St Jude Valves

[carolinemc]

vivekd - with all due respect, I think you may be overdoing it with the Lovenox any time your INR drops below 2. If you test your INR twice a week (this is what it sounds like), your INR probably wouldn't have been below 2 for more than three days or so. Increasing your dose after the low INR reading should raise the INR in about 3 days. I don't think your risk justifies the use of Lovenox (although, I guess, it can't hurt).
According to what I've read, though, it takes about a week or longer with an INR below 2 for a clot to form on the valve. I guess, as you said, it's better to be safe, but I'm still not sure the Lovenox is appropriate for the few days your INR is only slightly below 2.

(I had an INR of 1.1 a few years ago -- I DID go the Lovenox route back then, but tested daily and after a day of increased dose of warfarin, my INR was again in safe range. )

I just saw your response. For this week, at the lab I use, they are good at what they do for me. My protime was 1.8, due to antibiotic and two salads close together two days in a row. I do not usually eat salads like that, but they tasted so good on hot days. But what the plan is to stay at regular dose and test within 10 days. I am care for carefully. I did lovenox once with I did without Warafarin for a few weeks, no medical insurance at the time. Made myself go to a charity hospital and got the care I needed. And had an eye clot two days before. I was a lucky lady. So glad that you are giving great advice. I would have said the same. Always use caution on meds. You have a great weekend and I will give you a hug for today. LOL!

 

[vivekd]

I just saw your response. For this week, at the lab I use, they are good at what they do for me. My protime was 1.8, due to antibiotic and two salads close together two days in a row. I do not usually eat salads like that, but they tasted so good on hot days. But what the plan is to stay at regular dose and test within 10 days. I am care for carefully. I did lovenox once with I did without Warfarin for a few weeks, no medical insurance at the time. Made myself go to a charity hospital and got the care I needed. And had an eye clot two days before. I was a lucky lady. So glad that you are giving great advice. I would have said the same. Always use caution on meds. You have a great weekend and I will give you a hug for today. LOL!

I only did lovenox once when I was testing only once a week and my INR went from 2.9 to 1.4 after missing my warfarin for 1 day. I consulted with my cardiologist and nurse and decided to go with lovenox the next day. Now, I'm testing twice a week (even though i don't need to), but till my INR stabilizes i plan to continue doing it. I've lovenox as backup, but I know that I wont need them and don't plan to use them without talking to my cardiologist and nurse. I've moved from generic warfarin to brand name coumadin to see if it helps with crazy INR fluctuations.

 

[Protimenow]

I've had some issues with generic warfarin. This wasn't called 'warfarin' but was the same.

I wasn't able to regulate my INR with this other generic.

Not all people respond to generics from different manufacturers -- rather than pay the high price of coumadin, I suggest asking your pharmacy if they can get warfarin from a manufacturer different from the one that you had problems with.

My pharmacy knows that I can only use warfarin from a specific manufacturer - and that's what I get.

(When I got warfarin from a new manufacturer, I was careful to test more frequently (every three days or so), to see if it works differently. When you find warfarin that allows you to actually control your INR, you should be able to stick with it.

 

[vivekd]

I'm planning to stay with coumadin for rest of the year and then move my prescription from walmart to CVS and go back to generics.

 

[Protimenow]

If you can afford Coumadin, go for it. My pharmacy (Costco) was very willing to switch generic warfarin providers. Even if you're taking Coumadin, I still suggest that you test your blood more frequently once you switch, just to be certain that you can easily control your INR while using it.

 

[vivekd]

If you can afford Coumadin, go for it. My pharmacy (Costco) was very willing to switch generic warfarin providers. Even if you're taking Coumadin, I still suggest that you test your blood more frequently once you switch, just to be certain that you can easily control your INR while using it.

Does Costo get it from Teva? Before switcing back to generics, i wanted to know if brand name stabilizes my INR or not.

 

[QuincyRunner]

During my first year post surgery I was unable to stabilize my INR with warfarin. Upon recommendation of my pharmacist I switched to Coumadin and for the past seven years I have tested within range 92% of the time. Although Coumadin comes at a cost of $50.00 per month (even with insurance) versus $3.00 per month for warfarin, it is well worth it. As my wife says, my heart is worth it.

 

[Keithl]

I only did lovenox once when I was testing only once a week and my INR went from 2.9 to 1.4 after missing my warfarin for 1 day. I consulted with my cardiologist and nurse and decided to go with lovenox the next day. Now, I'm testing twice a week (even though i don't need to), but till my INR stabilizes i plan to continue doing it. I've lovenox as backup, but I know that I wont need them and don't plan to use them without talking to my cardiologist and nurse. I've moved from generic warfarin to brand name coumadin to see if it helps with crazy INR fluctuations.

I test twice a week as well and plan to do so for some time. I tend to eat more salad during week. I test Wednesday evening and Sunday morning. Today I dropped to 2.2 I suspect I ate a few things this weekend that might have more impact. I also got a Shingrix vaccine so I want to watch things closely. I bumped my dose today a tad to make sure I give it a slight kick. I also skipped my normal vegetable juice that has high K so will retest Tuesday to make sure.

 

[Keithl]

Does Costo get it from Teva? Before switcing back to generics, i wanted to know if brand name stabilizes my INR or not.

My CVS gets it from Teva, but I recall reading some articles last year that Teva had some questionable issues and quality control as they make a lot of the generics in China. I get my other prescriptions from Express-Scripts and they source from anywhere all the time. Fortunately they now allow 90 day refills at Walgreens so I need to see what Walgreens tells me when I get my next batch refilled.

 

[Keithl]

During my first year post surgery I was unable to stabilize my INR with warfarin. Upon recommendation of my pharmacist I switched to Coumadin and for the past seven years I have tested within range 92% of the time. Although Coumadin comes at a cost of $50.00 per month (even with insurance) versus $3.00 per month for warfarin, it is well worth it. As my wife says, my heart is worth it.

I need to check my coverage as I would much rather do same thing and use name brand, never cared for Teva and some of the other Chinese made generics, just look at all the recent losartan recalls.

 

[dick0236]

I have used warfarin from TARO Pharmacy USA for many years. Taro Pharm. has manufactured warfarin since Dupont Chem lost patent protection for Coumadin several decades ago. I believe Bristol Myers Squibb now owns the brand name Coumadin. I found TARO warfarin to be very effective in managing my INR. I get my Rx from a RiteAid Pharmacy which is now owned by Walgreens. They have "use Taro only" in my file and have no problem in supplying from that lab.......Walmart was unwilling to guarantee a specific manufacturer when I checked a few years ago.

I am a big believer that you should stick with one Warfarin manufacturer.......and adjust your dosage to that manufacturer.........manufacturing tolerances and inactive ingredients can screw up your numbers.....been there done that.

PS: don't confuse TARO with TEVA.

 

[carolinemc]

I've had some issues with generic warfarin. This wasn't called 'warfarin' but was the same.

I wasn't able to regulate my INR with this other generic.

Not all people respond to generics from different manufacturers -- rather than pay the high price of coumadin, I suggest asking your pharmacy if they can get warfarin from a manufacturer different from the one that you had problems with.

My pharmacy knows that I can only use warfarin from a specific manufacturer - and that's what I get.

(When I got warfarin from a new manufacturer, I was careful to test more frequently (every three days or so), to see if it works differently. When you find warfarin that allows you to actually control your INR, you should be able to stick with it.

Here is my take, some people cannot take the generics due to their body chemistry. I can take the warafarin, the generic. And I can take the real deal, Coumadin. It just depends on your body chemistry.

 

[Protimenow]

Generic warfarin (not warafarin) contains different coloring, binders, extenders and other 'inactive' ingredients that may vary from manufacturer to manufacturer.

People may react differently to the warfarin from different manufacturers. I've had situations where I couldn't manage my INR using certain generic warfarin. I determined this by testing my INR every few days after changing to warfarin from a different manufacturer.

I have no problems taking the generic manufactured by Teva.

So - we can't condemn ALL generic warfarin as bad - we just have to confirm that generics from a particular manufacturer will allow us to manage our anticoagulation. And, once this has been determined, we have to let our pharmacies know which manufacturer's generic warfarin works with us.

But, again, we can't condemn ALL generics as bad, when it may come down to determining WHICH manufacturer's product allows effective INR management.

 

[Keithl]

Well I just found out going to name brand will cost me $180 for each pill for 3. Moth supply so that is about $120 a month for both pills. I guess I will see if I can specify a brand at Walgreens.

 

[Keithl]

TEVA has been working for me, I just don’t like their reputation.

 

[Protimenow]

**** was right. The manufacturer of my warfarin is Teva, not Taro.

 

[afraidofsurgery]

I switched to generic over 5 years ago, have had no problems. I pay next to nothing so it's a no brainer for me. Pharmacies will switch generic suppliers depending on availability, price, etc so that may introduce some variability. Also, while generics contain the exact drug molecule, there is a bit of a wider range of amount differences that are allowed for generics vs brand name, that can also cause some fluctuations in INR. My dose is high enough these potential effects don't seem to matter.

 

[vivekd]

We all would love to be on generic if it works, since it's almost free. My INR was stable just after surgery and i used to get my warfarin from CVS at that time (probably Teva), but then last year, I moved warfarin prescription to Walmart and had some other medical changes, things have not been same since then. I may end up going back to CVS after my experiment with Brand name Coumadin. I switched to coumadin 4 weeks ago and have been in the range for all those 4 weeks.

 

[tom in MO]

In the US, generic drugs need to be approved by the FDA. https://www.fda.gov/media/89135/download

A firm has to show the generic drug product is bioequivalent to the patented drug product through . Both the generic and the brand name are tested to the same specifications. If there is a property of the brand name drug that is important to the product's performance, the generic will be tested for the same specification.

Some companies outsource the manufacturing of their brand name drugs. When the patent expires, the factory can manufacture both the generic and brand name products in the same facility, the only difference being the final finish (e.g. color, imprint shape) of the dosage form, sometimes the packaging, and the label. Your generic and brand name drug could be made by the same factory.

 

[DMS]

Does anyone have a St Jude Mechanical Valve? Any issues?

The surgeon I had recommended SJM so I had one AVR bi-leaf implanted in 2012. Aside from some audible noise when nothing else is competing, it just ticks along. I'm glad I chose it as it requires a pretty low INR warfarin requirement of 1.8 to 2.5 (for me anyway, your requirement may differ). I use a Coaguchek XS and test at home. I work out doing cross-fit exercises concentrated on functional movements to get me through old age. Hope this helps.