to go for me too.
You guys are priceless,:biggrin2::biggrin2::biggrin2::biggrin2::biggrin2::biggrin2:
Colleen

 

[COLLEEN S]

Hey, just wanted to let you guys know...I retested and got a 3.1 YAHOOOOOOOO! Now, in singsongy voice, "I got it right, I got it right" Reducing by 20% and only took 5mg day of the 5.0 and 5mg the day after. Worked like a charm. If I had held 3DAYS like (cough) the cardio wanted me to, I would have been down to like....ZERO!

 

[Bina]

that is excellent news.

 

[Jkm7]

Happy you are back in range.
Did you tell or do you plan to tell your coumadin manager/cardio you did not follow their directions and advise what the correst dosing to get you back in range was?

 

[Freddie]

Good for you Colleen, been wondering how things were going for you.

IMPO, warfarin is a type of drug that needs to stay in your system, no matter how low the dosage is when reducing.