Brief Answer:
Imuran and prednisone is reacting with coumadin

Detailed Answer:
Good evening. I am Dr. Saghafi and a neurologist. I have many patients with CIDP on coumadin. What is happening is that your coumadin is being made less effective by both the prednisone and imuran. Unfortunately, there is no easy method or method to improve or at least maintain the action of your coumadin or reduce your vigilance of your PT's unless your neurologist would like to consider doing something like plasmapheresis to possibly substitute for the prednisone. However, the Imuran is still on board and will still cause reduction of effectiveness of your coumadin. I don't think there's an easy solution to your problem.

Frankly, if your current regimen for your CIDP is working I would counsel you to keep that and simply go for the increased control of your PT's with some boosts here and there. In my patients when I have had difficulties with PT's/INR's due to other drugs we've had to use for their CIDP I've tried giving them some agents such as Vitamin E as well as aspirin, Plavix, and Aggrenox. The problem is that there is no scientific way of knowing exactly HOW much of any additional agent you should be using in order to guarantee adequate anticoagulation is anybody's guess.

Your regimen seems reasonable and should be dosed according to your INR's and PT's.

In my patients that are having to make frequent or numerous adjustments of their coumadin due to interactions of other medications and who have known AF...I have been known to send patients every 6 months for echocardiograms to look for the presence of blood clots in the heart. And that means a transesophageal echocardiogram in order to specifically look at the left atrial appendage where a lot of small clots can hang out and shoot into arterial circulation.

I hope this answer satisfactorily addresses your interesting question. If so, may I ask your favor of a HIGH STAR RATING with some written feedback.

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Please keep me informed as to the outcome of your situation.
All the best.

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