Warfarin and Asprin

[Superman]

@sharky7

I speculate that the majority here self test. How that’s handled varies greatly by where people live, what insurance, etc.

I understand that Medicare fully covers self testing. I suspect by going to the VA, you would be covered too?

For my insurance, I have a coaguchek machine that is “leased” from a third party (RealTime Diagnostics in my case). They have an arrangement with my insurance that covers all but $11 and change a month for the use of the machine, the test strips and lances, and the clinic managing dosing. I email my result in weekly and typically get a call from the clinic after that confirming dosing or discussing changes as needed.

I never go in for lab pokes anymore.

Some people here are completely out of pocket. They paid cash for their machine (about $1,000 or so?) and buy supplies online ($5 - $10 a strip I think). They get a prescription from their doctor for Warfarin, but largely self manage dosing.

 

[vivekd]

My range is also 2.5-3.5 on 5mg warfarin for the last several years. I started 81mg aspirin daily a couple years ago with no effect on INR. I was on Coumadin while it was still patent protected and for several years after it was off patent because doctors were scared to prescribe the generic warfarin. I have been on generic warfarin for the past 10-15 years with no effect on INR. I have found that changing brands of warfarin (mfg. tolerances and/or inactive ingredients) can affect my INR......so I am careful to stay with one brand "Taro".

PS: If I miss a dose my INR will also drop like a rock.......that's why I keep pills in a seven day pill box.

I'd to make following changes after i forgot to take warfarin last month and my INR dropped from 2.9 to 1.4

a) Started using seven day pill box, so that i can check warfarin dosage when i take other medicines.
7:09 am - Levothyroxine
7:09 pm - 13-15mg warfarin
9:09 pm - Baby Aspirin
b) Added apps medisafe and pill reminder to provide notifications
c) Added alarms @ 10:00 pm and @ 7:00 am for verification
d) Testing @ clinic on Wednesday and testing @ home on Sunday
e) Getting ready to move from generics (Warfarin - from Walmart) to brand name (coumadin)

 

[dick0236]

e) Getting ready to move from generics (Warfarin - from Walmart) to brand name (coumadin)

I used to get my drugs from walmart. They are notorious for buying on "price" from their suppliers and I found it difficult to get the same brand of warfarin on an ongoing basis. I now use Walgreens with instructions to only use Taro warfarin when filling my Rx.

I remember being forced into using Coumadin while it was patent protected and for a while, after it went off patent.....and back in the '70s-80's Coumadin was about $100/30 day supply..........and since drugs were not well covered by insurance $100/mo was a significant expense. Now I understand the cost of Coumadin has significantly lowered. One benefit of using the "brand name" is you are assured in getting the same product on each refill without looking at the pill bottle.

 

[Protimenow]

I've read through the thread, and have a few comments.
Sharky7 - I use a Coag-Sense meter. There's a new model (a really nice, updated model that I use), but for years, I used the original. There are vendors on eBay who sell it (I think it's new, but am not sure) for less than $200. Strips are around $4 or $5 each.
CoaguChek XS usually sells for a bit more (although the new Coag-Sense and a new CoaguChek XS may be priced similarly). Strips are also around $4-$5.
For myself, I much prefer the Coag-Sense.
I could probably have Medicare buy me a meter - but I already have one, and don't want to put myself at the whims of a 'provider' who charges Medicare a LOT of money for services that I do myself.
I self-test and self-manage. My crappy diet is pretty consistent, and my INR is usually in a small range.

Next -- I take 81 mg aspirin every night. I haven't seen any problems caused by it.

I believe that Weekly testing is very important. A study conducted by the Duke University Clinic a few years ago showed that, if an INR is too low, the possibility of having a stroke significantly increases. A few years ago, I trusted my Hemosense meter to be accurate. It showed an INR of 2.6. After a few weeks at 2.6, I had a TIA (doctors called it a stroke), and the 2.6 reported by the meter was actually 1.7 in the hospital. It's a lot cheaper to go through an extra $15-20 a month of strips than it is to be hospitalize and damaged by a stroke.

As others have said, it's important to keep your warfarin doses as consistent, day to day, as possible. Although there was talk about a total weekly dose, this doesn't make a lot of sense.

Years ago, before I knew better, I'd take 7.5 mg on Tuesday and Thursday, and 5 mg on the other days. What I didn't realize is that, if I took my INR on a Friday or Monday, it would be higher (maybe looking like it was at the top of my range) than it would have been on the other days. This is because the effects don't show up right away. With the ability to break 1 mg pills in half, and to halve the other common doses, you can practically create any dosage that works for you. True, it may be a bit of a pain to take two or three pills in order to get the right dose, but it's worth the trouble.

As Dick mentioned, you should try to learn and keep generic Warfarin from one manufacturer. A few years ago, Costco tried to give me a different manufacturer's product. I tested to see how my body used it, and wasn't able to effectively control my INR. Now, Costco knows that I will ONLY take Warfarin.

If you pharmacy gives you warfarin from a different manufacturer, it's a good idea to test every few days until you can confirm that your body handles the dose the same way it did on the old version.

 

[vivekd]

forgot to mention that my cardiologist provided me Lovenox injection, so that if my INR goes too low, I can self administer lovenox without rushing to get prescription or head to ER.

I'm planning to move to Brand name Coumadin for next 90 days and then decide if i should stay with brand name and go back to generics. I may end up moving back to CVS Pharmacy, if i decide to go back to generics warfarin.

 

[carolinemc]

@sharky7

I speculate that the majority here self test. How that’s handled varies greatly by where people live, what insurance, etc.

I understand that Medicare fully covers self testing. I suspect by going to the VA, you would be covered too?

For my insurance, I have a coaguchek machine that is “leased” from a third party (RealTime Diagnostics in my case). They have an arrangement with my insurance that covers all but $11 and change a month for the use of the machine, the test strips and lances, and the clinic managing dosing. I email my result in weekly and typically get a call from the clinic after that confirming dosing or discussing changes as needed.

I never go in for lab pokes anymore.

Some people here are completely out of pocket. They paid cash for their machine (about $1,000 or so?) and buy supplies online ($5 - $10 a strip I think). They get a prescription from their doctor for Warfarin, but largely self manage dosing.

I don't have a machine at home, so it is better for me to go to lab at hospital, no insurance. Not all people manage their dosage on their own. I suffer badly from pump head affects from my last OH, valve replacement, I would forget my head if it was not attached to my body. LOL!. But I cannot afford to get the machine without insurance.

 

[carolinemc]

I used to get my drugs from walmart. They are notorious for buying on "price" from their suppliers and I found it difficult to get the same brand of warfarin on an ongoing basis. I now use Walgreens with instructions to only use Taro warfarin when filling my Rx.

I remember being forced into using Coumadin while it was patent protected and for a while, after it went off patent.....and back in the '70s-80's Coumadin was about $100/30 day supply..........and since drugs were not well covered by insurance $100/mo was a significant expense. Now I understand the cost of Coumadin has significantly lowered. One benefit of using the "brand name" is you are assured in getting the same product on each refill without looking at the pill bottle.

I have had no problems with any manufacturer of warafarin. NONE. It is more to do with your dosage and diet than who makes the pill. Being consistant is more important.

 

[marvsehn]

I now use the generic from cvs with no problem. I switched this year from walmart. I did not have any noticable difference. I am on medicare and only out of pocket the $186 annual deductable. However i do pay premiums monthly, 134,79,18 dollars for medicare, supplemental and drug. I test weekly, using a weekly dose rate and try to flatline the daily doses. For me, I find the dose has an impact over abt 4 days. I developed a spreadsheet to help target daily impacts for inr. Testing weekly gives me a check point and I am usually within +/- 0.3 inr. My inr jumps a bit when i travel alot across country.