Yikes

[Orangebrittainy]

I missed my first dose last night. I fell asleep about 30 minutes before I take it (really rare for me) and DH didn't think to wake me up to see if I took it. I had to lest this morning and I tested at a 1.5 It was a nurses appt and no doctor is there today, so they said they would call me back after they talked to the doctor and got a recommendation. I couldn't think of why it was so low at the time. I called them when I found out I missed the dose but still waiting on a call from them since I got a machine.

I have set up an alarm clock (much to my husband's dismay) in the living room. I carry the bottle of meds with me in my purse in case I am out of the house so I can still take them. But I set up the pills in a weekly pill thing, which is how I found out I missed it. I am taking steps to prevent this from happening again.

Does missing one dose really have that much of an effect? I am supposed to be 2.5-3. What can I do to help get my levels back up??

If I do miss again and catch it in the morning (which is 12 hours later) is it safe to take it then, or should I wait til that evening?

 

[Herb M]

Missing a dose will show up in 2 or 3 days, but not the day after missing the dose.

Test again to see how low you are. If still low, I would add a half dose for 2 days and check in a couple of days.

 

[Eva]

I am not an expert, but I will share my views until the real experts answer your post.

Firt, the 1.5 result is not due to having missed yesterday's dose. It normally takes three days before any dose change is detected! So, you may need to up your dose a little bit, but wait until you heart from others or from your doctor's office.

Definitely, you go ahead and take the missed dose if you have not yet done so. I take the missed pill as soon as I remember!

 

[Protimenow]

Dosing isn't particularly time sensitive. I usually take mine before I go to bed -- sometimes it's at 10:30 PM, sometimes it's closer to 2 AM. It really doesn't matter much.

Warfarin's effects aren't like the effects of a missed insulin dose. The three, four, or five hour range I use for my daily dose doesn't have much effect on my INR.

The advice you've gotten from those who responded is good -- you may have to adjust your dosage because of that 1.5. The 1.5 has little or nothing to do with the dose you missed last night. You should be able to safely take the missed dose in the morning, and take your usual nightly dose tonight. On your doctor's advice, you'll probably want to increase your dose anyway, to bring you in range.

Is this the first time your INR has been this low? Have you made any dietary changes, or major changes in your activity? Are you taking any new medications (even the organic ones from a vitamin store)? There may be some relatively subtle changes in diet, medications or activity that made it drop.

The missed/late dose wouldn't have done this.

 

[Orangebrittainy]

Doctor got back to me today, I have to take 10 mg today and tomorrow. (which is 4 pills a day) When I tested last thursday I was at 2.3. I go back on friday to retest.

Its the first time it has been this low. I have been digging and digging in my head for dietary changes. I eat almost the same thing everyday right now because my BIL and SIL are the ones shopping so my choices have been extremely limited. I cannot wait to be able to get out and fix it because my diet has no nutritional value to it at all. BIL does not eat anything healthy, since they are staying with us Food is about the only thing they contribute to the household right now. George and I have NO extra money. I am having to dig in my 4 year old's change jar to renew my coumadin prescription since I will finish a week early and we aren't paid until another week from now. The in laws will be moving soon, so when I get back to work I can fix the nutrition, I figured I would have to toy with my dosage levels at that point and was going to arrange to be tested more frequently.

My diet for the last two days has been 2 waffles or 2 pieces of toast in the morning. 1 Grilled cheese sandwich and a half pack of ramen noodles for lunch (sharing with my son). And Chicken nuggets and mac and cheese one night, chicken breasts and rice the next.

I did drink a carnation shake a few days ago. I hadn't had to have them in the last two weeks, but since my diet has no nutrition to it, I thought it would help. Maybe that did it?

As for activity levels, I am gradually becoming more active every day. (I am 5 weeks post op) The doctor had me to start taking Vitamin D supplements on Friday because test results showed I was extremely low.

 

[njean]

Aye caramba girl! :eek2:

Do you have a pill box? If not, get one & train yourself to take the coumadin earlier in the evening if need be. I take my evening meds, 3 other meds plus the coumadin, at around 5 pm every evening. This plus the pill box, keeps me from ever forgetting to take them. I've been on coumadin for 35 years & I think I may have forgotten to take it maybe 3 times in all those years.

And I hate to sound motherly or bossy to you, darling, but chicken nuggets, mac & cheese, are very high in sodium.....not good for heart patients! I've gotten to where I read every label of everything i buy & always go for the lowest in sodium or no sodium at all. Hard to get used to but alot better for you in the long run!

Stay well!

 

[dick0236]

The first thing I would do, if I had a 1.5, is retest to confirm the 1.5. If the retest was really that low, I would increase my weekly dose by 15-20% (per my Al Ludwick Protocol). Since you also missed a dose, I would go with the 20% for a week and retest......or take the missed dose now and increase by 15% for the next week and retest. I don't believe that dosing times are "time critical".....but you should consistently take the med in the AM, early PM, dinner time or late PM. Warfarin takes a few days to affect your INR and a few hours, one way or another, in taking the pill makes little differance.

 

[Protimenow]

That Instant Breakfast may have helped bring the INR down, but if your diet changed from real food to the things that you're now eating, it's probably no surprise that your INR changed.

I feel your pain, and am sorry that you have to endure on just foods that may stave off hunger pains, but don't really nourish. Your body may be consuming itself from the inside out (metabolising stored fat just to keep going), and this may also effect your INR

One thought -- if you're still taking Coumadin -- consider changing to generic Warfarin. Depending on what state you live in, you may be able to get 90 5 mg Warfarin pills for as little as $10 at Krogers/Ralphs, Walmart, or Target pharmacies. These 5 mg pills are scored in the middle, so you can break them into 2.5 mg doses, if necessary. If you're actually taking more than 2.5/day, the 10 mg pills can be broken into 5 mg. SEE IF THAT DOCTOR WILL PRESCRIBE GENERICS IN A DOSAGE YOU CAN BREAK IN HALF. Also, see if that doctor may have some Coumadin samples to help you get through.

Personally, I'm taking 7 mg/day - and this equates to 1/2 of a 4 mg pill and 1/2 of a 5 mg pill every day - and costs about a dime a day. When I was taking Coumadin, if I recall correctly, it was 40 cents or more a pill (years ago). Switching to generic, and getting pills that you can break in half, might help you to save enough money to let you get more protein into your diet.

If you're only five weeks post-op, it may take a while to get over the see-saw effect of initial anticoagulation. It's probably better to shoot a bit high for your INR than to risk dropping too low.

Your body is still working hard to heal you - this is not a good time to shortchange it (although I REALLY DO understand what you're going through).

I hope things get good for you right away.

 

[Orangebrittainy]

Thanks everyone for the input!! I am hoping we will get this fixed soon!

 

[Freddie]

Carnation Instant Breakfast

Nutrition Facts
Serving Size: 1 package
Amount per Serving

* Calories 130 Calories from Fat 9% Daily Value *

* Total Fat 1g 2%
* Saturated Fat 0g 0%
* Trans Fat 0g
* Sodium 135mg 6%
* Potassium 240mg 7%
* Total Carbohydrate 25g 8%
* Dietary Fiber 0g 0%
* Sugars 18g
* Protein 6g 12%

* Vitamin A 35%
* Vitamin C 45%
* Calcium 25%
* Iron 25%
* Vitamin D 0%
* Vitamin E 25%
* Vitamin K 25%
* Thiamin (B1)20%
* Riboflavin (B2)8%
* Niacin (B3)25%
* Vitamin B6 20%
* Folic Acid (Folate)20%
* Vitamin B12 10%
* Magnesium 20%
* Panthothenic Acid 20%
* Zinc 20%
* Copper 25%
* Manganese 25%

Est. Percent of Calories from:
Fat 6.9% Carbs 76.9%
Protein 18.5%


Read more: http://www.livestrong.com/thedailyp...tion/instant-breakfast-dry-mix/#ixzz12wQ7doJz

 

[Orangebrittainy]

Wow! They tried to get me to drink 3 a day in the hospital because I had zero appetite. I usually finished one. I figured they would be safe. That explains some of the drop. Not so sure it would explain the whole thing. But I will talk to the nurse about those in the morning.

 

[Freddie]

It would take 24 to 36 hours before your INR is effected by a missed dose.

 

[Protimenow]

While you were in the hospital, they probably gave you other medications that would have helped keep you anticoagulated while you were there.

At home, it may be a different matter. However, if your MD is able to test as often as he/she thinks you should be tested, this may almost be as easy as using your own meter. I can't see much wrong with using your insurance coverage for more frequent tests while you're stabilizing your INR (unless it's a long drive to the doctor's office). When you're able to have a real diet, you should be able to better regulate your dosage and achieve an INR within range.

 

[kfay]

The other big thing to consider in her INR dropping like that is that she is becoming more active so the amount of coumadin they had her on in the hospital is probably not going to be enough to sustain her as she heals and gets back to living her normal life.

Kim

 

[ALCapshaw2]

Whenever I miss a dose, I take the missed dose IMMEDIATELY to minimize the 'down time'.

If it is less than 12 hours since my usual time for taking my Warfarin, I just continue my usual schedule.

If it is over 12 hours, I split the Next Dose in half, take 1/2 at the usual time (before bed) and the other half the next morning to avoid 'double dosing' at one time.

I agree with the others, First, double check to make sure the 1.5 INR reading was not an error.
If not, then you need to increase your normal weekly dose as suggested.

I *assume* you have already had your surgery (your profile suggests that you have not had surgery yet). If so, when was your surgery? It is not uncommon for INR to drop as you recover and your metabolism increases with increasing activity.

What is your Normal Dosing Schedule?
I'm concerned about your Doctor's recommendation of 10 mg for the next 2 days.
If you take 5 mg/day, that is a 100% increase for those 2 days. If less, that is a HUGE increase.
Either way, that could cause your INR to go high after which he/they will likely suggest lowering your dose. This is how patents get into the Roller Coaster Effect. NOT GOOD. I'm wondering how many Coumadin patients this Doctor manages and if he is "up to date" on the latest dosing protocol (which does NOT recommend "Loading Doses" which have been proven to cause the Roller Coaster Effect).

I also wonder how long your INR has been low. If more than a few days, it is not uncommon for Coumadin Care Providers to recommend protecting yourself with Lovenox Injections until your INR returns to your target range.

'AL Capshaw'

 

[skrob49]

I remember, my wife was on 2mg upon hospital discharge. But INR keeps dropping. Probably due to stopping of hospital medication and increased of activity after discharge. She is now on borderline INR 2.0. we are thinking to add Omega3 as supplement - any comments from the old timers out there??

 

[Jkm7]

A way to stretch your Prescription dollar is to get larger Rx from your doctor for larger milligram than he orders for you and then split the pill. The cost for 10 mg is usually the same as the price for 5 mg. If you split the pill to the dose your doctor wants you to take, you get two pills for the price of one.

Obviously, same practice works for 4 mg splitting into two - 2 mg tablets etc
This only works for pills that are scored down the center.

 

[ALCapshaw2]

I remember, my wife was on 2mg upon hospital discharge. But INR keeps dropping. Probably due to stopping of hospital medication and increased of activity after discharge. She is now on borderline INR 2.0. we are thinking to add Omega3 as supplement - any comments from the old timers out there??

It is usually best to start a new thread for New Questions to gain a wider audience and not confuse two issues / members within a single thread.

FYI, it is not uncommon for INR to drop as the patient becomes more active.
Higher metabolism typically causes INR to decline.

Who is managing your wifes INR Testing and Dosing?
Is she testing at home? Does she have a Dosing Guide?
There are various Dosing Guides available on-line as well as an online Dosing Calculator.
See the "stickies" at the top of the Anti-Coagulation Forum Listing for more information on this issue.

'AL Capshaw'