Suggest treatment for elevated INR levels despite medication

Posted on Fri, 12 Jun 2015 in Medicines and Side Effects
Question: Thanks for asking. I am not doing well as I would like. I went for an INR this morning and it was 6.8. There have been no changes in my medications, eating habits, etc.. A few weeks ago it was so high they couldn't get a reading but figured it was because I was taken off primidone. My liver enzymes have been elevated and I had a hydeaskan (normal), an endoscopy (everything normal) that was checked and the doctor made that emphatic. So they decided it could be the primidoneand they started decreasing it and after 2 weeks off I went for labs and the liver enzymes were normal. But the INR continues to stay high. If you or any colleaguues have any ideas that might help me I would certainly appreciate it.

I have been taking warfarin for 10 years and never have had a problem. I have A--Fib and am in A-Fib 100% of the time, also a pacemaker. The Essential Tremors are especially bad since not taking the Primidone.

Answered by Dr. Shafi Ullah Khan 2 hours later
Brief Answer:
Needs management to achieve target INR of 2-3.

Detailed Answer:
Thank you for asking

I read your question and i understand your concern. Primodone is hepatotoxic and may cause deranged liver functions in some cases. But your INR is persistently high and the only good explanation to that is warfarin Over use.

Age related decline in body functions cause reduction in dosages of the medications including warfarin. With INR 6 and above warfarin can be and should be stopped for a while. Weekly followup and checking of INR and keeping the target INR between 2 and 3 is advised.

Just take half tablet after than of warfarin which will be 2.5 mg dose. Take some vitamin K orally and if possible get some prothrombin precipitates or fresh frozen plasma to get this INR back to normal and reduce the bleeding risk.

Nutshell, patient with warfarin on, one should not find another cause of raised INR and should immediately stop the warfarin till Target INR achieved and dose adjusted accordingly.

I hope it helps. Take good care of yourself and consult your doctor for further management. DOnt forget to close the discussion please.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Answered by
Dr. Shafi Ullah Khan

General & Family Physician

Practicing since :2012

Answered : 3614 Questions


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