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Heart Disease (Expert Forum)
INR
Answered by
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INR
by Robert-A, Oct 13, 1998 12:00AM
My Mitral valve was replaced (Carbomedics) at the Cleveland Clinic Florida in late January. I was discharged in 4 days and had a very easy quick recovery. On coumadin, my INR had been running 2.5 to 3.1 untill 3 days ago when I found blood (a lot) in my urine. My doctor prescribed another PT, urine specimin, and complete blood count. Diagnosis was an infection in my prostate and an INR of 10 (ten). My question: Is it possible to go from 3 to 10 in three weeks with no diet change? The only possibilty I can think of, is the addition of 50 mg per day of Atenolol for blood pressure, 3 or 4 days before this problem began. By the way, I stopped the Atenolol.
Thank You
Doctor's Answer
by Cleveland Clinic, MD, Oct 13, 1998 12:00AM
, Oct 13, 1998 12:00AMDear Robert,
It is possible for jumps in the INR to occur and this is why careful monitoring is important. Atenolol may interact with coumadin (generic warfarin). Common foods such as grapefruit juice, leafy green vegetables and many drugs can also change coumadin levels. Smoking also changes drug levels.
The following is information on warfarin and it's drug interactions.
Coumadin (generic name Warfarin) is a anticoagulant (blood thinner) that is used for a variety of conditions. Common reasons for coumadin use are in atrial fibrillation to reduce the risk of stroke, in persons with clotting disorders, in persons with mechanical heart valves, and sometimes in people with severe heart failure. The usual dosage is somewhere between 1 and 15 mg a day. Potential side effects include bleeding, hair loss, nausea, vomiting, stomach cramps, diarrhea and leukopenia (low blood cell count). The half life (amount of time for half the drug to be cleared from the body is 42 hours but varies widely depending on the individual).
Many drugs interact with coumadin and may cause more anticoagulation effect (clofibrate, diazoxide, ethacrynic acid, nalidixic acid, phenylbutazone, salicylates, aspirin, sulfonamides, alcohol, allopurinol, amiodarone, cimetidind, phenytoin, erythromycin, gemfibrozil, propranolol, thyroid drugs) or decreased anticoagulation effect (smoking, estrogens, vitamin K, aluminum hydroxide - antiacids, cholestipol, spironolactone). See complete list below. The effects of coumadin must be carefully monitored by a blood test called an INR. Usually this is checked more often at the onset of taking the drug and less often once a steady state has been reached. Therapeutic INR is usually 2 to 3 depending on the condition being treated.
Pregnant women and those with a hypersensitivity to coumadin should not take this medication.
The medication should not be taken with food and any signs of bleeding should be reported to your doctor. Use a soft toothbrush, avoid hazardous activities, carry Medi-Alert ID identifying drug useage and notify your doctor if you have any dark brown urine or red or tarry black stools.
Known Drug interactions with Warfarin
Increased Effect :
Highly Probable
Alcohol (if concomitant liver disease)
Amiodarone
Cimetadine
Clofibrate
Cotrimoxazole
Erythromycin
Fluconazole
Isoniazid
Metronidazole
Miconazole
Omeprazole
Phenylbutazone
Piroxicam
Propafenone
Propanolol
Sulfinpyrazone
Probable
Acetaminophen (Tylenol®)
Anabolic steroids
Aspirin
Chloral Hydrate
Ciprofloxacin
Dextropropoxyphene
Disulriam
Quinidine
Phenytoin (Dilantin®)
Simvastatin
Tamoxifen
Tetracycline
Influenza vaccine
Possible
Disopyramide
5-Fluorouracil
Ifosphamide
Lovastatin
Metolazone
Nalidixic Acid
Norfloxacin
Ofloxacin
Topical salicylates
Sulindac
Tometin
Doubtful
Cefamandole
Cefazolin
Gemfibrozil
Heparin
Indomethacin
Sulfisoxazole
Decreased Effect
Highly Probably
Barbiturates
Carbamazepine
Chlorodiazepoxide
Cholestyramine
Griseofulvin
Nafcillin
Rifampin
Sucralfate
Probable
Dicloxacillin
Possible
Azathioprine
Cyclosporine
Etrelinate
Trazodone
No Effect
Highly Probable
Alcohol (if no liver disease)
Antacids
Atenolol
Bumetanide
Diflunisal
Enoxacin
Famotidine
Felodipine
Fluoxetine
Ketorolac
Metoprolol
Moricizine
Naproxen
Nitrazepam
Nizatidine
Psyllium
Ranitidine
Probable
Ibuprofen
Ketoconazole
Ketoprofen
Doubtful
Diltiazem
Tobacco
Vancomycin
Other Web Sites:
http://search.excite.com/search.gw?c=web&s=coumadin+or+warfarin&showSummary=false&start=20&perPage=20&prev=Previous+Results
Package insert and patient information:
http://www.dupontmerck.com/coumadin/cnsmindx.htm
Food interactions with coumadin:
http://www.rncentral.com/library/health/warfarin.html
Patient information and links:
http://www.hsforum.com/HeartSurgery/TLC/Coumadin/Coumadin.hsf
I hope you find this information useful. Information provided in the heart forum is for general purposes only. Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.
Coumadin
