Coumadin protocol using only 5mg tablets?

[pinkyrx]

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http://www.aafp.org/afp/990201ap/635.html

Has anyone seen this method used in practice where they attempt to use only 5mg tablets and adjust doses based on 1/2 tabs? (Scroll down to the table: "Warfarin Dosing Adjustment Using One Tablet Strength (5 mg)")

The two clinics I rotated through both used all the strengths, but I recently heard of a clinic that tries to keep everybody on the 5mg tablet only. (again, adjusting up/down with 1/2 tabs) They said that it won't work for 100% of their patients but that they are able to keep the majority within range with this system.

If it worked, it seems like it would be so much easier for patients to understand the dose changes that occur. Compliance should be improved as well because of less confusion with the different strength/color tablets.

Thoughts?

 

[ItsOverZyvox]

http://www.aafp.org/afp/990201ap/635.html

Has anyone seen this method used in practice where they attempt to use only 5mg tablets and adjust doses based on 1/2 tabs? (Scroll down to the table: "Warfarin Dosing Adjustment Using One Tablet Strength (5 mg)")

The two clinics I rotated through both used all the strengths, but I recently heard of a clinic that tries to keep everybody on the 5mg tablet only. (again, adjusting up/down with 1/2 tabs) They said that it won't work for 100% of their patients but that they are able to keep the majority within range with this system.

If it worked, it seems like it would be so much easier for patients to understand the dose changes that occur. Compliance should be improved as well because of less confusion with the different strength/color tablets.

Thoughts?

Because of a long half life, I used to dose my patients based on weekly dose. So using 5mg only, I would be able to provide the patient a weekly dose in increments of 2.5mg. Sure...why not.

Well, here is why not. The new Joint Commission NPSG3E mandates patients receive the most ready to give unit dosed medication. This means no tablet splitting when it comes to anticoagulants.

So throw that 5mg for everyone protocol out the door.

 

[pinkyrx]

What if it's not a hospital environment... does the mandate apply to clinics etc?

Did you have success with dosing that way before?

 

[ItsOverZyvox]

What if it's not a hospital environment and therefore the mandate doesn't apply? Do you still think it's a bad idea?

Did you have success with dosing that way before?

No, I didn't dose it that way. I would figure out the weekly dose and created the easiet regimen for the patient using different strengths. But my goals was for the patient to take same dose daily.

It doesn't have to be a hospital environment to be safety conscious. Why would I want to restrict the regimen using 5mg tablet only? To simplify? I don't think it's simpler as long as it involves patients splitting tablets. Generic warfarin is dirt cheap...

So, if patient needs 4mg daily...approximately 28mg per week, yes, I can do 5mg daily for 5 days then 2.5mg on one day then skip a day... but I would prefer patient take 4mg daily.

 

[pinkyrx]

So, if patient needs 4mg daily...approximately 28mg per week, yes, I can do 5mg daily for 5 days then 2.5mg on one day then skip a day... but I would prefer patient take 4mg daily.

That makes good sense! I definitely agree that it seems simpler to just take the same tablet everyday.