Ouch, INR under my range

[sue943]

I had my INR tested yesterday and when my book arrived in the post today, it showed that my INR was 2.5 and with a range of 3.0 to 4.0 that is not good.

I have been taking 5.5mg per day but on Monday I forgot to take it - I told the phlebotomist and it was noted on my test slip. The instructions given to me are to take 11.5mg today then up my dosage to 5.75mg per day as I had been in the lower part of my range and this is the second time in the past few months that I have dipped under range but this time is the lowest. Testing again in just over a week.

That sounds fairly sensible to me, 5.5mg has been my dosage for quite some time so the small increase won't make me yo-yo.

 

[njean]

2.5 is not bad Sue. I was told by my cardio here to make sure to keep mine between 3.0 - 4.0 due to my double valves. But when I went to Houston in May, my old surgeon told me that I should just try to keep it between 3.0 - 3.5. He said that anything more than that was not recommended by him. And this is coming from one of the most respected & influencial surgeons of all time, Dr. Denton Cooley.

Hopefully yours will get back into your desired range but like I said, 2.5 is NOT anything to worry about.

Take care!

 

[Bina]

I would not take a double dose.
When a dose is forgotten the best solution is to take that missed dose split up over 2 or 3 days.
Don't worry about the INR of 2.5 just increase your weekly total in the future by 5%-10%

 

[ALCapshaw2]

I'm not fond of taking a Double Dose, although I do recall Al Lodwick saying that a double dose taken ONE TIME is "probably" OK.

When I miss a dose, I take the missed dose IMMEDIATELY, then split the Next Dose in half and add the remaining half dose to the second day's dose.

Going from 5.5 mg/day to 5.75 mg/day is equivalent to changing your weekly dose from 38.5 mg to 40.25 mg.

You could probably round that off to 40 mg/week which could be realized by taking 6..5..6..6..6..5..6 mg each week. This is easily done with 5 and 6 mg tablets (or 5 and 1 mg tablets but is more costly due to taking 2 pills on several days).

'AL Capshaw'

 

[Lisa in Katy]

I'm assuming that when you realized you missed the dose, you didn't take anything to "catch up". If so, the double dose now shouldn't hurt anything, especially knowing your INR is "low" (although 2.5 isn't dangerous and I thought 2.5-3.5 was the usual range for double valves). Just don't make a habit of it! Everyone treats missed doses a little differently. I take mine at night, so if I realize it in the morning, I take the missed dose immediately and then get back on schedule that night. If I don't realize it until the next night, I do what Al suggests. Anyway, I think what they told you sounds fine.

 

[njean]

Also, pill boxes work great! I have one for my morning pills & another one for my evening pills. They help keep me straight & I haven't missed any dosages in a very long time!

 

[sue943]

I keep a notebook in with my pills and mark the day and the dosage taken, it was just that I was away and my pills were not in the kitchen where I prepare my food so I forgot. I didn't realise until I was due to take my next dose, so a full 24 hours later.

5.75mg will not be hard to take, I will take 5.5mg one day and 6mg the next. I have 0.5, 1, 3 and 5 mg tablets - they cost nothing here so I can have the full range available to us.

I prefer to be in the higher half of my range so really am not happy at being 2.5 but not panicking as I might at 2.0.

 

[BigOwl]

I have a Coumadin alert message on my iPhone; I assume you can do that sort of thing with other cell phones or with your computer. That and my all-day pill box have meant that there have been been no missed doses since I started this rigamarole three months ago.

The new warfarin online calculator sticky makes it easy to figure out how to deal with a missed dose, should you need to--or how to address high/low issues.