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.
Sign Up for Free e-newsletters
- Scalp Cooling With Dignicap May Reduce Alopecia During Chemotherapy for Breast Cancer
- Evolution of HER2-Positive Breast Cancer: Yesterday, Today, and Tomorrow
- Dedicated End-of-Life Education Program Improves Nurses' Care, Patient and Family Satisfaction
- Reflexology, Aromatherapy May Reduce Pain, Anxiety of Brachytherapy for Cervical Cancer
- Oncology Extended Care Clinic Reduced Urgent Cancer-Related ED Visits
- Hair Dyes and Cancer Risk (Fact Sheet)
- Taste Changes After Hematopoietic Stem Cell Transplant Affect QOL in Blood Cancers
- Hope, Optimism Reduce Psychological Distress in Advanced Cancer
- Mitomycin Extravasation Protocol
- Accurate Understanding of Capacity May Improve Workflow, Efficiency in Infusion Suite
- Nursing Practice Change Improved Chemo Administration, But Old Habits Die Hard
- Simple Adjustment Key to Paclitaxel Infusion Protocol That Reduced Hypersensitivity Reactions
- Online Program Aims to Assist With Clinical Trial Enrollment for Hematologic Cancers
- Education May Better Equip Nurses to Hold End-of-Life Conversations in Advanced Cancer
- Skipping the SICU Post Head and Neck Cancer Surgery May Improve Outcomes
Regimen and Drug Listings
GET FULL LISTINGS OF TREATMENT Regimens and Drug INFORMATION
|Head and Neck Cancer||Regimens||Drugs|