Monitoring and Adjusting Your Amount of Warfarin

Monitoring Warfarin Dosages

Warfarin monitoring is essential. Even people who have been on a steady dose of warfarin for years require frequent monitoring. This is done using a blood test known as a prothrombin time (also known as a "protime" PT) or international normalized ratio (INR). The INR is actually just a standardization of the PT test to account for laboratory variations. This monitoring will be done daily when you first start warfarin, until you reach a stable and appropriate INR. Thereafter, INR monitoring is done periodically, usually every one to four weeks (and more often when necessary).
Although your physician may choose to monitor your warfarin, he or she will often suggest having a "warfarin clinic" manage your monitoring and dosage. These are clinics run by specially trained pharmacists (or sometimes nurse practitioners) who specialize in monitoring and dosing for this drug.

Adjusting Your Dose of Warfarin

Several factors may cause your warfarin dosage to be adjusted. Often, starting or stopping another medication (or even just changing the dosage) can affect the dosing requirements, since many medications interact with warfarin (see Warfarin Interactions). Changes in the diet can also affect the dosing requirements (see Coumadin Diet). Sometimes, there is no apparent reason for the change, which is why frequent monitoring is necessary, even for people who are stable on a certain dose.
Please be honest and accurate with your healthcare provider about any warfarin doses you have missed or any dietary changes that have occurred. Your healthcare provider will adjust your dose based on the information you provide, and providing inaccurate information may lead to a dangerous overdose or underdose.
Since warfarin dosing can be complicated, many people find it useful to keep track of their dose using a calendar. This is especially useful for people who do not take the same amount every day, such as one dose on certain days of the week and a different dose on other days.
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