I'm going to need an antibiotic next week for a tooth abscess and doing an advance check most seem to be contraindicated if on Warfarin. What have ones here found to suit their medication.
One report of a woman given Clindamycin whose INR went up to 13 after seven days. Evidently most reduce the production of vitamin K from gut flora.
Antibiotics are not so much contraindicated, they can just mess up your INR. They do vary in their tendency to do this. When I had an eye infection a few years ago we tried three before settling on Augmentin. In my case INR was always below range. You will have to go with whatever cures the infection. Be prepared for more frequent testing for a few weeks. This malarkey was one of several reasons that made me switch to an NOAC.
Hi,
Have been treated with various antibiotics and just had my INR checked regularly and warfarin adjusted accordingly, there are always ways around it.
Wendi
Just phone up your INR clinic and ask for a booking next week. They'll fit you in and will also want to retest you until the antibiotics have worn off.
Mike 'in exactly the same situation at the moment due to a tooth infection'
There's a lot of it around.
I don't want to go back to the NHS surgery I have used for the past ten years as it has changed hands and now they have none with English as their first language.
Generally speaking you should always request an early INR test if you start or stop any medication. Antibiotics can affect INR and in most cases the doctor prescribing them will tell you when to have your next test.
Agree with the comments about elevation in INR and need to have level checked frequently whilst taking antibiotics.
In my case, GP who prescribed an antibiotic did not warn me to arrange a check. It was only whenI had to go to Walk In Clinic as I reacted with a rash that the duty GP took INR himself, that was high, and arranged follow ups and adjustment of Warfarin dose, that he did himself in case I could not get an appointment elsewhere.
Firstly check with your dentist by phone in advance as to which antibiotic they are proposing (name, dose, number of times a day and the duration of the course) reminding them of your medication and condition. Tell then you need to know this because of contacting the anticoagulation clinic.
Then phone up your anticoagulation service and tell them the details. They will then be able to advise you as to what adjustments you need to make to your warfarin dose over the phone there and then. They can do this using their knowledge in conjunction with your warfarin history.
If you have had an INR test in the last few weeks they probably won't want to do one but they could very well want you to have one within a few days or a week of starting the antibiotic.
This works for me and I have had to take antibiotics on two separate occasions this year (Add to dictionary).
I have had antibiotics previously without much variance in my INR. This time I am concerned as my wife who is allergic to penicillin has a tooth infection and was in severe pain and was given Metronidazole last week by our new private dentist. The only medication she takes is a low dose of thyroxine so nothing to cause an interaction but she had a severe reaction to the antibiotic an hour after taking the first tablet. I spoke to the pharmacy who said to ask the dentist for a different one. He later phoned the pharmacy several hours later and called us to say that he had never had a patient with such a severe side effect and she should see her GP in case she had something else wrong with her. He even suggested that she take another one to see if it happened again we said no to Russian Roulette. We went to the doctor the next day and he confirmed it as a known side effect and gave her a prescription for an antibiotic she has been O.K. with in the past.
That made me read the information leaflets that said to tell your GP if you are taking warfarin and to Google warfarin and antibiotic side effects with the answers being quite worrying.
I have a dying much filled molar that often twinges that now has an inflamed area at one side of it and a crowned molar that is tender round it and the gum a bit swollen. That I had a few times several years ago and my dentist at that time found it was caused by a build up of gunge around it that had become infected.
My last INR test (2.5) was September 7th and I am at the moment on two monthly checks.
Metronidazole, also known as Flagyl, is a pretty hard core drug and almost everyone has some bad reaction to it. However for tooth infections it is the drug of choice for those who can tolerate it.
Recently had 2 x courses of doxycycline ( can't take any penicillin related ones ) both times got INR appoint during course, warfarin levels adjusted and rechecked following week and again in two weeks times or as required. Levels rise with doxycycline. Notices plastered over walls in our Warfarin clinic to always contact them when starting any antibiotic
We don't have a clinic as such just two of the nurses at the GP practice who do it on certain days. The INR clinic at the hospital was stopped. My concern is that they are not experts nor are the GPs. When I was prescribed Amiodarone while already taking warfarin she could not understand the change in my INR. After two weeks on an unchanged dose and rising INR I did the research and told them.
Wow. If they are in the practice doing it they are supposed to receive special training which includes things such as what affects the INR. Look up to see if there is any anticoagulation clinic within the CCG.
Sometimes they go and ask a doctor for advice but that never seems to be all that good. The clinic day I normally go is my GP's day off. But he did not know about the amiodarone effect. The local pharmacist said that he must have forgotten. Though a couple of time since I have heard her ask customers getting it if it for the first time and what they have been told about it.
Gosh we are lucky here. Even though I am on weekly blood tests still told to phone up straight away for any change in medication rather than submit the form at the next blood test.
For some reason all areas run different systems. At least I get my result and any new dosage in the few minutes I am at the GP's surgery.
Most GP's would evidently like to be rid of testing as it takes up so much time. In Brighton it is contracted out to pharmacies who draw blood and send it off for testing and have to phone the patient back with the result and any change of dosage.
Round here it's run by the CCG although a few surgeries do their own. The clinics are mostly in one of the local hospitals. In my case what was the plc local small hospital. Less than 2 miles away.
I started off at the local hospital for about ten weeks when first taking warfarin four years ago. It was a two hour stint.
You checked in with a vast number of others and waited to be called to have blood taken. You sat for another hour to be called for the result and to get your new dosage.
1. Doctors often forget, or they get mixed up. Some pretend to know more than they do. Fortunately, there are several sources of information in your power to consult.
a. The BNF. The British National Formulary. Online you have free access in UK. Appendix 1, drug interactions
b. Various drug interactions sites. Note, the advice is often quite vague and you need to consult a few of them
2. Often the interactions are suspected but not proven. Act accordingly
3. Some antibiotics increase the INR and some decrease it. Both are possible.
4. Check your INR BEFORE taking them. If your INR is on the low side, you can risk a moderate interaction/increase without changing the dose. You cannot risk a decrease, therefore a small change of 10-15% would cover you. Similar reasoning applies for the high end.
5. Some antibiotics have a large effect. Ask the doctor to prescribe one with lower effect
6. My experience is that Augmentin has no effect, and this is the first choice. When travelling, for emergencies, I carry Azithromycin and take it for up to 6 days despite the recommended 3 days only.
7. The other major problem is the time delay. With the 2 day delay built in to Warfarin, yet the effect kicks in faster with some drugs, and information on this is hard to find. Therefore, if I knew I needed to change my dose, and if I had a choice, I would change the dose a day before starting the antibiotics, and change back again a day before stopping.
Life can get more interesting than that. I once had a tooth out in hospital while abroad, using the heparin bridge. I had not re-stabilised, at a new dosage, when I went to UK. Then the doctor messed up my blood test, and prescribed an antibiotic byt first class post with known severe action on the INR. It was bank holiday. Sunday I went to boots, the pharmacist took time to consult books and show me. I was then on my own, without a baseline. I reasoned carefully, balancing probabilities and risks, and established a path. When I finally got a test (I was too busy travelling to go for a test) a few days after finishing, I was bang in the middle of my range. Note, I accept a wide range, 2.5 to 5.0 preferring 3.0 to 4.0 so perhaps I had it easier.
Conclusion, there is a lot you can do yourself. If your conclusions differ to the health worker, then you can ask them why they think so, and ask them to show you what is wrong with your reasoning!! That last question usually puts them on the spot, and you can see if they are reasoning, or just being dogmatic.
I use the online BNF and other sources. Doctors still seem to prefer the book with a lot less detail.
I have no way of getting a test except on their clinic days of Monday and Wednesday. They say that their computer has to be set up for it on those days. All I would need would be them to check it on their machine without recording it. There is a walk in clinic at the station but I don't know if they would do it and it is always very busy. I once looked in on a Saturday and turned away. I went to one in Exeter once when on holiday with a problem and sat there for four hours.
I agree, the BNF is extremely concise. Unfortunately, it is often left to patients to do more research. We have the time, but not everyone has the background or the skills. I think most people, even those without a science background, could learn well enough to
a. present information to doctors for their comment -- ie we do their homework for them.
b. We take more and more of the decisions.
c. know where the limits are: personal, and for the doctors
The postcode lottery! Maybe you can find out which GP surgery in your area, which does the test strips test, then declare yourself a temporary resident and ask for a test! Seriously! I once suggested to the British Heart Foundation that they produce and keep a list of places where you could get an emergency INR. Of course, no one took any notice of something so practical.
It is precisely that problem that stopped me trying to get an INR when I had an emergency, and I handled it myself, double checking my last lines of reasoning with my wife. And that is why a very sensible doctor recommended me to have my own machine.
Why is getting an INR test such a big deal? -- especially if you are self-dosing.
I have been asked by consultants if I had been in the medical profession because of the way I presented my symptoms and health history when as often happens at our local hospital they did not have my notes.
There must be a list of places to get INR tests in the UK. A neighbour who travels a lot to Spain and the Spanish Islands has been told where he can have tests done.
Go for it! My mother was in no way medical, but right to the end she kept a clear diary for diabetes etc. Everyone loved her for it.
Now I google it I find as usual, inexplicably high prices in UK, (minimum of 50 pounds with the special offer!) and misinformation about Tunisia which I know well. Here, walk into any lab, and even small towns have them. Cost is about 4 pounds, result is often only 30-60 minutes. Nowadays, you can even get by without knowing French, especially if you choose one of the newer labs.
But, given the choice between endless hassle, for a one off test and daylight paying a high fee, I might just shrug my shoulders and say, 'force majeur' and cough up.
Just tried it for France. tripadvisor.com/ShowTopic-g...
Just as I thought: go direct to any lab, the cost is less than 15 Euro. They will email you the result. Now that is a realistic fair price.
Well spotted. I would never have thought to look there. So long as the pharmacy staff speak English. It will probably work for other countries.
I once went to a pharmacy in Quebec City ( not for INR) and neither the pharmacist or his staff spoke English. The French Canadians are more French than The French.
Believe me there are quite a few who understand everything in English and could happily communicate in fluent English but choose not to!!! If the discussion was about them being given $1 million if they did certain language tasks they would score 10 / 10 !!!!!
We stayed in a small hotel where the owner and his wife did not speak English. When we asked how to get to a couple of places she got her teenage kids to translate.
First time we went to China very few spoke English. The next twice every one wanted to practice their English as there was a programme on TV teaching English called Follow Me.
When we turned our hotel TV on David Lean's version of Oliver Twist was on surprisingly followed by the Benny Hill show.
Seeing dentist tomorrow afternoon. My wife had an appointment there with the hygienist this morning. I went to the osteopath two doors away this afternoon. That street is seeing a lot of my credit card 
The advice for dentists for patients with various cardiology problems.
Hello - isn't this site interesting and informative - I first started posting around June after my Husband had been in and out of Hospital four times in the matter of weeks after his first AF in April. He was started on Warfarin and Bisoprolol but after a very short time became very poorly indeed with the 'Bisoprolol effect' He was (and still is) also taking Tamsulosin and Dapsone,However the Doctor then prescribed Digoxin and he then felt much better for a while until his legs started to get very swollen so then came Furosemide 40mg x2 but then this was upped to 3 x 49mg daily. Until ten days ago this (the Furosemide) was changed to Bumetanide 1mg after his legs were now twice the size and looking like the colour of raw meat with a dense rash (the rash like red pin pricks cover his body) but his legs are taut and blistering especially on his legs below the knees. When he came off the Bumetanide he was also given a anti-histermine Cetirizine Dihydrochloride which has since been chanaged to Fexofenadine 120mg x 1 but now Antibiotics (Clarithromycin x 2 250mg) were prescribed after the INR nurse saw his legs when he went for regular checkup on Tuesday - that was 2.3 - she called the Doctor. OK, but with this cocktail of drugs we just don't know what will happen next.Sorry this is confusing - but can anyone say anything, any ideas? that might help. Thanks
Omnicef antibiotic is the best for you. It is ok with wafaran.
Just checked and it is listed as discontinued in March
Perhaps because of its price. Tetracylne is OK too.
There was a reference to a generic version but I could not see a name for it.
Thank you.
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