INR Above or Below the Therapeutic Range
Increased INR, Coumadin over-dosage; low INR, inadequate Coumadin dosage
Clinical conditions that increase Coumadin effect and elevate INR include:
Low vitamin K intake
Poor nutritional state
Congestive heart failure
Connective tissue diseases
Conditions known to decrease Coumadin effect and decrease INR include:
High vitamin K intake
Many drugs are known to increase warfarin effect and elevate INR:
Effects may be dose-dependent & may not occur in all pts receiving Coumadin & the drug mentioned.
Drugs in this category include carbenicillin, allopurinol, erythromycin, indomethacin, ibuprofen, fluconazole, fenoprofen, isoniazid, ketoconazole, naproxen, metronidazole, phenylbutazone, moxalactam, cephalosporins, trimethoprim-sulfa (Bactrim), amiodarone, quinidine, cimetidine, clofibrate, lovastatin, omeprazole, phenytoin, tamoxifen, thyroxine, quinolones, rofecoxib, celecoxib.Drugs that can decrease warfarin effect & lower INR in some pts include antacids, antihistamines, barbiturates, rifampin, sucralfate, trazodone, carbamazepine, cholestyramine, griseofulvin, haloperidol, oral contraceptives, penicillin, dicloxacillin, and nafcillin.
Suggested Additional Lab Testing
Most important: INR value on a daily basis until patient shows a consistent value within therapeutic range at least 2 or 3 times.
Monitoring is then less frequent but at least 1 times per month.
Lab tests may be helpful in uncovering other conditions, such as liver disease, which lowers the level of coagulation factors and makes therapeutic anticoagulation difficult. Pharmacogenomics testing is a consideration, either before initiation of warfarin, shortly after initiation, or for patients with apparent hypersensitivity to warfarin.
Copyright © 2017, 2013 Decision Support in Medicine, LLC. All rights reserved.
No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. The Licensed Content is the property of and copyrighted by DSM.
- Increased 5-Year Survival Rate Seen in NSCLC Subset Treated With Nivolumab
- Health Care Expansion Tied to Increased Rates of Surgical Treatment of Thyroid Cancer
- JAK1, JAK2 Inhibition Improves Outcomes in Myeloproliferative Neoplasms, But More Is Needed
- Including a PI3-Kinase Inhibitor with an PARP Inhibitor Improves Tumor Shrinkage in Patients with Resistant Ovarian Cancer
- Hormone Refractory Prostate Cancer Responds to Abiraterone Acetate in Some Cases
- Exercise, Psychological Interventions Better for Cancer Fatigue Than Medications
- ASCO Issues Global Guidance for HPV Vaccination for Cervical Cancer Prevention
- Discharge Events Improved With Standardized Inpatient Palliative Care Consultation
- Little Opposition to Early Palliative Care for Symptom Management in Pediatric Oncology
- Physical Activity Improves Outcomes for Patients with Breast Cancer and Survivors
- CQGS Releases Standards for Surgical Care of Older Adults
- Radiation Protocol Deviations Linked to Worse Outcomes in Pediatric Brain Malignancy
- Use of Counseling, Surgery Rates Show Limited Physician Knowledge of Breast Cancer Genetic Testing
- Family History Does Not Exclude Active Surveillance as Treatment Option for Prostate Cancer
- Beans, Whole Grains in Diet Beneficial for Colorectal Cancer Survivors
Sign Up for Free e-newsletters
Regimen and Drug Listings
GET FULL LISTINGS OF TREATMENT Regimens and Drug INFORMATION
|Head and Neck Cancer||Regimens||Drugs|