The Largest Daily Dose of Warfarin

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The Largest Daily Dose of Warfarin

  • 25 mg per day or less

    Votes: 9 40.9%
  • 25 to 50 mg per day

    Votes: 6 27.3%
  • 50 to 100 mg per day

    Votes: 5 22.7%
  • 100 to 250 mg per day

    Votes: 1 4.5%
  • 250 to 500 mg per day

    Votes: 0 0.0%
  • More than 500 mg per day

    Votes: 1 4.5%

  • Total voters
    22
G

Guest

What is the largest daily dose of warfarin ever reliably reported to keep a person's INR in range?
 
Hint:
There are two types of warfarin. They are mirror images of each other like the right hand and the left hand. The hand (warfarin) has to fit into a glove (receptor site) for the warfarin to work. Most of the gloves in the body are left-handed. Most of the warfarin in a tablet is left-handed. This person had no left-handed gloves, so most of the warfarin in a tablet was inactive for him.
 
My PCP told me once that she had a patient on 75mg daily. I thought at the time that maybe she mispoke. Now I'm not so sure. I'll choose 50 to 100.
 
660 mg per day.

Picture this - you go to visit your in-laws for Christmas and you forget your warfarin. You go to the ER and try to convince the doc to write a prescription.

Now if you were successful you trundle down to the local Walgreens to see if they have 7 bottles of warfarin 10 mg tablets on hand.
 
And MNmom think she has problems, sheesh.

What was this person, the MOTHER RAT?

I'd like to have seen YOUR face if someone walked up to you and asked you to fill a prescription like that! :D
 
Al, since this person had a problem with warfarin receptors, would it have been an option to go with Lovenox shots?
There is no way I could take that many warfarin pills each day.....
 
Jaw dropping!
I'm trying hard to imagine this person's coumadin manager who had to get the patient into range!! :eek:
 
This was probably long before the Lovenox era. It probably would be an option today.

The story was told to me by a DuPont sales rep when they owned the brand Coumadin. It seems like it was a little tidbit that the sales people had been told about. Remember that there were much less regulations way back when. We were just having lunch one day. She said that the receptor reversal had been confirmed by electron microscopy. Today this would make a big splash in medical journals -- back then there was much less push to get things published.
 
Is 10 mg the highest mg per warfarin tablet manufactured?
This person took 66 tablets per day?? :eek: Plus any other medications they may have been prescribed!
 
I'm sorry to be such a pest with this, Al, and you'd think I could put all my questions into one post but it is intriguing me.

Do you have any idea how many years this person lived on that regimen?
I'm now ashamed I was uneasy with my (still increasing) 88 mg per week. Never did reach range on that dose before I was permitted to stop. (tissue valve).
Thank you for all your help, patience and fascinating info.
 
No. I have told everything I know about this.

I have never heard anything about dose correlating with life expectancy.

One thing that is going to argue against the newer drugs is that we have almost 60 years of experience with warfarin and know that, aside from bleeding, it is fairly non-toxic.
 
So what is the highest dose in your experience

So what is the highest dose in your experience

I realize the 660 was an off the wall exception that happened a long time ago and is likely a one in a million experience, but what is considered a "high" dose now? Are there really people out there taking 25-50 mgs a day, or higher? Or is that pretty rare? My PA said the highest she has worked with is 15 mgs a day. I am now still working up to my range and am up to 12.5 mgs.
 
No. I have told everything I know about this.

I have never heard anything about dose correlating with life expectancy.

One thing that is going to argue against the newer drugs is that we have almost 60 years of experience with warfarin and know that, aside from bleeding, it is fairly non-toxic.


My Dad was on coumadin in about 1962 or so. He must have been among earliest users.
 
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