Warfarin for older people

[Juan P. Negret]

When warfarin patients get older, many of them face a rising number of common health issues for older people, such as being overweight, rising cholesterol levels, and if they are male, prostate enlargement.

How dangerous are the interferences of warfarin with the typical drugs that older people need, such as simvastatin for cholesterol control or tamsulosin for prostate enlargement?

Juan

 

[Cris N]

You searched for interactions between:

* warfarin
* Simvastatin (simvastatin)

Simvastatin may slightly increase the anticoagulant response to warfarin. The mechanism may be warfarin displacement from protein binding sites. The clinical significance of this interaction has not been established, however, clinical monitoring of patient warfarin response and tolerance is recommended. Simvastatin may interact in a similar way with other oral anticoagulants. In addition, a case study has reported reversible rhabdomyolysis and acute renal failure 7 days following initiation of warfarin in a patient stabilized on simvastatin. Pravastatin, another HMG-CoA reductase inhibitor, does not appear to affect anticoagulation. Patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools.

You searched for interactions between:

* tamsulosin
* Warfarin (warfarin)

Studies evaluating a potential drug interaction between warfarin and tamsulosin have provided inconclusive results. The manufacturer recommends caution if these agents are used together. Clinical and INR/PT monitoring is recommended. Patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools.


According to drugs.com - doesn't sound too bad.

 

[dick0236]

When warfarin patients get older, many of them face a rising number of common health issues for older people, such as being overweight, rising cholesterol levels, and if they are male, prostate enlargement.

How dangerous are the interferences of warfarin with the typical drugs that older people need, such as simvastatin for cholesterol control or tamsulosin for prostate enlargement?

Juan

I am 73 years old and have been on warfarin continously since age 31. Up to the present time I have few problems with warfarin (except one big one at age 38 that was probably my fault). As I have aged, factors such as drug interactions have created little problems in maintaining my INR range, but these problems have been easily managed. My most recently problem was when my dose of Simvastatin was increased from 20 to 40mg. It caused a significant increase in my INR wich was corrected by me going back down to 20mg....I'll "live with" a little higher cholesterol. Older friends of mine have had similar problems with a few of their drugs. I feel that warfarin will not cause me serious INR problems, but I think it will require a closer management as I age, especially in dosing. My biggest problem will probably be "forgetfullness" (senior moments) in dosing. Recently I posted that if I had to get another valve (or my first valve) at my age of 73, I would go Tissue to try to avoid ACT at an older age. However, I do not regret getting a mechanical at 31 as, so far, I have needed no additional surgeries.

 

[ALCapshaw2]

Cris -

What Website did you use to provide this Drug Interaction Report?

 

[Lynlw]

Cris -

What Website did you use to provide this Drug Interaction Report?

her post says drugs.com

 

[COLLEEN S]

I love this "older people" thing. A lot of us have been heart patients since our twenties.

 

[Ross]

Let's understand, while almost everything interacts with Coumadin, it can all be adjusted for. As you see, Dick and RCB are our two longest surviving Warfarin takers and have experienced little problem and the problems they have, they feel was their fault and not the drug. As we age, some bleed easier with or without Warfarin, but you won't know if your one of those people until your that age. In General, Warfarin taken for a mechanical valve, will allow you to reach that age!

 

[ALCapshaw2]

Don't forget about Nancy's Husband, Joe, who lived to age 75 (dying of multiple organ failure) when some Doctors were predicting he wouldn't make it past age 50. He had Multiple Open Heart Surgeries for both Heart and Lung issues. His Heart and Valves were still working fine until the very end.

 

[Juan P. Negret]

Thank you all.

Ross, you are one wise and kind veteran of this valveland.

I was thinking about the cumulative effect of common conditions that older people face. Imagine a typical 70 year-old, a bit overweigh, with high cholesterol, some arthritis or back pain, if a male, perhaps with prostate problems, if female, perhaps with a stomach ulcer. That person will face many routine medical exams, many of those invasive. In addition, the chance of facing some common types of surgery increases (gallbladder...prostate...cancer).

For that typical person, is the warfarin a big issue, or is it the manageable annoyance that Ross says?

Juan

 

[csutherland]

Jerry is 72 and has been on warfarin since he was 65. Annoyance would be the correct term. A colonoscopy is something that Jerry is putting off longer than he should, simply because the high-powered anti-fungal he's on messes with his INR and he just doesn't want to deal with the colonoscopy right now. Also a lung biopsy last fall necessitated Lovenox shots which were very expensive and troublesome. Some on here don't seem to mind the Lovenox but we didn't like dealing with it.

However, all in all, coumadin management hasn't been too bad. At least a mechanical valve & coumadin are better than another surgery!

 

[Lynlw]

Thank you all.

Ross, you are one wise and kind veteran of this valveland.

I was thinking about the cumulative effect of common conditions that older people face. Imagine a typical 70 year-old, a bit overweigh, with high cholesterol, some arthritis or back pain, if a male, perhaps with prostate problems, if female, perhaps with a stomach ulcer. That person will face many routine medical exams, many of those invasive. In addition, the chance of facing some common types of surgery increases (gallbladder...prostate...cancer).

For that typical person, is the warfarin a big issue, or is it the manageable annoyance that Ross says?

Juan

Alot of the concerns with coumadin and the elderly (some studies consider elderly over 60) has to do with both falls amd the fact alot of the bones break easier, ect

 

[dick0236]

In General, Warfarin taken for a mechanical valve, will allow you to reach that age!

Amen, Ross

 

[catwoman]

When warfarin patients get older, many of them face a rising number of common health issues for older people, such as being overweight, rising cholesterol levels, and if they are male, prostate enlargement.

How dangerous are the interferences of warfarin with the typical drugs that older people need, such as simvastatin for cholesterol control or tamsulosin for prostate enlargement?

Juan

Statins aren't just for the "elderly." My 52YO brother-in-law has been on statins for 10+ years. High cholesterol runs in his family.
Note: He's not on warfarin.

My husband (now 63) is on an Rx for prostate enlargement. It's not tamsulosin (Flomax), because his insurance won't cough up for that. He was taking terazosin for a long time and changed to another generic last fall.
After his MV repair two years ago, he was on warfarin for 7 months. It would be difficult to determine the effect of terazosin on his INR, because he was already on terazosin when he had his surgery.

 

[dick0236]

.



I was thinking about the cumulative effect of common conditions that older people face. Imagine a typical 70 year-old, a bit overweigh, with high cholesterol, some arthritis or back pain,

For that typical person, is the warfarin a big issue, or is it the manageable annoyance that Ross says?

Juan

Juan....I meet all your conditions....older than 70, bit overweight, slightly hi cholesterol, some arthritis and degenerative disks in spine. I successfully manage my warfarin therapy will little problem....so far. Warfarin is not a big issue for me. However, if I were going into surgery at my age, I would go tissue. Some here may think I am a "heretic"....but unless there are extenuating circumstances, my opinion is "mechanical for the young" and "tissue for the old"....but then, I am no expert.

 

[KristyW]

if I were going into surgery at my age, I would go tissue. Some here may think I am a "hertic"....but unless there are extenuating circumstances, my opinion is "mechanical for the young" and "tissue for the old"....but then, I am no expert.

Dick,

I agree wholeheartedly with your thinking. I think that if my docs started talking about replacing my wonderful mechanical aortic valve when I reach 65 - 70, I would ask for tissue myself. I love that this mechanical valve has given me a new lease on life, but it would be nice not to have to worry about anticoagulation when other procedures come up.

 

[tobagotwo]

There are always some concerns with other prescriptions interacting with Coumadin, but as Ross points out, this can usually be prepared for by a very modest amount of research before starting a new prescription or supplement, a variation of "dose the diet."

Generally, the items that seem to create a very slightly higher risk from warfarin in older people are the increasing fragility of some people's brain blood vessels, increased likelihood of falling with injury, and an increased likelihood of intestinal bleeds.

None of these are caused by the Coumadin, but warfarin can make them more dangerous when they do occur. The rise in risk is not large, and is not equal among all oldsters.

Best wishes,

 

[Ross]

Thank you all.

Ross, you are one wise and kind veteran of this valveland.

I was thinking about the cumulative effect of common conditions that older people face. Imagine a typical 70 year-old, a bit overweigh, with high cholesterol, some arthritis or back pain, if a male, perhaps with prostate problems, if female, perhaps with a stomach ulcer. That person will face many routine medical exams, many of those invasive. In addition, the chance of facing some common types of surgery increases (gallbladder...prostate...cancer).

For that typical person, is the warfarin a big issue, or is it the manageable annoyance that Ross says?

Juan

Nothing more then an annoyance, if you even want to call it that. The largest problem by far is that the medical field, at least here in the U.S., is not on the same page where Coumadin and dosing are concerned. Those of us here are of a new breed that self test and self dose. No one understands the drug better then those taking it. Invasive procedures are treated like anything else, adjusted for. We call it BRIDGING with Lovenox.

Most every conceivable question you have can be found at these two sites;
http://www.warfarinfo.com/warfarinfo.com2.htm

And mostly accurate, but some things are outdated and have been rethought, but mostly 93% or so accurate:
http://www.aafp.org/afp/990201ap/635.html

 

[BigOwl]

Juan, I'm "only" 61, but I fit your profile in that I'm a bit overweight, on statins (and niacin and zetia and metaprolol and synthroid and aspirin) since my late 40s, and recently started on Coumadin after getting a mechanical valve. Even with intermittent, mild arthritis (requiring occasional ibuprofen) there seem to be no real interaction problems. Despite having to add anticoagulation to the soup, I chose a mechanical valve because I didn't want further surgery. And now I'm healthier than I've been in years, am losing weight, and feeling younger--so interactions wouldn't seem to be much of a problem, despite advancing age.

 

[olefin]

Juan, I'm 74, been on warfarin for 18 years. It's been no big deal. Try to use a little common sense to protect my self. Also, I've always worn a Medic ID necklace. I was active before surgery and still at it. I fast walk 3 miles every day, fish, do all our yard work, (2 yards at two different homes) ride our ATV, drive the tractor brush hogging on our farm. Do anything I want to.

I'm not overweight or have high blood pressure or high cholesterol. I've taken medication for 25 years due to high triglycerides and Thyroid condition. Yeah, I have prostate enlargement but other than having to get up to pee at night it's no problem.

Years before AVR I had lots of blood in my urine on two difference occasions.. never found the reason. Last year it happen again, no worse from being on warfarin.

I had a severe bleeding duodenal ulcer the year before I had AVR. But the surgeon and my cardiologist still recommended going with a mechanical valve, even with a history of bleeding. I agreed with them!


Also this February I started INR home testing. Should have been doing that for the last 18 years or at least since 2001 when Medicare started paying for it. May not get to enjoy that for too long after our new President messes up my health care.

Good luck!

 

[ShezaGirlie]

Should have been doing that for the last 18 years or at least since 2001 when Medicare started paying for it. May not get to enjoy that for too long after our new President messes up my health care.
Good luck!

You know something I don't know..???