Warfarin Schedule

[JeffF]

Hello-

I am currently taking my warfarin around 6-630ish. Does anyone know if I can I switch it up and take the pills in the morning?

Thanks,
Jeff

 

[JV.in.TO]

Jeff,

I tried to do the same thing and caused a couple of issues with my INR. Talk to your doc... They told me to slowly move the time - 1 hour per week... I am at the three month mark (post surgery).

Work with the doc...

Good luck....

 

[JeffF]

Thanks JV.....

 

[dick0236]

Hello-

I am currently taking my warfarin around 6-630ish. Does anyone know if I can I switch it up and take the pills in the morning?

Thanks,
Jeff

Warfarin can be taken morning, noon or nite, but it is important to develop a consistent, convenient, easily remembered dosing time. For me, that has always been in the AM, when I first get up along with the other RXs that I take. However, that AM hour can range from 5am to 9am+ depending on what is on my schedule for the day. I also use a seven day pill box as a reminder for the occassional times I slip up.

 

[njean]

Great advice from Dick, Jeff. Take the warfarin when it is convenient for you and can be easily remembered.

I take my coumadin in the early evening along with my other meds for the night. This has been the same schedule for me for 37 years!

 

[Bina]

Hello-

I am currently taking my warfarin around 6-630ish. Does anyone know if I can I switch it up and take the pills in the morning?

Thanks,
Jeff

Many people take it in the morning, and it is always a good idea to use a pillbox that is loaded for the week,
sometimes we get distracted and don't remember if we took it or not.
I take mine after dinner at 7 pm and if I should forget the pill in my pillbox, I will see it later when I take my
nightly BB pill. I also mark on my agenda the dose that I took.

 

[Bina]

Jeff,

I tried to do the same thing and caused a couple of issues with my INR. Talk to your doc... They told me to slowly move the time - 1 hour per week... I am at the three month mark (post surgery).

Work with the doc...

Good luck....

Hello JV,
I really don't think that it is necessary to make the move that slow and prolonged....If you are taking your med
at dinner time and want to take it in the morning, you can just move one day's dose to lunch time and the next
day you can continue on mornings.
Coumadin/warfarin takes a couple of days to work in our system, but you
don't want to take a second dose within 12 hours of a previous dose, if possible.

 

[JV.in.TO]

Thanks for the insight - I was not sure on why the doc suggested the cautious approach. Although my INR is only now starting to stabilize (was like a "jojo" for a couple of weeks).

JV

 

[Bina]

Yes JV, those first few weeks post op we shouldn't jiggle the routine too much

 

[yotphix]

When I travel from the West Coast of North America to Central Europe, I like to continue taking my warfarin at bedtime. That always means shifting the time ahead 9 or 10 hours (depending on the time of year), and then back again. I do it in just two steps, roughly half of the change per day. Since I bring my monitor on trips, I know that this has worked perfectly so for me at least, it's no big deal to shift 4 or 5 hours at a time. As Bina said, it the pill you take today is actually doing the bulk of it's work 2 or 3 days later so we have a bit of freedom to shift things around.

 

[JeffF]

Thanks everyone for the great advice (as always). I currently do have a pill box and without it I know I would forget something. I take all of my other pills in the a.m. so I was figuring it would be easier to just take everything at once.

Jeff

 

[mecretired]

When I started on warfarin, it was suggested that I take it in the evening. That way if I need to make an adjustment in the dose, I can make it in that day's dose. Most INR checks are done during the day after morning medication is already taken.

 

[sarahsunshine]

Skyler always takes all his pills in the morning.

My only caution is that some things prevent the uptake of warfarin… like Magnesium and should be taken separately. So if you take a cal/mag supplement, it needs to be taken at a different time of day as the warfarin!

 

[catwoman]

I was put on a p.m. schedule post-op for taking my warfarin. I switched it one day to the a.m. There was no problem with the INR. If you are going to a lab or Dr's office for your INRs, I would advise making a schedule change AFTER not just before the next INR test.

 

[Superman]

I've taken it in the A.M. for 21 years. I still have to correct the lab when they adjust my dose and say, "Tonight when you take your does, change it to X..." I say, "You mean tomorrow morning? I already took it today." Every time. Don't those places keep charts?

 

[Bill B]

When I travel from the West Coast of North America to Central Europe, I like to continue taking my warfarin at bedtime. That always means shifting the time ahead 9 or 10 hours (depending on the time of year), and then back again. I do it in just two steps, roughly half of the change per day. Since I bring my monitor on trips, I know that this has worked perfectly so for me at least, it's no big deal to shift 4 or 5 hours at a time. As Bina said, it the pill you take today is actually doing the bulk of it's work 2 or 3 days later so we have a bit of freedom to shift things around.

This is very reasonable. I take mine at bedtime, whenever that is. The point is to have a schedule that is "regular" in the sense that you are sure to take your dose that day and not get confused as to whether you had taken it that day. Bedtime might be 10 pm or 3 am. What I know about warfarin metabolism and dynamics tells me you could take it any time you want, even every other day. The half-life of warfarin is about 60 hours. So, during any 10 or 12 hour period there is only a rather small fractional change in the blood level of the drug. The main reason medical people want patients to be so anal about when they take the drug is that medication compliance is so lousy. If people thought it didn't matter when you took it, they might take it one morning, maybe the next night, then get all confused the following morning as to whether they might have already taken that day's dose. (Note there are some people who are rapid metabolizers with a much shorter half-life; for them timing may be more important.)

 

[RealtorRick]

My INR Clinic told me I have an 8 hour window from my schedule, 4 hours each side of my normal time. If I wait longer than 4 hours after, just skip that dose and take the next days dose as scheduled. That seems like you could change from evening to morning in about 3 days. Keep in mind that people have missed doses and it was not a life ending event. From what I am told, the Warfarin thing is a build up over time of using the product. Bill B seems to have the technical scoop.

 

[catwoman]

Rick:
I'm not sure what is meant by an "8-hour window." It does take up to 72 hours for dosage changes to reflect in an INR.
I would never skip a forgotten dose.
When I forget a dose (almost always on a weekend) and don't realize it until the next day, I take the current day's dose + 1/2 the missed dose. On the following day, I take that day's usual dose + the remaining 1/2 missed dose. Yes, it is a little more than I would normally take, but my weekly dosage will be the same.
No, it's not a life-ending event, but I'd rather be safe than draw another black bean.
I've told my PCP and cardio about my method of handling forgotten doses. and they said it sure makes sense. My PCP's office has a CoaguChek; my cardio's practice has a large Coumadin clinic listed at www.acforum.org.
I've talked quite a bit with my PCP and my cardio about home-testing and dosage changes, and they have said I have just as good (even better, my cardio says) than their professionals in their offices. Both doctors have copies of the algorithm chart that I base dosage changes on.

 

[dick0236]

When I forget a dose (almost always on a weekend) and don't realize it until the next day, I take the current day's dose + 1/2 the missed dose. On the following day, I take that day's usual dose + the remaining 1/2 missed dose. Yes, it is a little more than I would normally take, but my weekly dosage will be the same.
.

I also follow this routine in order to keep my weekly dose the same.

 

[sarahsunshine]

Personally I'd be scared to follow this routine with Skyler.

What we usually do is up his daily dose (8.5mg) by 2mg for the day after he forgets... He usually takes his meds in the morning, but if it's been a half day, he'll take them all in the evening. If a full day, then we up by 2mg or so depending on his activity and diet level.