Too much warfarin

[Adele95]

My inr was 5.8, on 29 of January, then 4.1 last Friday so my nurse told me to take 4mg, which I have, until tonight, I think I've taken 12mg, mind not on the task in hand, I've masses myself sick and I'm waiting for nhs to call back, as anyone got any advice please.?

[pip_pip]

I think you need to be more aware. However it will sort itself out over the next few days IF you stay to your regular dose. I would suggest not taking any tomorrow. However, 3 times your dose is a lot. See what they say if they want you to have blood check and or antidote (which is unlikely).

Phil

[Adele95 in reply to pip_pip]

Thankyou phil

[jeanjeannie50]

Have the NHS rang you back, if so what have they advised? I've occasionally been the other way and forgotten to take my warfarin. Sometimes it's easy to get confused as to whether you've taken it or not. I put my tablets into a seven day tablet box which can help, but I've sometimes seen the day before's tablets still in there. I hate to think what I'd be like without that pill box.

Jean

[Adele95 in reply to jeanjeannie50]

No they haven't rang me back yet, I made myself sick within about 15, mins, I've got a pill box but haven't filled it for the week at the time I took my pills, I have since filled it with the right dosege. Lol.

[jeanjeannie50 in reply to Adele95]

Did they ever ring back?

Jean

[seasider18 in reply to jeanjeannie50]

When I as taking warfarin I used to take just before I put the potatoes on.

[Alil]

That's reminded me I haven't taken mine yet! Thank you

[Susiebelle]

I count out my tablets and put them into a weekly tray - do not know where I would be without it - best present my sister bought me

[Hidden in reply to Susiebelle]

£1.50 pill box best present ever !!! I'd get a new sister 😉

[Susiebelle in reply to Hidden]

Best present ever 😀

[PeterWh in reply to Susiebelle]

Just a few words of warning to EVERYONE taking multiple medicines and using a pill box:

..... It is VERY important to check the instruction leaflets of every tablet / capsule that you put in there as some must be kept in the blister pack until you are actually going to take them and some others must be kept in the dark. You can always achieve this by cutting the blister pack into individual tablets and putting in the pill box.

..... Check teh minimum and maximum storage temperature as some people keep tablets them on the window sill or table which can get very hot from sunlight or hot if there is a radiator or fire nearby and if on a window sill cold from draughts. Conservatories are often bad for this!!!!

[Enjoy]

Each morning I put my warfarin box/boxes in the spoon compartment of my cutlery drawer. I know I will have a cuppa in the evening and seeing the warfarin on top of the spoons reminds me.

I have also made myself a chart with all my meds on it, and tick each one off as I take it. Currently 7 if I include my inhalers.

Hope this helps.

[SteveBiss]

I have a App on my mobile called Care4today which will buzz when you have to take pills. It takes time to set up, but is very helpful after that. It will also let you know when you have to reorder your medication.

[Hidden]

I have a pill box, also reminders set on my phone and my laptop, plus an Excel file where I fill in what I take every day. I still forget to take them sometimes !!! But have never overdosed because of the pill box, as long as you know what day it is .

One extra worry for me was the different coloured Warfarin pills. I restricted myself to one colour to avoid confusion. Had to split pills though.

Koll

[Hidden]

I have a pill box that has an alarm and I set my phone alarm too... Three times as much is a lot, what did the NHS say?

Our pharmacist didn't give me the 5mg pink tablets last time for some reason, so I am having to make up the dose with blue and brown (8mg, two blue, two brown). So many tablets is making me gag!

I don't know whether it's the doctors or the pharmacist decided to kick the pink ones, but I wish they hadn't, like you Koll I worry that I'm getting the dose right.

[Adele95]

The nhs came knocking at my door at midnight, no phone call , I didn't hear it then they phoned me asking me to come and have my inr checked, I have 2 children and no one to look after them so I told them this then I said I'd go and see the nurse in the morning, which I have done and my inr was 1.4, low for me but it wasn't through the roof, she said it was good that I'd made myself sick.

[Hidden in reply to Adele95]

Good to know that you are OK Adele . You won't be making that mistake again !

Also something to bear in mind for the rest of us if we should overdose to this extent .

Some years back I double dosed on a top dose of Disopyramide in the midst of getting kids off to school and my heart rate ' took off '. I phoned AE and they were able to calm me down and reassure.

[Adele95]

Thank you everyone for your concern and your advice, no I won't be doing it again, lol.x

[ILowe]

OK. Several points. A bit more detail would have helped.

First you had 5.8 then presumably reduced the dosage which brought it down to a healthy 4.1. All would have been well, except for the delicate question, was this 5.8 an exception (meriting no dose change, or the procedure of miss one day then resume normal dosing and see if it goes high again).

Then, in the middle of all this, you took a treble dose. In this case you were sure you had taken a treble dose. You also thought your INR was high already, so increasing the risk.

m.hopkinsmedicine.org/hemat...

According to this article, you do not need to fear a temporary high INR of up to 9.0 provided you do not do something stupid, and provided there are no other danger signs like bruises or bleeding. They say to stop INR, and test daily until in range (say, less than 4) then resume *normal* dosing, given that you know the cause of the temporary increase. Consider taking Vitamin K of 1-2mg if less than 9, or 5-10mg if over 9.

I have oral Vit K available. You can get it in 0.1mg tablets. The recommendation is for when the INR is known to be really high. The trouble for you with a triple dose is you knew the effect would peak roughly two days later. Therefore, in your shoes I would have

1. missed a day,

2. taken half your normal dosage of Warfarin on day two, since you want to avoid swings

3. Measured it again on day 3. Only if still dangerously high I would consider Vit K.

Even without access to testing, (for instance, if travelling) I would have done that, since you know the cause, and the body will work it out over the next 10 days or so. The fact that even an INR of 9 is not that bad, especially when you know the temporary cause, is reassuring.

On the other hand, high INR and bruising/bleeding is a sign for instant action. Oral Vit K is nearly as good as Intravenous. If not sure, then go to A and E.