Up and down INR!?

[Warrick]

Hi I think with your INR at 4.0 a 50% one off dose reduction is a safe bet and it will get you down to in range a bit quicker.

Im lucky im on 9.5mg a day (a bit easier to adjust whole pills )
so with an INR over 4.0 I would probably do a 5mg one day 7mg the next and then back to normal dose, do what you feel comfortable with as said 4.0 shouldnt be harmful, Iv been up to 7.7

 

[user 16827]

Do you think I should take 1mg of warfarin today rather than my scheduled dose of 2mg?

your post says you have been stable for over a month taking 2mg.

i agree a dose of 1mg tonight followed by your usual dose would be prudent.

along with no grapefruit juice i think you will back in range soon enough


good luck.

another endorsement to self test on a weekly basis

 

[pellicle]

The Roche control sample I tested gave the result is was supposed to 1.9. Makes me think my blood inr was correct.

I'm a little unfamiliar with that process

When was the last phlebotomist test?

 

[pellicle]

Maybe that's the cause?

100% that's the cause


https://www.valvereplacement.org/threads/my-monty-python-moment.42094/
https://cjeastwd.blogspot.com/2021/05/grapefruit-and-warfarin.html
It's such vile tasting stuff we need to add it's own weight in sugar to make it palatable. And why even drink it? Perception of its healthy? It's not.

Never touch it again is my advice

 

[pellicle]

Do you think I should take 1mg of warfarin today rather than my scheduled dose of 2mg?

I do

And it's helpful to hit reply so one knows you've replied to them (or who).

 

[pekster11]

I'm a little unfamiliar with that process

When was the last phlebotomist test?

had my last test on Monday 7th...my result was 2.8

 

[pellicle]

had my last test on Monday 7th...my result was 2.8

so, if you don't mind, what does it mean where you said:

The Roche control sample I tested gave the result is was supposed to 1.9

 

[pekster11]

so, if you don't mind, what does it mean where you said:

oh, that
Roche supply quality control samples, which are actually not needed for the INRange meter I have, as this model does its own QC check before every test
However you can still use it as QC sample , which I did. This sample has a known INR of 1.9...so I was able to test it (just the same as blood test sample) and check my meter was giving accurate results

https://www.medisave.co.uk/coaguchek-xs-plus-pt-controls.html

 

[pellicle]

also, @pekster11 as you have such an extraordinally low dose (which will be hard to manage if it does go AWOL because you'll be dealing with fractions of a mg) it implies to me that you have a very slow disposal of warfarin (sort of discussed in that blog post about grapefruit) and as such you should definitely avoid anything that interferes with your P450 disposal enzyme(which is also discussed in that blog post) because it will have a magnified effect on you.

 

[pellicle]

owever you can still use it as QC sample , which I did. This sample has a known INR of 1.9...so I was able to test it (just the same as blood test sample) and check my meter was giving accurate results

ahh ... thanks ... I knew approximately of the QC system but didn't know the details of what INR it was designed to show.

 

[pellicle]

also (partially to @pekster11 ) this is a good time to remind people that the vast majority of stuff sold at "health food shops" is not only not "healthy" its uncontrolled, and while not doing harm to healthy people may actually interfere with the drugs that unhealthy people are on to be healthy (hypertension medication also comes to mine).

 

[pekster11]

also, @pekster11 as you have such an extraordinally low dose (which will be hard to manage if it does go AWOL because you'll be dealing with fractions of a mg) it implies to me that you have a very slow disposal of warfarin (sort of discussed in that blog post about grapefruit) and as such you should definitely avoid anything that interferes with your P450 disposal enzyme(which is also discussed in that blog post) because it will have a magnified effect on you.

yes. I've thought the same myself....and it kind of makes sense to me how just a few glasses of dilute to drink grapefruit juice (10% from concentrate) could have such an affect on my INR...given how little warfarin i need to bring my INR in range

 

[pellicle]

Home test my inr again in a couple of days and get my Inr clinic to test me during the week. That's my plan

sounds like a good plan ... if you remember to, please post a follow up mentioning the days between testing and the new INR.

Best Wishes

 

[pellicle]

just a few glasses of dilute to drink grapefruit juice (10% from concentrate)

the thing is that its a concentrate so when you dilute it you're not really diluting it but re-constituting it. This adds the confusion of exactly how much furanocoumarins is actually in the "juice" (or indeed how much was in that batch of fruit, which is known to be irregular anyway).

Best Wishes

 

[pellicle]

Its interesting to me how the gate keepers of INR (clinics) are so friggin clueless about this stuff. They will tell you not to shave because you'll bleed to death from a nick but not know to warn you about actual threats (which have been widely known in medical publications for at least a decade); and you need to come to a group like this to get "the actual dope"

(shakes head in dismay)

No wonder so many surgeons are backing a push to tissue prosthetic and reoperation when needed)

 

[pellicle]

PS:from the wikipedia article I linked in my blog post, one may miss this point:

Furanocoumarins have various effects which can specifically increase or decrease (depending on the drug) the blood levels of many pharmaceuticals in ways that can be life-threatening and so FDA approved drugs will include warnings for grapefruit.​

anyone in the USA see these warnings about grapefruit? It sure ain't on my bottles

 

[pellicle]

a university source:
https://health.ucsd.edu/news/featur...od-for-naught-grapefruit-and-medications.aspx

Grapefruit and grapefruit juice interact with dozens of drugs, 85 at last count and rising. Many of these interactions produce adverse effects; some potentially fatal. A Canadian study in 2012 reported that the number of known drug-grapefruit interactions with possibly fatal side effects grew from 17 to 43 in just four years. ​

...​

​

Grapefruit isn’t the only troublemaker here. Pomelos (a hybrid between an orange and an Asian fruit called Citrus maxima) also contain furanocoumarins, as do Seville oranges (used in marmalades) and limes. These fruits have not been studied as much as grapefruit so it’s not known if they pose the same degree of risk.​

​

It should be noted that not all medications in a drug class necessarily interact with grapefruit. Sometimes it’s possible to find a grapefruit-friendly drug that achieves the same health benefit. Here are some rules of thumb to remember:​

​

• If you take oral medications of any kind, check with your doctor or pharmacist to see if they interact with grapefruit. Assess the potential side effects. Some drugs are less effective if mixed with grapefruit.
• Remember grapefruit isn’t the only food that may cause unwanted interactions. Pomelos, limes and Seville oranges may be problematic as well.

​

 

[Amy]

Alright - I’ll be the lime guinea pig. Just bought a bag and was gonna make limeade (it’s 99 degrees F out!)

 

[pellicle]

Alright - I’ll be the lime guinea pig. Just bought a bag and was gonna make limeade (it’s 99 degrees F out!)

sure ... sounds good. I often squeeze a fresh lime into a bit of Gin for a Gimlet

aside from feeling good on a warm afternoon I've not seen much exposure. How many limes are you going to eat?

 

[Chuck C]

do what you feel comfortable with as said 4.0 shouldnt be harmful, Iv been up to 7.7

As some here are aware, when I was released form the hospital I was put on amiodarone, without any warfarin adjustment and I went from 3.1 to 9.7 INR in 3 days, staying on the same dose of warfarin. Just to reinforce your comment, 4.0 INR is a cause for action in reducing warfarin to get back in range, but not any reason for alarm. A brief visit to 7.7 INR did not do you in and a brief visit to 9.7 did not do me in, although I figured that was probably not a good day to do any downhill off road mountain biking, not that I could have at that point anyway. 4.0 being not cause for panic is also strongly reinforced by the graphs showing the range of events that Pellicle posts often and the one I recently posted.
I would also support the advice to go with a 50% drop in warfarin for a say. That is probably about what I would do.