Warfarin, weekly doses and doctors' stubbornness

[Mister_James]

These are lies I report in and in August for me to test 4 times in a month I was out of range and was trying to get back slowly (my doc doesn't need the details) 2.7 to 3.2 are real values. Below or above that are what they need to know while I make my adjustments

 

[Bubba T]

We found a good balance with 7-6-7-6-7-6-7 weekly, rolling into double 7's on the weekends. The RPH prescribed 8668666 which gave us some low days (2.5), so we broke the 2-8's into 4-7's and got a better balance in our preferred range. We also wanted to eliminate the warfarin spikes so we could better watch for the APS interference. Erratic unexplained spikes are the first indication of undiagnosed APS, so we needed to identify them and monitor their frequency. If they continue, we will need to start lab testing occasionally instead of POC testing at the clinic.

We are in the camp of finding the correct wall height, and keeping that warfarin level consistent. We have no problem with splitting pills, double splitting pills is where I draw the line

 

[pellicle]

We found a good balance with 7-6-7-6-7-6-7 weekly, rolling into double 7's on the weekends

seems like a good and gentle alternation to me ... the double 7's will have some small elevation effect so that's all good.

so we broke the 2-8's into 4-7's and got a better balance in our preferred range

so its lie 7,7,8,7,7,8 (which is missing a dose if your week has 7 days)

We have no problem with splitting pills, double splitting pills is where I draw the line

indeed, if only the medical system supports the pill sizes that are needed (which often they don't) and recognize that "one size fits all" (which often it doesn't)

 

[Bubba T]

so its lie 7,7,8,7,7,8 (which is missing a dose if your week has 7 days)

Actually its 7,6,7,6,7,6,7, 7,6,7,6,7,6,7. Same 46 mg / wk as the 8,6,6,8,6,6,6

 

[dick0236]

All these numbers make my head hurt.

 

[pellicle]

All these numbers make my head hurt.

which is exactly why I

1. don't like the "thinking in weekly doses"
2. prefer to just have the same number of mg's each day of the week

its so much easier

 

[Seaton]

Like Finland, I can only get warfarin by prescription here in the UK. I can order 1mg, 3mg and 5mg tablets, precisely because of the need to make small dose adjustments. If I can find official guidelines that advise doctors to prescribe this variety of tablets I will add it here.

Same as you, I get the 1, 3 and 5 mg tablets prescribed in London. But I also requested additional 0.5 mg tablets, which they don’t automatically prescribe it seems, but which the doctor seemed fine about prescribing. So the 0.5s are now part of my regular prescription.

I currently take 8.5 mg daily on average.

 

[Bubba T]

prefer to just have the same number of mg's each day of the week

7676767 weekly works good... I'd have to double cut the 2mg tablets to get a daily dose of 6.5 mg. They don't quarter very well..

 

[carolinemc]

View attachment 890858
These are lies I report in and in August for me to test 4 times in a month I was out of range and was trying to get back slowly (my doc doesn't need the details) 2.7 to 3.2 are real values. Below or above that are what they need to know while I make my adjustments

Those are withing range numbers. Doing good.

 

[pellicle]

7676767 weekly works good

I'd agree with that and that's not a significant variation anway (when compared with what the OP was complaining about). He sayis:

to avoid big jumps like the ones I get recommended to make from day to day within a week (5 to 2.5 mg, i.e. 50%).

which is actually a big jump and with stupid alternations to reach his required "daily mg" ...

But back on your schedule there is a small issue: this pattern
Sun 7
Mon 6
Tue 7
Wed 6
Thu 7
Fri 6
Sat 7

would result on a double 7 when you think it through as your body doesn't know about weeks, just doses

...
Fri 6
Sat 7 <<
Sun 7 <<
Mon 6
...

so If you measured Friday I'm suspicious you'll get a different value to if you measure Monday ...

 

[3mm]

Fri 6
Sat 7 <<
Sun 7 <<
Mon 6
...

so If you measured Friday I'm suspicious you'll get a different value to if you measure Monday ...

I agree with Pellicle's analysis. But the change in value (for me) seems to be 0.1 INR, which is a trivial error as long as I stay well above the bottom of my range.
I make sure I'm measuring INR before the 2 days of high doses, and I also try to stay close to 2.5.

 

[Bubba T]

The double 7's on the weekend give us a little boost since we actually trend lower with average 6.5 daily. Note that she takes the warfarin at 23:00 hours, so the double 7's (Saturday and Sunday night) are really feeding Sunday and Monday, with a peak INR Tuesday and Wednesday (3.2 to 3.3),
Weekly minimum is currently Saturday and Sunday morning around 2.6.
Friday is typically 2.7-2.8.

 

[pellicle]

Morning

But the change in value

Agreed it's not at all likely to be significant.

 

[pellicle]

The double 7's on the weekend give us a little boost since we actually trend lower with average 6.5 daily

Logical

 

[pellicle]

to be 0.1 INR,

a quick plug in shows it may be more, but probably less than a 0.4INR swring

ps: which is important to recall that this is not a "clinically significant" variation (from center)

 

[pellicle]

The double 7's on the weekend give us a little boost since we actually trend lower with average 6.5 daily. Note that she takes the warfarin at 23:00 hours, so the double 7's (Saturday and Sunday night) are really feeding Sunday and Monday, with a peak INR Tuesday and Wednesday (3.2 to 3.3),
Weekly minimum is currently Saturday and Sunday morning around 2.6.
Friday is typically 2.7-2.8.

interestingly I sort of found that plugging that into my model shows something similar

I created values for M to match what I'd sort of expected (based on an INR of 2.5 for a dose of 7mg