Well, I never actually found out. I was looking it up on my IPhone and then got distracted and I kind of forgot about it! . I think I'm going to ask my pharmacist next time I pick up my RX. I think I've had those 5s since 2008 so I'm not sure I'd want to risk it anyway but it's good information to have.

Yeah, I know the feelin-- ooh, shiny link! let's go there!!! :)

Just did a quick google, and found that survivalist site... ummmm...

a UK site lists
Securitainers: 5 years

HDPE containers: 5 years

Blister packs: 3 years

No idea if accurate or not, just for curiosity and discussion
Chris

The term "shelf life" of a drug slightly differs from a drug's "expiration date."

The shelf life generally relates to a drug's quality, whereas the expiration date relates to its safety.

Shelf life

A drug that has passed its shelf life might still be safe for consumption, but its quality is no longer guaranteed.
Shelf life is variably influenced by storage conditions, such as exposure to heat, light and moisture.

Read more at Cleveland Clinic site:
http://www.cleveland.com/healthfit/index.ssf/2009/07/medications_shelf_life_vs_expi.html

Just like Cave76 shelf life will expire soon(grin)

I've never met any doctor in the US who advocated for patient self-management, but I really do think it is in the future. At one point, diabetics were not allowed to manage their insulin, but I don't think any of them call the doc every time they give themselves a shot anymore.

I do home-test, but the CoaguChek people have me on a short leash in terms of reporting the results, which they then forward to my doc.

I have been known to self-adjust my doses, depending on what is going on. My doc knows this, cause I usually tell her once it is done. She's told me she'd rather have me "go rogue" on dosing then have most of her patients follow directions, which I think means she trusts my judgement.

If I'm adding new stuff to my diet (meds, etc.), I always check with her to find out what effect it is likely to have. Then, we both watch my levels for a few days.

Other times, like this week, I kind of just take care of things. I started antibiotics, my INR went up, and we dropped my dose. This week, I finished up with the antibiotics and I'll probably just go back to my old dose without direction from my doc. We're both comfortable with that level of self-management.

But really, I wouldn't advocate it for someone without a fair amount of experience with wonky dosages and without a doc to fall back on. Wouldn't do it if I were a newbie.

And I've got extra warfarin, but just cause my dose switches all the time. I get 90 days of 5's and 1's, but sometimes my dose is 5 and sometimes 6. I also have some 2's from a time when I was taking 7. Mix it all together and I could probably go 3-4 months without refills.

Concurrently, at least here in the U.S., patient self-management is not approved. There was a small study performed (only about 40 patients) which did show that long-term patients can handle self-management as good or better then the Coumadin Clinics. Keep in mind, this was a very small study:

http://archinte.ama-assn.org/cgi/content/abstract/155/20/2185

Dr. Ansell, a highly respected hematologist, was one of the investigators.

As the study concludes, a much larger study would need to take place to determine the safety of such practice.

BTW, I may be wrong saying it is not being approved. I'll have to look that one up for sure and let you all know the answer.

I just wrote a hub on self testing and did notice that self management is still not accepted in the US and Canada. Some European countries do participate in self management. Self testing can be done though. Alere is releasing another study on self testing soon. Maybe it will address self management and it will become more common stateside.

I would love it if anyone here would jump on my page, read it over, and leave comments. You guys are what inspired me to start to write about clots and I am still writing! Thanks to anyone who does hop over!

http://hubpages.com/t/2f032c

The difference with diabetes is that you have to act fast and can't wait around for a doctor. So it's medically necessary to self manage. And insulin is more predictable that warfarin, I suspect. My husband and I will go out to dinner and he'll unknowingly eat something that makes his blood sugar skyrocket to seriously high levels and he'll need to shoot insulin right away. He's got his diabetes under control, but sometimes, his blood sugar gets wonky, like if he's under stress, or has a virus, and then will need to shoot insulin several times a day. It's not practical to consult with a doctor first every time that happens. Being on warfarin, we really don't need to check our INRs daily and any warfarin adjustments we make will take a few days to take a effect anyway. There isn't the urgency there like there is with diabetes.

I'd have no problem at this point in my warfarin use in making small adjustments. I've kept track of my INRs since starting warfarin, and document the dosage changes. So I can see trends and with my current doctor , I can see his thought process a bit when he does make changes. He is one to make very small adjustments, like by 1mg here and there. In contrast, my internist I had when I first clotted made knee jerk big adjustments and my INR was all over the place then. I likely could have managed my own INR back then better had it been left to me, honestly.

For some people more sensitive to warfarin in general, and to dosage changes, I think self management could pose a higher risk of bleeding.

I think ultimately, if you make adjustments, just let your doc know so they know what your current dosage is, and what's going on.

Agreed that diabetes requires much closer management than INR. Absolutely true and didn't mean to imply otherwise ... just saying that at one point docs were somewhat reluctant to let patients manage that also.

I think widespread self-management would really require home testing for all. It is much easier to self-manage when you can just check your INR yourself a couple days later. Easier to stay on top of it for sure.

I'm with RMB in that a couple dosage tweaks here and there (small ones, anyway) seem par for the course for those of us lifers.

TnT----- I appreciate you giving the details about how you self-manage and the fact that you have your doctor's appoval. I'm not at that stage yet, only been on Coumadin for less than two years. I do home-testing, which I love. My results are always given to my doctor/coag nurse that day.

After maybe another year I'll ask about self-management but for now I like the way it is.

I also appreciate that you said it probably wouldn't be 'the thing to do' for newbies or people who have wild swings in INR.

My insurance will only give 30 days at a time, with more refills of course. Does a doctor have to prescribe the 'extra' pills to have on hand in the event a person does self-management?

TNT, no, I knew you what you were saying, totally. I recall seeing someone on the forum in the past trying to say it's the same thing, and I suppose broadly it is, but it's not an apples to apples situation.

Dr Ansell said self management does not require any special approval, only the willingness of a MD to allow his/patient to perform this. He also said from a physician stand point, it is not commonly practiced here in the US. I dont know of any physician who allow this but that doesnt mean that their isnt a MD that may.

Only coveying the response to my question which i asked regarding this topic

I wouldn't say I"m 100% self-managed ... not even close, really, and I heavily rely on my doc with big adjustments or when I'm on and off other meds like antibiotics.

I guess we just have an understanding that she's OK letting me tweak for small issues and I'll be in contact if I'm switching/adding meds or have some sort of wild fluctuation. I appreciate that she trusts me and also that I can trust her to back me up with big issues. Really the pluses of having a doc you can work with.

How self-testing is handled is a matter still very much in development.

The self-QC meters, which for many if not most circumstances are as reliable as legacy AC clinics, have been around only since 2005. There was, and still is, an entrenched sub-industry of AC management that has been billing thrombophiles $100s per frequent visit, sometimes for decades, for what is relatively straightforward work by medical standards. AC care has been a cash cow for the various health systems. They have been understandably resistant to change. Even some physicians and PAs "can't believe they're letting people" manage or even check their own INR.

None of that is new. Diabetics went through a similar thing 35 years ago as diabetic self-testing and self-management was becoming more practical. Prior to what diabetics know now, accurate blood sugar readings happened only in a doctor's office once a week, with the potential for injurious or deadly glucose swings in between. Now, the most conscientious diabetics can keep tabs on their blood sugar several times a day at relatively low cost, and adjust things accordingly. They often show remarkably excellent health after several decades with the condition.

Just how much freedom to allow individual patients varies from case to case. I am acquainted with one doctor and one hematologist who have no problems advising their PTs to make half-pill-per-week adjustments should the INR go up or down. One even allows them to authorize their own "hold" if over 4.0. It is likely we will see more of that kind of thing, especially for long-term PTs with known response patterns to the drug, as liberty wins out over control - which invariably happens.

None of that is to say that self-management is the perfect thing for everyone under every circumstance. Going back to the diabetics as an example, not all of them are, or have been, ideal candidates for self-management; not even with as long as the practice has been in place for them. Reasons for that may vary.