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Urgent Advise for Entecavir Usage
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Urgent Advise for Entecavir Usage

Dear Friends,

I am a chronic Hepatitis B patient (29 male from Turkey) and I need your help for the medicine (Barclude 0.5mg) usage schedule and some suggestions (if you have).

Before you answer, I would like to share my story and my daily life.

I learned that I am a chronic Hepatitis B patient in last day of July 2013 after the Elisa test for the marriage (I got married in September). I was shocked because I have a fit body, eat quality foods, and I do not have any illness or discomfort.

Then I have done some test including HBV DNA. The results are;

HBSAG: 492
HBEAG: 882
ALT: 86 (it should be 15-60 for healties)
BILIRUBIN: Normal
ALBUMIN: Normal
HBV DNA: over 170 millions (could not be counted. It is may be over billions)
ULTRASOUND: TOTALLY NORMAL

Then after 2 months later I have been done biopsy. The results were not good:

FIBROSIS: stage 3
HAI: phase 11

My doctor is one of the leading professors on Hepatitis B in the world. He and his assistant started treatment with Baraclude 0.5mg (Entecavir) 2 days ago. I will buy the medicine and start taking today. My doctor told me that it does not differ that what time I take the medicine. The only important think is that I should take it everyday in the same time.

My main question is “ At what time should I take the medicine for the best results? ”. I need the suggestions of Hepatitis B patients using Baraclude.

I know it differs for everybody because everybody has different daily life routine. So, before write your answers please read below and see my daily life routine and the natural supplements for Hepatitis B.

MORNING
07:00 am ; eat one dessert spoon of black seed (nigella sativa) with honey and continue sleeping
08:00 am ; eat one dessert spoon of honey-royal jelly-propolis-bee pollen mix and continue sleepig
08:45 am ; wake up and breakfast (bread+white cheese+juice) plus garlic
09:30 am ; start working (by computer in my office)

NOON
12:00 am ; lunch (with vegetables and a little bit meat)
13:00 pm ; start working (by computer in my office)

AFTERNOON
16:00 pm ; a little bit junk food (such as; biscuit)
17:30 pm; stop working

EVENING
18:30 pm ; at home
18:45 pm ; dinner (with vegetables or fish ) plus garlic
19:30 pm ; fitness (15min treadmill and 7 exercises OR swimming )
21:30 pm ; stop fitness

NIGHT
22:00 pm; at home, watch TV (or internet surfing), and eat some fruit
23:00 pm; take natural turmeric (curcuma longa)
23:30 pm; eat one dessert spoon of honey-royal jelly-propolis-bee pollen mix
24:00 pm; go to bed

Above you see some natural supplements (such as; black seed, turmeric, royal jelly-propolis and etc.). All the natural supplements are for Hepatitis B and I have started taking them for 3 months (after I learned I am patient). They have anti-viral effects and renewing the liver cells (I hope).

When it comes to question: “AT WHAT TIME SHOULD I TAKE BARACLUDE FOR THE BEST RESULTS?” I need the suggestions of Hepatitis B patients using Baraclude (Entecavir). And also I am very open your suggestions and sharings about Hepatitis B to get rid of this or to be more comfortable with this.

Thank you for your reading this stupid and long writing.
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Avatar_m_tn
Entecavir is usually taken with an empty stomach, that is, two hours before a meal and two hours after a meal. So some patients take it before going to bed. However, this is not suitable for everyone, as some patients report that they have difficulty falling asleep.
So maybe take Entecavir two hours after breakfast or two hours after lunch?

Don't be too concerned about taking the medication at the same time, but a routine does make you remember to take it everyday.

If you are taking antiviral treatment for the first time, the empty stomach rule is not that important, according to the label information.
34 Comments Post a Comment
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Avatar_m_tn
Dear friends,

I will start taking the medicine today. I really need your advises.

Please read the above post and help me..
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Avatar_m_tn
Entecavir is usually taken with an empty stomach, that is, two hours before a meal and two hours after a meal. So some patients take it before going to bed. However, this is not suitable for everyone, as some patients report that they have difficulty falling asleep.
So maybe take Entecavir two hours after breakfast or two hours after lunch?

Don't be too concerned about taking the medication at the same time, but a routine does make you remember to take it everyday.

If you are taking antiviral treatment for the first time, the empty stomach rule is not that important, according to the label information.
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Avatar_m_tn
Thank you for your advise.

I got the new report with the medicines saying that HBV DNA is 557 million.
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Avatar_m_tn
Don't be too concerned about your hbvdna numbers, they are often very very high. Just follow your doctor's instructions and be monitored by him. Your viral load should come down within a year, allowing your liver to rest and hopefully your fibrosis will reverse within a few years. No smoking, no drinking, healthy lifestyle and diet, take vitamin D if your are deficient.
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Avatar_m_tn
Is it possible to reverse fibrosis 3 ? If yes, How many years does it take?

I haven't been smoking for 2 years and I had never drunk more than 1-2 times in a mounth since I am young. Finally I have stopped drinking  for 3 months.

What kind of diet?
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Avatar_m_tn
Yes, it is possible to reverse fibrosis, a surprise but most happy discovery. How long it takes depends on how quickly and how persistently you can reduce your viral load to undetectable. This is just my opinion.

What diet? A balanced diet.
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Avatar_m_tn
Just cut out junk food, alcohol and cigarettes and start researching food that are good for liver health.
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Avatar_m_tn
I got the new report with the medicines saying that HBV DNA is 557 million.

My HBV DNA was 840 mil before I start ETV and it went UNDETECTABLE in 14 months. I stayed on it for another 8 months before stopping. So hopefully you will do the same, albeit faster. Because during those time (I was stupid and ignorance/uneducated), I was still smoking and drinking soda/alcohol/eating junk food and unhealthy lifestyle.

I have just changed to a healthy lifestyle March this year.

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Avatar_m_tn
My ALT was 112 before ETV in 2009. Biopsy indicate F2.

When I start IFN this late July, I had a piece of paper that state Fibroscan 4.3kpa - F1 on my name. The thing is, I did not even know I did a Fibroscan.

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Avatar_m_tn
thank you for your sharing. This is my 4th week that I take Entecavir. 8 weeks later I will have a test to see the results.
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Avatar_m_tn
you are hbeag pos and very high hbvdna, entecavir is not the best choice and most potent antiviral for this status and hbvdna might take too long to become undetectable.
tenofovir is the most potent hbv drug and has over 16% hbsag clearance over 3 years use so if your liver specialist is so expert i really dont see this stupid choice of using entecavir

another very bad and annoying point on entecavir is that it is on strict surveillance for cancer since on mices it made lung cancer, it looks like it is not dangerous for human until now but there is no history on its usage over 10 years so.....
it was also a pain in the.....for the 4hrs empty stomach

i suggest to discuss tenofovir plus entecavir and then stop entecavir when hbvdna undetectable if entecavir monotherapy is not able to make hbvdna und by 6 months or if you prefer a more potent antiviral without empty stomach request

also keep in mind that hbsag clearance on entecavir is about 5% only
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Avatar_m_tn
above all tenofovir is also cheaper and soon out of patent (this is the reason of prescrbing i beleive), generic tenofovir is about 20usd per month in india.in case you pay for the drug tenofovir is a better choice on all aspects
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Avatar_m_tn
this is the real reason of prescribing entecavir when not the best choice i believe
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Avatar_m_tn
Thank for your sharing Stef2011. I am not an expert so I do not know why my doctor started Entecavir instead of Tenefovir. But I will keep in mind what you say.

What I want to ask that my fibrosis is 3/4 and I have a health life style (see above). Is it really possible to regress the fibrosis?
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Avatar_m_tn
I do not pay for the pills.
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Avatar_m_tn
I would also suggest TDF. My viral load came back after I went off ETV. Probably should never be taken off it. Good luck with your treatment with ETV and I think it's probably too late for you to switch to TDF.

As with the fibrosis, the anti-viral should regress it along with healthy diet, supplements (Vit D3 a must) and no/little alcohol/junk food/soda drinks and cigarettes. Just don't do things that can hurt the liver.



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Avatar_m_tn
Just saw your HbsAg value. Maybe IFN would be a better option for you. But with your biopsy result, maybe your Doc decide a safer option.
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Avatar_m_tn
Your HbsAg quite low and your immune system seems to be active (because of the high ALT) and you are HbeAg positive. IFN would be ideal now.

Anyone else thinks so? Maybe a combo with ETV.
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Avatar_m_tn
it wasn t hbsag quantity, no unit after the number and impossible to be so low on hbeag pos with such high hbvdna
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Avatar_m_tn
the best way to clear hbv is:
entecavir 3 years or etv+tdf 3 years or tdf 3 years, then pegintf add on until hbsag is cleared (response to antiviral better be hbvdna und by 6 months)

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Avatar_m_tn
stef: does it seem strange? still EAG +ve and F3 fibrosis???
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Avatar_m_tn
are you on f3?do you have firbsocan number?
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Avatar_m_tn
in your case it is inflammation i think unless it is a biopsy result

in any case you better start tenofovir, it doesn t make sense to let the virus free of replication in your status
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Avatar_m_tn
no no I mean how SafiSifa can be on F3... it is so young and EAG+..
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Avatar_m_tn
it can be it all depends on immune attack, i have a friend but with autoimmune hepatitis her cirrhosis dates back since childhood
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Avatar_m_tn
Thank you for all of your shadings dear friends. I think he plan Tenefovir as the ultimate or alternative weapon if Entecavir does not work.

Do you think that if I have a health life style and goof eatings?

MORNING
07:00 am ; eat one dessert spoon of black seed (nigella sativa) with honey and continue sleeping
08:00 am ; eat one dessert spoon of honey-royal jelly-propolis-bee pollen mix and continue sleepig
08:45 am ; wake up and breakfast (bread+white cheese+juice) plus garlic
09:30 am ; start working (by computer in my office)

NOON
12:00 am ; lunch (with vegetables and a little bit meat)
13:00 pm ; start working (by computer in my office)

AFTERNOON
16:00 pm ; a little bit junk food (such as; biscuit)
17:30 pm; stop working

EVENING
18:30 pm ; at home
18:45 pm ; dinner (with vegetables or fish ) plus garlic
19:30 pm ; fitness (15min treadmill and 7 exercises OR swimming )
21:30 pm ; stop fitness

NIGHT
22:00 pm; at home, watch TV (or internet surfing), and eat some fruit
23:00 pm; take natural turmeric (curcuma longa)
23:30 pm; eat one dessert spoon of honey-royal jelly-propolis-bee pollen mix
24:00 pm; go to bed
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Avatar_m_tn
Doctor was thinking to start with interferon. But after he saw my HBV DNA and Fibrosis, he started with Entecavir.
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Avatar_m_tn
the apporach is ok... better lower DNA before ifn... ifn may also lead to heavy flare during therapy so they can be dangerous in your casw with F3..

am I right Stef?
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Avatar_m_tn
absolutely and it is also on guidelines by now that high hbvdna leads to pegintf non response, we know all the pathway by which hbv blocks intf

i think that the best approch is mine, all thanks to pisa researchers who shared some data since 2009 about avoiding peg all at once or combo peg+nucs all at once and starting by longterm sequential treatment

since we also know that nucs are necessary to recover some immunity for the add on of immune modulators it makes sense to make hbvdna und first and then try all immune modultor drugs available or vit d and gcmaf

i dont have yet my sister's results as hbsag but as an example she had no effect from gcmaf and vit d on hbvdna and alt, so according to me making hbvdna und is mandatory to expect good response from peg, gcmaf, vitd and so on
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Avatar_m_tn
it is hard English. Difficult to understand for me:) Please be clear :)
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Avatar_m_tn
As you know my fibrosis is 3 and the viral load is 557 million.This is my 4th week with Entecavir (before that I have not used any medicine).

Does it mean that my fibrosis will not go to 4 from that point and turn back to 2-1-0 because of Entecavir? or Is it possible to go to 4 even I use this medicine.
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Avatar_m_tn
if you change life style/diet like you see many others in the community your liver will be back to 0 fibrosis and full health in few years, 1-2 years if etv+diet+vitamins+antioxidants
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Avatar_m_tn
@safisifa..

i remeber me reading somewhere thath fibroscan/bviopsy results are not accurate at all when ALT AST are so high.. high alt means liver is suffering in that moment so it can be stiff... so i would not be 100% you are F3..

am i rigth stef?
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Avatar_m_tn
yes alt over 200 increase inflammation which in turn increase stiffness, there are new ways to determine correct fibroscan per abnormal alt but i d wait 3-6 months after a alt flare or simply recheck by 6 months

fibroscan is the sum of fibrosis, inflammation and when present nodules and fatty liver too, so when reading results all this must be taken into account

empty stomach needed for best accuracy
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