Warfarin

[Marsha]

Hi, I've had a Aortic valve replacement and a Mitral valve repaired in Feb. of this year. I'm on Warfain and Coumadin and haven't been able to get my levels where they should be, they keep bouncing around. My question is, has anyone heard that taking Coumadin and Warfarin together affects your levels. Talked to a nurse and she thought that it could do that. Has anyone else had this problem.
Thanks
Marsha

[baradonai]

Warfarin was a generic form of Coumadin... or vice versa.:confused:

[Christina]

Marsha,

Welcome.:) :) You've come to the right place to ask questions.
I've been on this forum for 6 years and haven't come across anyone taking Coumadin and Warfarin together at the same time. FYI...Coumadin is the brand name and Warfarin the generic name. They have the same effect.
What I do know is that it is very difficult for some doctors/nurses, medical professionals to monitor this drug and it really takes someone experienced to do it correctly. Most medical personnel that I have come across with in the past 6 years have no clue. That's why I hometest with the Protime and am taking no risks going to clinics or labs.
If you have more questions, please gear them to Al Lodwick. He runs a Coumadin clinic in Colorado and can tell you more.

[Ross]

Marsha welcome

Can you provide more information such as your dosage for the week, how you take it, what your diet is like, how often your tested and how often your dose is changed? Oh yeah, other medications too?

As Christine said, it's usually the clinic managing a person that doesn't know what they are doing that causes this.

[RandyL]

you are talking about the same drug. My prescription for coumadin ends up being Jantoven after the insurance company gets hold of it. It's all the same, just watch your INR and you will be fine.

[ALCapshaw2]

WHY are you taking BOTH Coumadin and Warfarin?

WHO prescribed them? (The same person? or two different people/doctors?)

WHO is managing your Coumadin AND Warfarin?

As everyone has already said, Coumadin and Warfarin are the same animal, called by different names.

And as has already been said, the most common cause of someone not being able to become stabilized is POOR MANAGEMENT by someone who does NOT know how Coumadin and/or Warfarin work.

'AL Capshaw'

[ALCapshaw2]

One of the Best Places to learn everything you need to know about Coumadin / Warfarin is on AL Lodwick's website www.warfarinfo.com AL is a registered anticoagulation specialist, author, and expert witness who heads a Coumadin Clinic in Pueblo Colorado. He also monitors the Anti-Coagulation Forum on this webside and will answer questions, either on the forum or via e-mail or private mail.

'AL Capshaw'

[allodwick]

Marsha,

You are in a heap of trouble if you are taking both warfarin and Coumadin. You are in even worse trouble if the nurse didn't know that they were the same and is trying to manage your warfarin. You need to find competent medical care before you eat lunch today.

[Marsha]

I appreciate your feed back. Did some more research and found that the two drugs don't mix real well. Am going to stick with the warfarin only and see what happens. I had my prescription filled at two different pharmacies and didn't realize that I couldn't mix the two. I just figured they were both the same. Geeze you learn something new every day. Again thank you all very much.
Marsha

[Ross]

I've mixed them before and didn't have a problem. I'm just wondering.

[baradonai]

I appreciate your feed back. Did some more research and found that the two drugs don't mix real well. Am going to stick with the warfarin only and see what happens. I had my prescription filled at two different pharmacies and didn't realize that I couldn't mix the two. I just figured they were both the same. Geeze you learn something new every day. Again thank you all very much.
Marsha

If Warfarin and Coumadin are the same thing, how can it matter if you mix them? Kinda like I mixed water and H20 together.:confused:

I can see if one manufacturer doesn't mix the stuff quite right. With that I would stick to one or the other.

[ALCapshaw2]

Without more information on how your Coumadin / Warfarin is being managed, no one on this site will be able to offer any specific recommendations.

It would be helpful to know how often your INR is tested and how (veinous draw or finger stick machine), what your target INR range is, and what dosage recommendations (especially changes in dose) are suggested after each INR test. It would also be helpful to know who does your testing and advises what dose to take after each test.

Warfarin is the Generic Form of (Brand Name) Coumadin. Their chemical composition is IDENTICAL. Several members (including myself) have switched from Coumadin to (generic) Warfarin, with NO change in INR, because insurance companies often won't cover the difference in cost.

If you want to get stabilized, it would help if you learned as much about Coumadin Management as possible. Again, one of the best places to do that is at www.warfarinfo.com Reading through some of the older posts on this Forum may also be helpful.

'AL Capshaw'

[Georgia]

Hey, pharmacists, doctors, other experts out there: is warfarin available as a liquid? Is it available as one of those "melt on the tongue" tabs? If not, I'm curious why not? Seems it'd be a good thing, considering there are small kids taking it, as well as seniors who notoriously have trouble swallowing pills. And there'll be more people who need it who've had gastric bypass and don't seem to absorb pills well. This is just curiosity.

[DrAllan]

Hi Georgia,

I’m not sure your question belongs in this thread which is about a patient being given two different prescriptions for the same chemical (with different brand/generic names) and the management of the INR seems to be ignoring the duplicate dosing.

Nevertheless, let me answer your question. Warfarin is in soluble in water so that you cannot make a water based liquid form. Many other medications are dissolved in alcohol. Warfarin is not soluble to any extent in alcohol either. The “"melt on the tongue" strips dissolve rapidly compared to sucking on a sugar based lozenge. The contained ingredient needs to be water soluble to be absorbed and not felt on the tongue as a solid particle. Neither mode of oral delivery will affect the problems of gastric absorption of drugs seen in gastric bypass patients.

[allodwick]

Marsha,

Were you using warfarin and Coumadin on the same day or just taking one or the other.

It is the total difference that is important. For instance if you took a 2 mg Coumadin and a 3 mg warfarin to make the daily dose of 5 mg that would be acceptable. A waste of money perhaps because of 2 co-pays but otherwise not harmful.

However, I have seen several people who did not know that they were the same and took nearly fatal overdoses.

[Bob M.]

I asked my surgeon if there was a difference in Coumadin and Warfarin with respect to INR variation. The nurse in the clinic I use to have my PT checked said that brand name Coumadin will vary less with respect to INR than will Warfarin. My surgeon said that Warfarin (genaric form of Coumadin) will vary, but to stick with the same manufacturer of the genaric.

[ALCapshaw2]

The nurse in the clinic I use to have my PT checked said that brand name Coumadin will vary less with respect to INR than will Warfarin.

One of the manufacturers of Coumadin (ownership of that trade name moved around if I recall correctly) liked to claim that THEIR Coumadin was better than all the Generics.

There was a Lawsuit (which revealed at least one of the Generic manufacturers varied LESS - I believe it was Barr). The manufacturer of Coumadin at that time LOST the lawsuit.

FWIW, I am very happy with my generic Warfarin from TARO (made in Israel). My INR is stable most of the time (as long as the rest of my life is CONSISTENT) and the pills are easier to split :D

'AL Capshaw'

[Marsha]

I have talked to my cardo, family dr, and the nurse that does the inr and they all have said that the generic brand might have different fillers in it although they use the same main ingredients. So the fillers might have an impact together. So I'm going in tomorrow for my protime and will see if just using the generic has had an effect on my levels. Thanks for all the imput. It is good to have different views on the subject/:)

[catwoman]

Marsha:

For what it's worth: My PCP was gung-ho on my taking Coumadin rather than warfarin. When the co-pay for Coumadin skyrocketed, I said no to Coumadin and yes to generic. Because I home-test, my PCP said OK, you'll be able to tell if there's any difference right away. I didn't notice any difference in my INRs that could be traced to name brand vs. generic.

I spend about $120-$180 in co-pays per year for warfarin. If I was using Coumadin, that would probably triple.

I still run into warfarin resistance from employees at my PCP's office. I chalk it up to strong marketing by Coumadin's manufacturer.

[RandyL]

Am I the only one that takes Jantoven(generic coumadin also)? The pharmacy I go to doesn't carry warfarin only Jantoven.

[DrAllan]

I suspect that our choice of terminology is not accurate. If by mixing, on means taking one or the other drug a a single dose per day then there probably is no problem. If, as i suspect, you are taking a pill from each of the bottles on a daily basis as directed by the label, then you are taking a double dose and thus are having difficulty with your INR. What exactly is happeneing?

[Ross]

Am I the only one that takes Jantoven(generic coumadin also)? The pharmacy I go to doesn't carry warfarin only Jantoven.
No Randy, your not the only one taking Jantoven, Hank does too. ;)

[Marsha]

DrAllen
I was taking a total of 8mg a day, 5 mg of coudmadin and 3 of warfarin. Last week I decided to take just warfarin (total 8mg) and had my inr test come back at 4.0. The dr. wants it between 2.0 and 3.0. So again I go get tested next week. They dropped the mgs to 6 now. So we will see what happens.

[Ross]

8x7=56mg for the week 56-10%=5.6 56-5.6=50.4/7=7.2mg or 7mg

I bet you come up too low this next test. It's going to be close.

[RandyL]

No Randy, your not the only one taking Jantoven, Hank does too. ;)

Who's Hank?

[afraidofsurgery]

I have talked to my cardo, family dr, and the nurse that does the inr and they all have said that the generic brand might have different fillers in it although they use the same main ingredients. So the fillers might have an impact together. So I'm going in tomorrow for my protime and will see if just using the generic has had an effect on my levels. Thanks for all the imput. It is good to have different views on the subject/:)

FYI generics have to show 'bioequivalence' and have the manufacturing site etc., approved by the FDA. However, variability can be between 80% and 125% versus a reference product for generics, and the allowed batch to batch variation for brand name products is only 10%.
This greater active ingredient variability has been shown to cause problems in drugs where there is an extreme sensitivity in dose to dose variations such as in antiepileptic drugs and contraceptives. I'm not sure if this would affect a PT/INR given the long half-life of the drug, but maybe in some people it might.

I just found out my cardiologist 'hates' warfarin and since he's typically not very anal retentive, I would guess he's had some problems in the past with patients' PT/INR staying stable on warfarin. I just know last month it cost me $75.00 for a refill of coumadin vs generic on my new insurance!!:mad:

[ALCapshaw2]

DrAllen
I was taking a total of 8mg a day, 5 mg of coudmadin and 3 of warfarin. Last week I decided to take just warfarin (total 8mg) and had my inr test come back at 4.0. The dr. wants it between 2.0 and 3.0. So again I go get tested next week. They dropped the mgs to 6 now. So we will see what happens.

I recommend that you buy the Al Lodwick's DOSING GUIDE ($5) through his website www.warfarinfo.com

That will provide you with a MUCH better idea of recommended dosing changes vs. INR. Going from 8 mg to 6 mg represents a 25% drop which seems on the high side to me.

You need to know that the SAFE RANGE for Coumadin (and Warfarin) is between 2.0 and 5.0 Below 2.0, the risk of STROKE rises linearly. Above 5.0 the risk of Bleeding rises. OTOH, many people have had an INR of 8 with NO BLEEDING.

Most Coumadin Clinic personel would not be worried about an INR of 4.0 Some of our members who have had strokes or have a high risk of stroke are advised to keep their INR in the range of 3.0 to 4.0.

One of our favorite sayings is that "It's easier to replace Blood Cells than BRAIN Cells". Bottom Line: Most of us prefer to be on the high side of our recommended range rather than risk STROKE from going Too Low.

'AL Capshaw'

[ALCapshaw2]

FWIW, last week my INR was 4.0 My target range is 3.0 to 3.5

I was told (by the CRNP at my Coumadin Clinic) to lower my WEEKLY dose by 2 mg which amounts to about a 7% decrease, no where near the 25% you were told.

Is your Coumadin manager a Doctor, Nurse, or Pharmacist?

Next to Self Testing and managing, the BEST results usually come from dedicated Coumadin Clinics.

Physicians who manage a limited number of their own patients have difficulty maintaining low variation, especially if their training was more than 10 years ago.

There has been considerable discussion with reports on this topic in the past on this Forum if you care to research the subject.

'AL Capshaw'

[allodwick]

The site is getting big when someone asks who Hank is. He is the founder and owner of the site. I'll bet he never dreamed that it would grow to this extent.

Marsha (not Catwoman) the fillers are not allowed by the FDA to affect the levels. They would only come into play if you were allergic to one of them.