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I have problems with my gait and my left hand is raising automatically. Why?

This Premium Q&A, reviewed and published, features a real conversation between an iCliniq user and a physician.

Patient's Query

Hello doctor,

I have noticed recently that my left arm seems to be raised automatically. This is also about my waist height. I saw a neurologist three years ago, and everything was fine. I also had a brain magnetic resonance imaging (MRI) because I was having problems with gait, sometimes need to put my hand on the wall when brushing hair or teeth. My orthopedic doctor found that have a bit of cervical stenosis in my neck C3 and C4. I also hold my cell phone in this hand for many hours while typing. Sometimes when I try to keep three things in my left side, it is a kind of clamps up, and I forget what I am holding (about five years like this). Intake blood pressure medicines, and I take a large amount of sleeping pill called Zolpidem 20 milligrams per day. I am finding it a bit difficult to work sometimes and also suffer from a sore neck sometimes.

Answered by Dr. Aida Abaz Quka

Hi,

I am glad you chose icliniq for your medical-related queries.

I understand your concern and will try to help you with it.

The clumsy hand and gait difficulties could be related to the cervical spine stenosis. Anyway, I would recommend performing a brain MRI (magnetic resonance imaging) and a physical, neurological exam by your neurologist, before coming to this conclusion. I would also recommend stop taking Zolpidem gradually. This drug should not be used for a long time because it can cause addiction and tolerance. Instead, I would recommend switching to Mirtazapine, which can help regulate your sleep without the adverse effects of Zolpidem. I hope you will find this answer helpful. I remain at your disposal for any further questions whenever you need.

Thank you for consulting me.

You can always reach me at icliniq.com.

Patient's Query

Hi doctor,

Thank you for your reply.

My primary question is could this be caused by taking too much-sleeping medicine as a withdrawal side effect. For example, should I try to see if I have the problem at tonight when I take my medication? Also, could this be caused by excessive use of my mobile phone when lying in bed or on the couch? It has been just over six months since my last MRI (magnetic resonance imaging), should I still have another one?

I tried Mirtazapine, I slept wonderfully, but it gave me heart palpitations. Are there any other drugs you might recommend. Can you recommend a program that could help me stop Zolpidem? About tapering down on Ambien, it was recommended to taper over six months, but that was too slow. I need to stop taking as it has been more than five decades I have been taking it.

Answered by Dr. Aida Abaz Quka

Hi,

Welcome back to icliniq.com.

I read and understand your concern.

Zolpidem could be implicated in the gait disturbances. I would recommend trying Trazodone instead, as you do not tolerate Mirtazapine. After a week on Trazodone, I would recommend reducing the dose of, Zolpidem to 15 milligrams at bedtime for a week and then gradually reduce the dose by 5 milligrams each week until stopping. There is no need to repeat the MRI in such a short period. But I would recommend consulting with a neurologist for a physical, neurological evaluation (attenuated reflexes and clumsy hand could be related to the spinal canal stenosis). I do not think that the mobile phone is related to this clinical situation.

Looking forward to your response in order to help you.

Thank you.

Patient's Query

Hi doctor,

Thank you for the reply.

You are an excellent doctor I have not heard of Trazodone but will ask my doctor here if he can prescribe it. Can too much Zolpidem make a substantial confusion sometimes also? I will reduce your he Zolpidem with your suggestions. Is there another term for the clumsy hand that a neurologist would understand?

Answered by Dr. Aida Abaz Quka

Hello,

Welcome back to icliniq.com.

No, a clumsy hand is a neurological symptom. So, you are ok with the description. Yes, Zolpidem can cause confusion, dizziness, lack of concentration, and gait instability. Mirtazapine and Trazodone are antidepressants approved for the treatment of insomnia. The most important thing is to start in low doses and increase gradually, so you do not experience adverse effects and tolerate the drug better.

Looking forward to your response in order to help you.

Thank you.

Patient's Query

Hi doctor,

Thank you for the reply.

I took SSRI’s (selective serotonin reuptake inhibitors) before, and they can make me a little bit hyper. Also, for neurological pain that sometimes comes. Should I mention this to the doctor they prescribed Lyrica but makes me too dizzy. I am dealing with a sleepless night of only four hours. I am confident that I can get back to bed this morning and I do not have much of a plan today I was left today open so it is good I could sleep for maybe a couple more hours and then enjoy the rest of my day.

I think I need my psychiatrist here to deal with my sleeping problem or help me to make a plan I believe the current sleeping pills I am taking are no longer working, and I am taking them for too long. So, I am going to ask for something new and eventually trying to find natural ways to get to sleep. I am thinking seriously about starting another psychological medicine, but my psychiatrist here wants me to take time. You should seek the help of a psychiatrist if the neurologist does not seem to find a new problem.

Answered by Dr. Aida Abaz Quka

Hi,

Welcome back to icliniq.com.

I read and understand your concern.

Yes, a psychiatrist can help improve your situation if the neurologist does not. It is essential to regulate your sleeping hygiene.

Looking forward to your response in order to help you.

Thank you.

Patient's Query

Hi doctor,

Thank you for the reply.

Thanks for your help.

Answered by Dr. Aida Abaz Quka

Hi,

Welcome back to icliniq.com.

I read and understand your concern.

Looking forward to your response in order to help you.

Thank you.

Patient's Query

Hi doctor,

Thank you for the reply.

I am really worried today, because the pain from my neck travel all the way down to my fingers on my left arm is really bad. I did go to my orthopedic doctor yesterday. He said that the problem with my clumsy hand would not be caused by cervical stenosis. Though when I use the grip test my muscle strength on left arm was quite a bit less like 25 verse 40 on my right arm. I am also having a pain in my left eye which I had checked at the eye doctor today. She said that it is completely ok. There is no bleeding or no retina problem. What should be my next steps to do? I have made an appointment to see a neurologist, but it takes some time. I am finding it hard to concentrate at work, cause I keep thinking about the pain in my arm.

Regards.

Answered by Dr. Aida Abaz Quka

Hi,

Welcome back to icliniq.com.

I do understand your concern.

Thanks for asking again.

In my opinion your symptoms seem to be related to a pinched nerve in the neck (the pain in the arm). For this reason, I would recommend holding a cervical collar and see if it improves your situation. I am sure that this will help until consulting with your neurologist.

Regards.

Once more, thank you for allowing us to be of service to you.

We value the high level of confidence you have in us!

Patient's Query

Hi doctor,

Thank you for the reply.

I saw the neurologist yesterday at a big University Hospital. They did not feel that I have any neurological problem. I suppose that is good news and they have referred me to a rheumatologist. I also have started the Trazadone with the about 75% ambien.

Answered by Dr. Aida Abaz Quka

Hi,

Welcome back to icliniq.com.

I do understand your concern.

I am glad to hear that nothing serious is going on. Let me know about Trazodone. I agree that some rheumatology tests would help exclude a connective tissue disorder and put your mind to peace.

Looking forward to your response in order to help you.

Thank you.

Patient's Query

Hi doctor,

Thank you for the reply.

The Trazadone is not really giving me much better sleep. I am taking only a small dose of 25 milligrams. The first day I felt much better afterwards but the second day not really. I am continuing to take 15 milligrams. of Zolpidem. Unfortunately, I am feeling pretty tired in the morning. Also, last night with the Trazodone I did wake up with a erection which seems to last for about 20 minutes or more. However, it seems to stop afterwards, I was wondering if this is a condition of taking the medicine as I also take warfarin which can cause this condition.

Answered by Dr. Aida Abaz Quka

Hi,

Welcome back to icliniq.com.

I do understand your concern.

Thanks for asking again.

I recommend increasing the dose to 50 milligrams at bedtime and see if your situation improves. If erection is related to Trazodone, it will probably get worse with the increase in the dose.

Regards.

Once more, thank you for allowing us to be of service to you.

We value the high level of confidence you have in us!

Patient's Query

Hi doctor,

Thank you for the reply.

Seems that I cannot send messages is it okay to open a new chat?

Answered by Dr. Aida Abaz Quka

Hi,

Welcome back to icliniq.com.

I read and understand your concern.

The last one, but no zolpidem.

Looking forward to your response in order to help you.

Thank you.

Patient's Query

Hi doctor,

Thanks for your reply.

Your suggestions, especially on tapering Zolpidem. It seems I am pretty much adjusting just in these four days to using less Zolpidem.

Answered by Dr. Aida Abaz Quka

Hi,

Welcome back to icliniq.com.

I read and understand your concern.

Please do not get used to lorazepam because it is similar to zolpidem. High dose of melatonin (5-10 milligrams) would be a safer treatment option to benzodiazepines.

Looking forward to your response in order to help you.

Thank you.

Patient's Query

Hi doctor,

Okay I will get some Melatonin ordered up today. Here was last nights sleep result.

Answered by Dr. Aida Abaz Quka

Hi,

Glad to hear from you.

I am here to answer all your questions.

It seems ok. Hope you will get better in the next days.

I am thankful that you have confidence in me to help you.

Please stay safe and healthy. Thank you.

Patient's Query

Hi doctor,

Thank you for the reply.

It is rainy season here, with high pressure in the air. Also, with the pain I’ve been having some really bad headaches that are so bad that it feels like my left eye is in pain and pressing out of the socket. Should I see my GP about this or is it better to see a specialist. Also, what kind of treatment for these, I am already taking 1000 milligrams of Acetaminophen, is there something else that should be done? It is been a week and half, it started before I started Trazadone.

Answered by Dr. Aida Abaz Quka

Hi,

Welcome back to icliniq.com.

I read and understand your concern.

This could be sinus headaches. I recommend trying ibuprofen. Looking forward to your response in order to help you.

Thank you.

Patient's Query

Hi doctor,

Thank you for the reply.

I am taking Acetaminophen now. I did not tolerate the Trazadone well and woke up two- or three-times last night with horrible nausea and pains, also heart rate went to 113-118 while walking in hallway. I think similar to Mirtazapine it may take some time to adjust. I think I will need to give up Trazodone tonight.

Answered by Dr. Aida Abaz Quka

Hi,

Welcome back to icliniq.com.

I read and understand your concern.

Try Melatonin 10 milligrams before sleep, if it can help improve your situation.

Looking forward to your response in order to help you.

Thank you.

Patient's Query

Ive ordered melatonin. A large university hospital gave me the results of my rheumatology tests. They did not find anything significant. So in the same place as before but I know that I have nothing major which is something to be happy about. My arm clumsiness is still pretty bad and it is very weak to grip. I’m also having extreme headaches and pain around my eye which won’t go away. Im getting muscle twitching in my lower forearm every 2 to 3 days last for about an hour or two and then just stops.
Answered by Dr. Aida Abaz Quka
Hello again! I recommend performing nerve conduction studies in order to examine your nerves. Duloxetine can help improve your situation, even the headache. Kind regards!

Patient's Query

I’ve started amitrypline 20 mg for headaches that has helped, Now my problem is vertigo. What neurological studies can be done for vertigo? Had MRI a year ago it was normal, how about nerve block or other strong treatment to put the balance system back it place It was closed after heavy vomiting, I’ve also taken for you goblet for cervical stenosis could that also be making it to suggest worsening from pregablin making vertigo worse?
Answered by Dr. Aida Abaz Quka

Hello again! Cervical stenosis can cause vertigo ( cervicogenic vertigo), Pregabaline can worsen vertigo too. Coming to this point I recommend taking meclizine or dimenhydrinate for the vertigo. There are not many tests for vertigo. I recommend performing an electronystagmogramm in order to exclude an inner ear disorder and checking thyroid hormone levels. Hope you will find this information helpful!

Patient's Query

dimenhydrinate I will use, also doctor gave me betahistine.For pregablin I will take only before bed so no damage or dizziness expected.Seems ENT doctor not comfortable to give Meclizine. Need to go to Neurologist maybe.If I can't get relieve in another week I may ask for a video or telephone call.How about vitamins is B12 really helpful?Regards.

Answered by Dr. Aida Abaz Quka

dimenhydrinate is the best for dizziness and vertigo. There is no reason to take meclizine, as it can not be taken concomitantly with dimenhydrinate. Vitamin B complex and betahistine are ok too. Hope you will find this information helpful! Wishing all the best,

Patient's Query

So just Vitamin B and Betahistine is okay right? Okay will stick with that.
Answered by Dr. Aida Abaz Quka
Yes, betahistine and vitamin Bcomplex are ok. Dimenhydrinate can help very much too, especially if you feel nausea.

Patient's Query

Also I’m normally suffering from migraine headaches and currently taking 20 mg of amitriptyline daily before bed. Since this onset vertigo has happened my headaches haven’t been occurring as often would that be normal that vertigo would supersede and replace strong migraine headaches. Also how long should one take muscle relaxants for I started just last Wednesday but I don’t want to take them too much otherwise you can get addicted right?
Answered by Dr. Aida Abaz Quka

Yes, one symptom like vertigo may subside migraine. Muscle relaxants can be used for some months without addiction . Hope you will find this information helpful! Wishing all the best,

Patient's Query

Well that may be a good outcome. Will Antibiotic be useful in the situation? I’m guessing since the problem started with food poisoning my tummy bacteria is already not normal so antibiotics may makes things worse right. At the same time I use a CPAP machine so sometimes it’s easy for my ears to get infected. But ENT doctor this time said he did not see any infection in my ears. I’m also not having any nasal discharge or anything like that. By the way I didn’t mention that I take pregabalin and amitriptyline pregabalin for neck pain and pain in my hands caused by cervical stenosis. Do you think pregabalin mix dizziness worse or better.
Answered by Dr. Aida Abaz Quka
Yes, pregabaline may worsen the dizziness as it is a common adverse effect of this drug. Anyway, it is ok to take it just in the evening. I don’t think that you need any antibiotics. But it is ok to take s probiotic for your tummy bacteria, in order to get a good balance. Hope you will find this information! Kind regards, Dr. Aida

Patient's Query

Okay I’ll continue pregablin might skip one day mid week next week. I have cervical stenosis- do you need mri? Are we sure that this is not something to do with cervical instability. Cervical instability and pinching of carotid artery can cause this. I’ve been in bed 12-15 hours some days and some times 24 hours. So my neck may be weak. How do we impact of of spine getting pinched at C3/c4 etc.
Answered by Dr. Aida Abaz Quka
I understand that but I don’t think that this is cervical instability, as you would feel other symptoms like pain in both arms, numbness in both feet and arms and extreme neck pain. Anyway, holding a cervical collar can help.

Patient's Query

Oh I see. I get numbness and kinda shock in left arm only. Thanks
Answered by Dr. Aida Abaz Quka

Hello again! Thank you for the additional information! Yes the numbness and pain in this arm could be related to the pinched nerve root in the neck. A cervical collar and AINS (ibuprofen, naproxen, acetaminophen) would help reduce the pain and numbness. Hope you will find this information helpful! Wishing all the best,

Patient's Query

I’m finding that helpful. I take Amitriptilyn for headaches. Originally prescribed 10mg and increased to 20mg at night. If I’m feeling a slight headache during morning time would it be OK to add another 5 mg to take the total dose a day to 25 mg. Or will it be too much and make me drowsy?
Answered by Dr. Aida Abaz Quka
No, I don’t think so. It could help increase the dose if your sleep is not good. You should try increasing the dose. If you feel drowsy, then reduce the dose again! Hope you will find this information! Kind regards!

Patient's Query

Okay I understand. So the two medicines I take for Migraine is Amitriptilyn 20mg and also Propranolol 40mg. I'll try a bit higher dose 5mg of the Ami.

Answered by Dr. Aida Abaz Quka
Hello again! Yes , this is a good combination of drugs. Regarding AImovig it is a monoclonal antibo, very effective for migraine with low risk for adverse effects. Anyway it has a high cost and it may be a problem for the health insurance. Hope you will find this information helpful! Kind regards!

Patient's Query

It’s covered underneath health insurance plan but if I’m ever to leave I’m not so sure about other places.

Answered by Dr. Aida Abaz Quka
I am sorry but I don’t have information on this. You should know that it is only covered in developed countries, as it has a high cost. In my country this drug is not covered by insurance. Hope you will find this information helpful! Kind regards!

Patient's Query

Yes those insurance companies is rich countries are also rich and available to cover such things. Okay back to pregablin does 75mg really do much and how do you effects the drugs like Amitriptyline?
Answered by Dr. Aida Abaz Quka
Hello again! This dose of pregabaline is really small. You can take 150mg daily in case headaches don’t improve, but a higher dose of pregabaline may lead to increased sleepiness or drowsiness. This drug is more effective in case of tension type headaches ( like pressure or when there is tingling or numbness of the head skin). Regarding amitriptyline, this is an antidepressant used to treat tension type headaches and migraine. It is quite effective in migraine patients, especially when there is also insomnia, as it can help fall asleep. Increasing the dose too much may lead to increased sleepiness and low blood pressure ( orthostatic hypotension). It is also advisable to perform regularly a resting ECG ( every 6 months) while taking this drug as it may lead to cardiac arrhythmia. Hope you will find this information helpful! I would be glad to assist you again whenever you need

Patient's Query

This is very informative thank you very much I have regular ECGs already so there’s no worry. I will be in touch more later.
Answered by Dr. Aida Abaz Quka
You are welcome! Kind regards! Dr. Aida

Patient's Query

Hi still having the dizziness and went to doctor of ENT today. He was happy to refer me to a middle ear specialist but thought that I’m best going to neurologist for MRI. My last MRI Neck was 2020 and 2019 and 2015 and Cervical stenosis was found c3-c7. Last head MRI was under 6 months by Tokyo headache clinic and 1 year before that and all normal. If I did MRI or PET or something newer what are they looking for. How about a new treatment that helps with light sensitivity, dizziness and headaches. Is there anything that works well?
Answered by Dr. Aida Abaz Quka
A new brain MRI would just exclude any possible vascular disease of the brain or a brain tumour. A new spine MRI would reveal possible progression of the cervical spinal canal stenosis. Regarding a possible treatment option, I would recommend flunarizine 5mg at bedtime, which is quite good for all these three symptoms. You should discuss with your doctor on the above treatment option. Hope you will find this information helpful! Kind regards!

Patient's Query

Okay I will ask her about flunarizine 5mg. Yes will discuss here and consult back to you from time to time thank you so much for your help.
Answered by Dr. Aida Abaz Quka
You are welcome! Let me know about everything! Wishing all the best, Dr. Aida

Patient's Query

Also when I visited a neurologist at the University of Tokyo. She mentioned to me that I have hyperreflexia and she said probably I have that for my entire life is there any examinations I should take to see if that has become worse or otherwise.
Answered by Dr. Aida Abaz Quka
Hello again! No, there is no examination besides neurological physical exam that may reveal any possible changes in hyperreflexia. This is an individual characteristic since birth, which does not change during life. There is no reason to fo any tests for it. Hope you will find this information helpful! Wishing all the best, Dr. Aida

Patient's Query

Dr. Aida , I want to see my neurologist here but before I show here this video is there any truth to what he is saying? https://youtu.be/-n5ySpqkhJs As you know I have cervical stenosis and I have felt very different in the last five years since it’s got worse especially around having headaches the last three years any idea if I take this to my doctor here who is not a native English speaker and ask her to listen to it is she going to think that not only is this doctor crazy but I am too or is there some valid points here ?
Answered by Dr. Aida Abaz Quka
Hello again! I understand your concern and I don’t think that this is entirely true. You should know that all patients who suffer from a chronic disease ( including chronic pain) are more prone to psychological and psychiatric disorders because of the chronic stress. I don’t think that cervical stenosis leads to specific psychological changes. So, in my opinion all patients suffering from chronic pain could be suggestive a psychological support or antidepressants. If surgery is not the best treatment option ( judged by a spinal surgeon) , I don’t think that it will treat the psychological symptoms related to this disorder, as the pain may persist even after surgery. Hope you will find this information helpful! I am sorry for the delay in answering! Wishing a nice weekend, Dr. Aida

Patient's Query

So the pain is pretty much solved by 1) pregablin and 2) Amitriptyline But I’m feeling much better so much that I didn’t think of writing to you. Pain is less frequent. What is the recommended dose for pre-Gabalin if I’m taking it with 20 mg of amitriptyline at the same time do you think that 75 mg of pre-Gabalin is fine.
Answered by Dr. Aida Abaz Quka
I am glad that you are feeling better! Yes, this is a very low dose. You may increase it further if necessary ( until you are 100% painfree). Please let me know in case of further questions! Wishing all the best, Dr. Aida

Patient's Query

When I do curls with 10 kg weight my left arm is much weaker and almost difficult to do 5 reps but my right arm is much stronger. The left arm/ hand also has weaker grip and where I get tingle and numbness in left arm only. Does that mean that my cervical stenosis is affecting my muscle development in my left arm?
Answered by Dr. Aida Abaz Quka
It means that there may be some compression of the nerve roots on the left side, which is causing numbness and weakness in the arm. I recommend discussing with a spinal surgeon if there is need for surgery. Hope you will find this information helpful! Kind regards, Dr. Aida Dr. Aida

Patient's Query

Okay but regular orthopedic doctor says no need for surgery. I’ll try to find a spinal surgeon in the area. Thanks

Answered by Dr. Aida Abaz Quka
The weakness and numbness in the muscle is a sign of sever nerve root compression. There is no other way to recover except for surgery and decompression. Physiotherapy can help improve the muscle tone. Hope to have been helpful! Kind regards!

Patient's Query

Okay thank you. Symptoms have improved since taking a bit higher dose of Amitriptyline and other pain meds. Does stretching help and phsio?
Answered by Dr. Aida Abaz Quka
Yes, stretching and physio can help too! Kind regards!

Patient's Query

Okay entering new hot and bright light office environment. What do you recommend to further prevent headaches, also do you have a Canada or US licences to write scripts here?
Answered by Dr. Aida Abaz Quka
I recommend taking both pregabaline and amitriptyline for at least 4 months and then gradually tapper the dose until stopping them. These drugs help prevent headaches. Unfortunately My medical license is not valid in these countries. Hope you will find this information helpful! Kind regards !

Patient's Query

Okay I’ll try tapering them after a couple of months. What is the best medicine for heel pain in left foot. Steroid injection seems difficult to obtain here.
Answered by Dr. Aida Abaz Quka
I recommend taling naproxen 500mg twice daily fot 7-10 days. It will help agains inflammation.

Patient's Query

Hi my son came down with a high fever last Friday (4 days ago). The first day even he had fever of 39.5 degrees but after that fever went down and he felt better on Sunday. Monday he got sick again. Should I take him to doctor or hospital. He has deep cough. Covid test was negative. He ate pretty well yesterday but not so much today. I’ve been giving him acetaminophen 500 mg every day Friday Sat and changed to ibuprofen on Sunday. What is recommended. Also as I have astma should I be extra careful?
Answered by Dr. Aida Abaz Quka
Yes, it seems to be pneumonia. He may need to take antibiotics. I recommend going to the doctor as soon as possible. Please hold a mask for you to avoid infection. Kind regards!

Patient's Query

He recovered okay without antibiotics. Thanks for your help. It was really tough but he completely recovered and seems as strong as ever now. Regarding myself I’m still taking 20 mg Amitriptyline and 75mg for headaches and cervical stenosis is that good level for man of 91 kg or should I take more. Headaches are only bad when it snows or rains. Otherwise frequency is much less lately.
Answered by Dr. Aida Abaz Quka
Hello again! I sm glad that everything is ok now! Yes, you have low dose medication and it seems really effective considering the fact that you have rare headaches. So, There is no reason to change medication. Hope you will find this information helpful! Kind regards!

Patient's Query

Hello I’m having ringing in ears and high blood pressure. I’ve just started restarted a stronger dose of blood thinners at 4.5mg. What else can I check in my brain for carrion artery flow and proper blood circulation and good flow of blood to brain. Also having horrible tinnitis. Especially evening,
Answered by Dr. Aida Abaz Quka
Hello again! An angio MRI will help determine the blood flow inside your brain. I would also recommend checking thyroid hormone levels for possible thyroid gland dysfunction. Hope to have been helpful! Kind regards!

Patient's Query

I checked tyroid three years ago. What will I tell doctors to get an angio MRI. I get MRIs for my headache and things look fine. How is angiogram MRI different ?
Answered by Dr. Aida Abaz Quka
Angiography MRI examines better the blood vessels of the brain and the blood flow in them and possible narrowing. From the other hand sometimes there is contrast enhancement when there is inflammation. You should discuss with your doctor on these issues. Hope you will find this information helpful! Kind regards!

Patient's Query

Have covid. I take amplolidine and warfarin. Should I just❗ skip taking warfarin for a couple days and start the new Pfizer Paxlovid. All my vitals are okay but headache and throat is a bit bad.

Answered by Dr. Aida Abaz Quka
Hello! Welcome back to Icliniq! I would not recommend stopping warfarin as it is really necessary in order to prevent any blood clotting related to covid. Warfarin is really necessary in your condition. You can monitor your INR level every 3 days while taking paxlovid concomitantly with warfarin, in order to be sure that there is no need for dose adjustment in case of any possible interactions. Hope you will find this information helpful! Please let me know in case of further uncertainties! I wish you a fast recovery! Kind regards!

Patient's Query

Okay I already stopped warfarin. Should I restart with the same dose before I started. As you know warfarin is a bit delayed in both its startup and how long the effects of warfarin remains in your body.
Answered by Dr. Aida Abaz Quka
I recommend starting with a higher dose and taper slowly to your previous dose ( for ex: first day 1 tab, second day half a tablet and then continue with your previous dose). But during 3-4 days I recommend taking concomitantly with warfarin a shot of enoxaparine or fraxiparine subcutaneous in order to prevent a possible blod clotting during these days ( as warfarin needs some days to show its effects). It is also advisable checking INR levels regularly every 2-3 days. When INR will be over 2 , you can stop the injections. Hope you will find this information helpful! You should discuss with your attending physician on this issue. Kind regards!

Patient's Query

When you said check PTINR I went today to check it and will get results tomorrow. I hope you are doing well. I will finish Covid medicine today and start back on warfarin. Do you think Covid will come back next week after paxlovid is stopped. Many people say it will come back. Regards Derek Simonson
Answered by Dr. Aida Abaz Quka
Hello again! I recommend taking high dose vitamin C 1500mg daily and vitamin D and zink supplements. Even if fever may reoccur, it is a mild form. No reason to worry about! Wishing good health, Dr. Aida

Answered byDr. Aida Abaz Quka

Medically reviewed byDr. Nithila. A

Published At July 12, 2019
Reviewed AtJuly 17, 2025

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Aida Abaz Quka
Dr. Aida Abaz Quka

Neurology

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