Warfarin

[DrAllan]

I suspect that our choice of terminology is not accurate. If by mixing, on means taking one or the other drug a a single dose per day then there probably is no problem. If, as i suspect, you are taking a pill from each of the bottles on a daily basis as directed by the label, then you are taking a double dose and thus are having difficulty with your INR. What exactly is happeneing?

 

[Ross]

Am I the only one that takes Jantoven(generic coumadin also)? The pharmacy I go to doesn't carry warfarin only Jantoven.

No Randy, your not the only one taking Jantoven, Hank does too.

 

[Marsha]

DrAllen
I was taking a total of 8mg a day, 5 mg of coudmadin and 3 of warfarin. Last week I decided to take just warfarin (total 8mg) and had my inr test come back at 4.0. The dr. wants it between 2.0 and 3.0. So again I go get tested next week. They dropped the mgs to 6 now. So we will see what happens.

 

[Ross]

8x7=56mg for the week 56-10%=5.6 56-5.6=50.4/7=7.2mg or 7mg

I bet you come up too low this next test. It's going to be close.

 

[RandyL]

No Randy, your not the only one taking Jantoven, Hank does too.

Who's Hank?

 

[afraidofsurgery]

Brand name vs generic

Brand name vs generic

I have talked to my cardo, family dr, and the nurse that does the inr and they all have said that the generic brand might have different fillers in it although they use the same main ingredients. So the fillers might have an impact together. So I'm going in tomorrow for my protime and will see if just using the generic has had an effect on my levels. Thanks for all the imput. It is good to have different views on the subject/

FYI generics have to show 'bioequivalence' and have the manufacturing site etc., approved by the FDA. However, variability can be between 80% and 125% versus a reference product for generics, and the allowed batch to batch variation for brand name products is only 10%.
This greater active ingredient variability has been shown to cause problems in drugs where there is an extreme sensitivity in dose to dose variations such as in antiepileptic drugs and contraceptives. I'm not sure if this would affect a PT/INR given the long half-life of the drug, but maybe in some people it might.

I just found out my cardiologist 'hates' warfarin and since he's typically not very anal retentive, I would guess he's had some problems in the past with patients' PT/INR staying stable on warfarin. I just know last month it cost me $75.00 for a refill of coumadin vs generic on my new insurance!!

 

[ALCapshaw2]

DrAllen
I was taking a total of 8mg a day, 5 mg of coudmadin and 3 of warfarin. Last week I decided to take just warfarin (total 8mg) and had my inr test come back at 4.0. The dr. wants it between 2.0 and 3.0. So again I go get tested next week. They dropped the mgs to 6 now. So we will see what happens.

I recommend that you buy the Al Lodwick's DOSING GUIDE ($5) through his website www.warfarinfo.com

That will provide you with a MUCH better idea of recommended dosing changes vs. INR. Going from 8 mg to 6 mg represents a 25% drop which seems on the high side to me.

You need to know that the SAFE RANGE for Coumadin (and Warfarin) is between 2.0 and 5.0 Below 2.0, the risk of STROKE rises linearly. Above 5.0 the risk of Bleeding rises. OTOH, many people have had an INR of 8 with NO BLEEDING.

Most Coumadin Clinic personel would not be worried about an INR of 4.0 Some of our members who have had strokes or have a high risk of stroke are advised to keep their INR in the range of 3.0 to 4.0.

One of our favorite sayings is that "It's easier to replace Blood Cells than BRAIN Cells". Bottom Line: Most of us prefer to be on the high side of our recommended range rather than risk STROKE from going Too Low.

'AL Capshaw'

 

[ALCapshaw2]

FWIW, last week my INR was 4.0 My target range is 3.0 to 3.5

I was told (by the CRNP at my Coumadin Clinic) to lower my WEEKLY dose by 2 mg which amounts to about a 7% decrease, no where near the 25% you were told.

Is your Coumadin manager a Doctor, Nurse, or Pharmacist?

Next to Self Testing and managing, the BEST results usually come from dedicated Coumadin Clinics.

Physicians who manage a limited number of their own patients have difficulty maintaining low variation, especially if their training was more than 10 years ago.

There has been considerable discussion with reports on this topic in the past on this Forum if you care to research the subject.

'AL Capshaw'

 

[Guest]

The site is getting big when someone asks who Hank is. He is the founder and owner of the site. I'll bet he never dreamed that it would grow to this extent.

Marsha (not Catwoman) the fillers are not allowed by the FDA to affect the levels. They would only come into play if you were allergic to one of them.