Question? Opinons?

mecretired · Mar 23, 2012

How important do you think it is to have a pretty consistant dose of Warfarin each day? I take 7.5mg some days and 10mg some days. I am a pretty "common sense" kind of thinker and it seems that there is a big difference between the 7.5mg and the 10mg and that there may be some swings in INR and possibly different INR readings on different days. My coumadin clinic doesn't think there is a problem. I am currently on 65mg/week and have only 5mg and 2.5mg Warfarin pills. So I'm just asking for your opinions. Has anyone had any experience with swings when changing the dose from day to day? Or do you think my coumadin clinic is correct and it's not a big deal? Thanks for your input.

AgilityDog · Mar 23, 2012

65/week = 9.28 per day.
you could make that more consistent by taking 9 mg 5 days and 10 mg 2 days.

I take 29 or 30 mg most weeks, and have 4 mg and 5 mg pills. I also have 3s and 1s for convenience, but I could take a dose of 2, 2.5, 4, 4.5, 5, 6, 7, 8 by splitting or combining just the 4s and 5s.

If you have an RX for 2 dosages, 1 mg apart, you can make up a huge range of dosages and keep the dosing more level.

My doctor says this is the optimum process, but the 7.5 and 10 method also works, like you are doing.

dick0236 · Mar 23, 2012

Most of the time I've been on warfarin I have been on a consistant dose ranging from 5 to 7.5 to 10mg daily. There where some periods when I did alternate pill strengths, such as you are doing. During those periods I don't think the alternating dosage had much effect on my INR. The alternating dosage strengths should minimize any up or down spikes in INR.

If you are on an alternating dose, I would suggest using a seven day pill box to avoid dosage mistakes.

PS: I have never kept several warfarin strengths on hand. I kept only 5mgs on hand. I could adjust my dosage from 0, 2.5, 5, 7.5 or 10 using only 5mg tablets. Fortunately, for the past 10+ years, my dosage has remained 5mg/day with only a handful of minor adjustmens.

Superman · Mar 23, 2012

If your 10; 7.5 alternating doses is keeping you in target range - I wouldn't mess with it. I alternate 5's and 6's daily. If you think about it - my low dose is only 83% of my high dose. Your low dose is 75% of your high dose. We aren't that different. I've been in range for a long time - so I'm not changing anything. My readings have been as high as 3.5 and as low as 2.4 on this dose (I do weekly tests home monitoring). With a target of 2.5 - 3.5 - I can live with that. Especially considering the additional fluctuations that can be triggered by diet, exersize, lifestyle changes (weight loss, etc.).

I was on this dose for years prior to my October 2009 second OHS. Took me about a year to get back to this dose after recovery, but I'm stable again for over a year now.

Freddie · Mar 23, 2012

I take 41mg/wk, which equals to: 6mg for 3 days, 5mg for one day then back to 6mg for 3 days.
It's strange, but when I bump up to 42mg/wk my INR will be over 4.0 (target range 2.5 - 4.0, happy spot 3.5). When I test 3 days after taking my 5mg dosage the results are below 3.0, but still in range; test after 3 days taking 6mg for 3 days and I'm above 3.0.

I agree with Laurie and the new dosage she suggests. You could always give it a try and see what happens.....then on the other hand, if your happy with the dosage your on now, stay with it.

Protimenow · Mar 23, 2012

I wrote about this quite some time ago, based on personal experience. I've been writing about it on this forum ever since.

If you're taking doses that are as far different as the ones you take, your INR will (other factors considered) fluctuate based on the day when you test. It's preferable, if possible, to vary your daily doses as little as possible from day to day, so that when you DO go to the clinic, their reading will more likely reflect an actual INR (and not one that changes from day to day).

Warfarin is really pretty cheap -- locally, it's about ten bucks for 90 pills. With a combination of dosages, and your willingness to break a pill in half if necessary, you can come pretty close to the same dosage each day -- or alternate with a dose that's only one mg (or is it mcg?) above or below other days. With minimal fluctuation, your INR should be roughly the same from day to day.

Back when I had a supply of strips (I'm down to three -- does anyone have any expired InRatio strips that they may be willing to sell or give away?), I was able to test on different days - not compulsively testing daily - but sometimes 8 days apart, sometimes less -- and I had a time when I had an INR of 1.4, and I tested fairly frequently to see if my dosing adjustments were effective (and not overly so). I saw that there can be fluctuations based on dosages a particular day (though I didn't try to figure WHICH day a particular INR related to, nor did I make wholesale changes in dosing).

All I'm suggesting is that your clinic is probably not exactly correct with its conclusion -- you should try testing on varying days of the week, just to see if your INR fluctuates based on the day you test. (And as Superman said, if the variance in your INR, probably related to varying dosage, is still within range, you should be okay. It's only when your INR is at high or low ends of the range and your clinic starts tweaking your dosage, that you may wind up with problems staying in range again.)

Cris N · Mar 23, 2012

I would agree with your clinic - not a big deal. The ideal thing would be to try to have less variation in your day to day dosage. One thing that some people experience is that when they are on a fairly large dose the different dosages can result in more spikes (small though they may be) While the FULL effect of a dose may take several days, approx. 50% of the effect takes place in the first 24 hours after taking it. (Sort of like a half-life progression). Many people who take a large dose will experience a rapid drop if they hold a dose. I'm on 7.5-8 mg/day. I recently had to have a procedure done and the nurse told me to hold for 3 days without any discussion of bridging. I asked her what they wanted my INR to be. She told me 2.0 - 2.5. Well, needless to say I wasn't going hold for 3 days. My test earlier that week had me at 3.9. I held one dose, tested 24 hours later and I was at 1.9. That night I took 5 mg, tested the next day - 1.7 took 6.5 mg and a Lovenox shot. Tested the next morning at 2.0.