What's Up With My INR Part II

[Ross]

3.8 today. Doc wants me to cut by 20% and retest in 3 weeks. I just called his nurse and asked about negotiations. Lets see if he'll meet me half way at a 10% reduction. If only I'd eaten some greens last night, I wouldn't have been out of range.

This is the first time I've been out of range in 2 months, so I'm not real thrilled with deviating very much from my current Coumadin intake. I explained to her that looking over my charts, whenever I was in the 35mg per week dose I tested at 2.1 and below. I told her I'd rather be high then low any day.

 

[bvdr]

Are you thinking about not changing your dose and just re-checking in a week? Just wondering .

By the way, was the 3.8 on your home monitor?

 

[Ross]

I know full well if I'd had some veggies yesterday, I'd of been in range, so really I don't see a need to adjust the dosage any. This is the only thing I hate about changing from the lab to the Doctor. Now I have to teach him and he's a stubborn cuss. My Coumadin Clinic Nurse finally saw the light and the last time I looked in her book, I saw she had a bunch of print outs from Al's site! Mr. Lodwick has a far reaching impact.

Yes the result was with the home monitor.

 

[Blanche]

Ross:

Three weeks is tooooo long. The protocol that the doctors in our area follow for an INR out or range on the high side is reduce coumadin and retest in one week. Al's range is 3.0 to 4.0. He is often at 3.8. Have you thought about doing another test on your machine?

Blanche

 

[Ross]

Have no fear my dear Maiden Blanche, I test weekly anyway. I haven't bothered retesting because I figure it's right. I haven't been eating much at all, so I'm living on rat poison.

The Doctors office just called and he said that if that's what I want to do, it's fine with him but its basically no change at all. Umm excuse me, it's a 10% cut and 10% still makes a difference. I know from past experience that if I did the full 20%, I'd be on the low side no matter what. I guess he was being kind of sarcastic about it, but at least he didn't hold a firm line. In time he'll see that I can do this. I'm not telling him to butt out, but I can manage my own care if given the opportunity.

 

[JimL]

When I test at 3.8, I consider reducing my dosage by 1 mg per week, about a 2% change -- unless there are other factors. 3.8 is not really "out of range."

 

[Raverlaw]

Ross and the others,

How do you adjust your dosage by 10% or 20% per week?

They've got me on 2.5 mg daily right now, so that works out to 17.5 mg a week. If I wanted to increase 10%, that would be 1.75 mg, which is less than one pill. How would I do that, and when would I take it?

Do you guys get an assortment of dosages? Can you get them as small as 1 mg or .5 mg? If you're measuring on a weekly basis, when during the week do you add or subtract the *extra* dosage?

Educate me on this so when my surgeon releases me to my PCP for therapy, I can tell THEM how I want to do it.

Thanks-

 

[LUVMyBirman]

Would not worry about it too much Ross. 3.8 is not really out of range when you consider factors lab vrs. home unit. As long as your unit is within .02 of your lab.

3.8 would be a good day for me. Tested at 4.5 yesterday. I am on a short term medication for another condition. Just decreased yesterday, finsh my meds today. By the time I test next week I am certain it will be back in range. What I have learned over the last five years. If you make a 10% knee jerk decrease decision for one slight out of range INR....... your gonna pay with a lower number.

 

[ccrawford]

Ross- I've been self dosing for about a year. The 10% sounds right and if you plan to test weekly, you are right on the money. Bill - I'd cut one of your 2.5 mg pills in two and take the two extra halves at equally spaced days during the week. Coumadin makes a wide range of doses. I get by with the 5mg and 2.5mg pills, and keep an extra stash for when my pharmacy gets spaced out. Usually I'm at 35mg/week but sometimes have to add one or two 2.5mg to keep in range. If you find you are really steady with your INR, then you can comfortably increase the time between tests. Any time you take a new drug (prescription or over the counter) or try a new herb, follow it up with a test in a week and then at two weeks.

 

[Ross]

Bill I think your going to find that they have you dosed way too low. I'm willing to bet you'll be using 5mg tablets for the most part. Chris pretty well covered it, but just as an example, I'm currently taking 45mg per week. 5mg on Mon, Wed, Fri and 7.5mg on the rest of the days.

Now I'm cutting 10% or should I say rounding from 45 to 40. Now I'll take 7.5 mg on Mon and Fri while taking 5mg the rest of the week.

Do you see the pattern or the spacing or just me being spacey?

Gina I know. Can you imagine if I cut 20% and tested in 3 weeks as suggested? I'd much rather be high then to be low and I know that's what would happen. 3 weeks worth at that! When dear Lord are these Doctors going to be on the same page?

 

[tommy]

Bill.

I take 5 mg four days (MWFS) and 2.5 mg 3 days(TTS). Just a couple of months ago (and for 2 years), it was 2.5 mg per week less than that. That was an easy change. Now I dance at the upper end of the range instead of the lower (that's a good thing).

There's nothing magical about 10% increase - the "range" covers that.

I used to have 5mg pills. Ran out of 5's recently and am just using 2.5. My insurance just changed, and I am sure that they will want 2 co-pays if I want 5's and 2.5's. So I doubt I'll get 5's again. My cardio prescribes "plenty" so we can adjust the dose without another copay.

Like Ross, I am willing to bet that you will settle out higher than you are. But last time I did that, I was wrong. Where do I send my dollar?

I'm sometimes amazed at the different dosages people have. The wife of a work associate is taking 20mg per day to keep her INR near 2.0. Go figure.

Ross,

I haven't been eating much at all,

Lot's of foods have vit K. If you are eating very little at all, that could be flavor the test results.

 

[Raverlaw]

Tom,

Rob (Rob-that's-me) won the pool, guessing my exact INR at 2.4. So, I guess send your buck to him, or see if he'll let you donate it to Hank to keep VR online.

 

[Marge]

Ross writes:

<< Bill I think your going to find that they have you dosed way too low. I'm willing to bet you'll be using 5mg tablets for the most part. >>

I bet Ross is right.

I have 2.5 mg tablets, the prescription I brought home from the hospital. At first the clinic had me taking only one of those a day, and my INR kept dropping (got as low as 1.1). Then they told me to take two tablets on Saturday (but stay on 2.5 mg the other days). INR went up a tiny bit. I did not get into the desired range (between 2.0 and 3.0) until they raised me to two tablets (i.e. 5 mg) every day. Last blood draw was 2.8. So finally I am in range.

 

[terry40]

How do you guys get to take such a low dose, I'm on 63mg a week and running pt-inr 2.6 last testing and now terrified about eating anything green!

I've never been over, it's usually on the low end of the therapeutic range, and I've never metabolized anything fast, that's why I'm overweight!

Just venting guys!
If I was you, Ross, I'd be planning my next salad, or steamed spinach, broccoli, kale, Heck! anything green and high in vitamin K, and forget about lowering my dose.

Terry40

 

[ccrawford]

Terry - I'm just guessing, but I bet you're taking a vitamin and I bet it has a healthy portion of vit K ??? Bill - nice avatar - I bet that's one of the few times in your life you wern't talking much huh //

 

[Raverlaw]

Chris,

I'm actually known as a *quiet* guy, believe it or not. But I thought you all would enjoy this avatar for a while - this is definitely the cheapest way to see a lawyer

 

[Ross]

*Brings back a lot of bad memories for me* Imagine 40 some days on that thing!

 

[Blanche]

Raverlaw

Raverlaw

Coumadin comes in the following 9 strengths: 1.0, 2.0, 2.5, 3.0. 4.0, 5.0, 6.0, 7.5, and 10.0. Albert has always had several strengths on hand. After he had his stroke in 2000, his INR was all over the place. The doctor directed him to take 3 different strengths over a week. Remembering what to take each day was very stressful, especially for someone recovering from a long hospital stay. I suggested to the cardiologist that it might be easier, and more accurate, for Al to take the same dose every day. He didn't agree. So, for that reason and several others, Al switched his anticoagulation monitoring to his internist, who sees him on a regular basis for other medical concerns. Now his daily dose if 6.5. There are several combinations that he can take to achieve this dose. Works well for him.

Regards,
Blanche

 

[JimL]

I was started on 2.5 mg tablets as well. I've heard that enough that I think it's the standard beginning dosage. Everyone's metabolism of coumadin is different, but 2.5 seems to work well at the beginning. However, as activity level increases, so must the dosage, and taking two or three 2.5 pills gets to be costly.

I have a double prescription for 5mg and 6 mg tablets. And I have a pill splitter, a handy little device, greatly overpriced, but handy all the same. That allows me to change my dosage from week to week by usually 1mg.

Taking the same dosage every day is the best.

 

[terry40]

ccrawford

ccrawford

Nope, my multi has no vitamin K, and I'm aware of where hidden Vitamin K lurks.

terry