20gm meal or snacks/ incivek dosing

Does any one else have any menu items containing 20 gm fat?  Chooosing to eat fat is new to me.

As far as my opinion on incivek dosing:  I believe getting as close to every 8 hours is important because of the duration of action of the drug.  If there are periods when the blood drug levels are below effective treatment drug resistance can result as well as subptimal viral killing.  So, thus we are harming our chances as well as those in the future.  Not a good scenerio.  And of course taking with fat is essential for complete absorption thru the gut.  The controlling factor is what's absorbed in getting results which over rides how much you put into the gut.
Ribaviron has a longer (half-life) duration of action as therefore can be taken every 12 hours.  As the half-life of a drug reduces the importance of keeping on schedule increases.
We all want the best results from our therapy.  I hate the idea of going thru this regimen and getting suboptimal results so... for me I am going to be as strict as any human being can be following protocol.  Varying 1/2-1 hour is not a deal buster but still opens the door to possible sub-optimal therapy.
I agree each MD has different personal protocol they like.  As a drug is on the market longer, new ways of administration become evident--but this is all new so who is to say what is best?  My MD was part of the Univ of Cincinnati that participated in the incivek trials.  My MD stands by a 5X dosing day with 6am incevik with meal and 8am ribaviron.  this was what this study followed, and with great results--so of course my MD believes in following what has been proven.  that is not to say that we will find other protocol just as effective.

As a fellow Hep C therapy patient and pharmacist my basic advice is:  Make sure you eat the 20GM of fat with incivek and get as close to every 8 hours as humanly reasonable, don't miss doses. Get as close to every 12 hours for the ribaviron as possible.  I will choose to separate incivek and ribaviron.

Another pharmacy 'pearl of information' is that some drugs can be given (for instance a 3 dosing/day drug) three times broken up while awake such as 8-2-8 but some require strict every 8 hour dosing.  Some examples of the ones requiring strict every 8 hours are antibiotics, antivirals (incivek) and antifungals.  This is due to the importance of keeping a minimum level of the med in the blood(kill level and kill time) at all times. Blood levels below 'kill levels' allows for the virus to replicate as well as 'morph' and produce resistance strains.  It is possible these strains could be produced during a 3month therapy.  So be as ridgid as possible-respect your MD advice (unless evidence to the contrary) and allow yourself to be human and not sweat 'the small stuff'.  Allow yourself to be human if you gett off timing or meals.  STRESS IN NOT A FRIEND to those on or off therapy.
Hope this helps.

Any 20GM

[ann61]

I love avocados and have started eating at least one a day.  Because I hate to get up in the morning, I usually make my self a peanut butter and butter sandwich and leave it wrapped by my bed and have a glass of 2%milk.  An 8 ounce glass has 5 grams of fat.  I find when I supplement the peanut butter with butter I don't feel like I am overdosing on peanut butter.  2 ounces of cream cheese on half a bagel, sausage, bacon and pepperoni, macaroni & cheese, grilled cheese, french toast with one egg and lots of buttter, 1/2 of Hagan Daaz ice cream are other things I am trying.  I hope this helps.

[bab10]

klondike bars - 16-17grams
one meat loaded pizza slice - 19 grams
Precooked sausage patty - 19 grams
A can of Raviolli's - 14 grams of fat with an 8 oz glass of mile - 8grams of fat
I found a book that contains fat grams for may food items.  That has been helping me out.  Where I am finding it hard is at 4:30AM - who wants to eat that early, but I am planning on staying on a very strict schedule with the meds.  My nurse told me you should try to eat at least 1/2 hour prior to taking the meds.  So far it seems to be working, but this is only day 2.  Long way to go, but we can do it!!!!!  Best of luck to you!!!

[joemc34606]

I do a protein shake with whole milk and a tablespoon of peanut butter, I figure about 30grams of fat, and much easier to drink than trying to eat that much. Also stouffers french bread pizza supreme has 21 grams pretty easy to eat.
Good luck
Joe

[scottincivek61]

Avacados seem to be the best as well as organic peanut butter and high fiber organic bread. Eat as healthy as possible to help support your immune system. Items so far we have to avoid is coffee due to diarrhea. Make sure you keep a journal to see what foods work and what does not.

[babs824]

i did lots of smoothies; putting half an avocado in a smoothie is amazing. u can add other fruit in the frozen form such as mangoes or raspberries and yogurt with a squeeze of lime and a wee bit of agave or honey.
peanut butter or almond butter in a smoothie is also good especially with frozen banana chunks to thicken. i also add liquid eggs that are pasturized too. good luck. babs

[dixiechicdana]

Jimmy Dean sausage biscuits are 26 grams of fat. While that isn't healthy, it is quick and easy. Nausea can be hard on treatment and make you not want to eat so I opt for quick food.

[mykids247]

Talk about,not healthy I was standing in the line at the grocery store tonight and they had an Ententmans (?) donut display near by so I look at the fat in ONE donut. Hello 24 grams of fat. Sounds like breakfast to me.

[crossroadsec]

I'm having a hard time w all these fat grams. Nausea is really getting to me. Loso options are limited. I'm just gagging it down most days. I'll do anything to SVR.
Besides the options listed above, frozen biscuits n milk, sunflower seeds, almonds, certain granola bars, and always a Boost or store brand high fat shake. Thanks for ur input!! Karen :) I'm pretty strict about times. I'll go 30 min trying to choke fat down before I take med some days..

[avians]

Just started the treatment with Incivek 8/15/11. This is the fourth go round with Interferon. The thing I did not hear from the Dr. was to take the riboviran 2 hrs after the incivek. Is anyone else doing that? It sounds like the right the right way to go.
I too am having difficulty choking down high fat content too early and too late. I am staying within 15 mins of my 8 hour intervals, but this fat is making me gag. Notice, I have no problem with the afternoon dose of "fat". LOL
I am also taking Imodium (immodium) 2hours before or 2 hours after an incivek dose. This part is killing me.
I am definitely going to try the smoothies

[indy531]

Am I to understand that dosing w/PTI, esp in a.m., should be seperate from riba? I'm scared I'll forget and I have to work around snacking on a schedule in nwhich I am actively in a classroom teaching 12 year olds. I had planned on 5am, 1 pm,5pm,9pm (I go to bed @9). Does this sound feasible. I cannot tell anyone at my work about tx since it is 'rumor central'. Thanks.

[orphanedhawk]

How about flax meal? You can add it to smoothies and sprinkle it over cereal.

[avians]

Rebecca, in the first post, last paragraph, mentioned the 2 hour delay.It gives your body a break AND gives each pill to do it's own thing without competition. Makes sense to me. Give Right now, I'm craming 9 pills, all at once in the AM. I feel like a chipmunk. LOL
I'm taking Interferon about 8pm on Monday. I then get to sleep through the "flu". My doses are 7a,3p and 11p for the incivek. I do OK until about 3p and then it's lights out fort me.
Even though this is the 4th time for me, I am ever go grateful to read what each and every one of you has posted. I was reading somewhere in here that yellow poo was an issue? Oh boy, I can hardly wait.
Thank you all again for the all the valuable information. Together, we can ALL do this!

[crossroadsec]

I'm a teacher also and have been back to work most of august in meetings, moved to new building, etc. I sometimes have to veer 30 minutes one way or the other w/ the afternoon dosage if I'm in front of a room full of adults. Now if it's students.. I'll just do it anyway. I take riba w incivik at 6. incivik at 2. Riba at 6. incivik at 10. Sry for the no caps. long day. low grade fever. Honestly, I run 30 diff occasionally on morning dose if I'm gagging. I don't wanna lose it, so I eat, lay down and then take meds.
Undetected week 4. Start week 6 tomorrow! Oh. and the low sodium crackers have changed my life. loso cheese spread, cream cheese dip, lotsa protein to slap on those suckers! Yay? Karen :)

[indy531]

Thank you for sharing your experience/info. w/me. If I appear even a bit ill my administration will immediately put me on disability. I would love to do 6-10 wk FMLA but I am the only working member of my household and the co-pays are murder. So I have to keep going until I barf in front of the kiddos. Then I'll take a paid sick day(s) as long as I can. SX does really concern me b/c of this situation-not whining, but trying to be prepared.

[AjaLee]

It's been so helpful reading about all of your experiences. I can't even begin to tell you how wonderful it is to have you here.  

This experience is really something that no one else can understand without going through it.

When I was diagnosed and treated,about 9 years ago, I told everyone  in my life what was going on.  Didn't give it a second thought.  I'm not sure whether I'm really naive or just have wonderful people in my life.   It just never occurred to  me to hide it, or maybe I was just not strong enough to do that.  

I had expected to  start treatment by now ( I work in a school, so I had hoped early July) but am having insurance "setbacks". Quelle surprise!

I think that I have my fats planned out, but I have a minor question about timing.  I think that 8 a.m. , 4 p.m. and midnight (I'll set my alarm ) would be best for me to be eating the fat and taking the Incivek. I'm not sure if this is a good idea, but I bought some flaxseed oil capsules.  If I  took 20 of them, it would be 20 gms. of fat.   At lunch, I'm planning to have a high protein, low fat  shake. Do you know whether you're supposed to take the Incivek WITH the fatty foods, or a bit before or after better?  

After spending years avoiding fat, it was kind of unnerving (sp?) to think of actually seeking out fat, but I'm taking my son's advice to just "Embrace it"  After all, it's only for 12 weeks and we don't often get a license to do something like this. Too bad doughnuts aren't going to taste that great right now.

Indy - I treated a long time ago and ended up having to take a leave the last 4 months.  I know that many people have very demanding jobs and manage to never miss a day of work, but then they say something like"but I couldn't make it up a flight of stairs by the end"  Yeah, well,  they have a different kind of job than we have, right?


To add to the list of fatty foods that have been in this thread - in case anyone else is a vegetarian...
Amy's vegetable pot pie  19 gms 420 cals
Amy's cheese enchiladas   28 gms! 480 cals
32 cashews
Burger King egg and cheese croissanwich 16 g fat 320 cals

Hoping to start treatment with you all soon, and doing it with such grace.

[indy531]

Thanks for your understanding. I absolutely cannot share this or there would be a big brew haha that I had 'knowingly' exposed the children to a contageous incurable disease. I ahve taught at several schools and this one is terrible; I do think this could be my last year here, but the economy is in such terrible shape and options are limited. I'm dancing as fast as I can.

[Cyn621]

Oh my god, I just read this post and I am freaking out.  My doctor never told me to take the ribavin every 12 hours.  All they said was morning and night.  So I've been taking it at 6am with my incivik and then again with the 10pm incivik dose.  Now I feel like I completely screwed up the whole first 4 weeks (tonight is my fourth shot).  Should I change the time I take the ribavin now?  I am totally pissed, why wouldn't they have told me this????

[indy531]

Check w/your MD's office, esp. nursing if you cant reach MD. Have them notate that you wernt given exact dosage times and ask them for auggested schedule-be sure to inform them of any needs such as work schdule that you have to adhere to. TX schedule could be ie:riba-6am/6pm; PTI8am,3pm11pm;Peg-Fri nite special. I am going to have to do riba 5am/5pm; Vic (PTI) 5am,1pm,9pm and Peg also Fri. night. Don't freak out yet; I'm not yet in tx (ins. pre-auth needed) but I have to work around my teaching schedule.Best of luck.

[elpasolady]

Well now, I guess we all have some different info and its confusing the dickens out of us.  I researched quite extensively about when to take the Riba. Even on the package insert, it states to be dosed twice daily.  It does NOT say it has to be 12 hours apart.  The phamacist who is supplying my triple therapy meds who has been doing this for 12 years, told me as long as the two doses are 8 hours apart, it's okay.  
With all this in mind, I started on Wed, this week and am taking my morning and mid-day Incivk with my Riba together.  It works well as I  have just eaten my fat grams and both need to be taken with food.  I take them at 6:30 and 2:30.  Of course, my last incivek dose is at 10:30.
I don't think anyone here needs to be too concerned that they are dosing wrong with  the Riba, as long as the Incivek is approx every 8 hours.
Before the Incivek came along only a couple of months ago, , it made sense to space out the Riba more evenly because there weren't any other pills to take,  The Riba has a much longer half life from what I understand and will stay in your body longer, thus the 2x a day dosage.
Does anyoner really know with absolute certainty?  I think not, based on all I have learned.

Good luck to all.....

[elpasolady]

oh, and as far as fat foods, I too, am leaning more for the healthy nutritious ones as much as possible.
Avocado w/ tomatoes on whole grain bread
Hummus with baked pita chips
whole fat yogurt with fruit
organic peanut butter with flax seeds
cinnamon muffins with cream cheese
homemade almond milk
trail mix
of course, permission to eat ice cream treats is kind of awesome.  I found the haagen das snack bars, coffee almond crunch, yummy
Also, a much healthier option is a Rice Dream ice cream cookie sandwich.  Made with rice milk and all whole grain ingredients....it was really really good, Found it at our local health food store.

[avians]

The people who make Incivek are offering help with co-pays. I know this because a very helpful nurse where my meds come from, set me up on the program. I don't know how easy this is but I urge all of you that have issues with your co-pay to contact your insurance co, your Drs. office, pharmacist and the manufacturer if necessary. You need a ref. # from the comapny in order to use it.
I hope this helps someone.
I tried to seperate the incivek and ribo (8hrs-12hrs). I don't have that many alarms.LOL 3 on my watch, 3 on the phone and that confuses me. I'm back to taking ribo with Incivek at 16hrs
I'm still working on this fat thing. I'm starting to gag. I don't feel like cooking so it's mostly what I can cram in my mouth. Lot's of peanut butter.
I do have to say I'm inspired by this group. I must be a total wimp because I could never take this treatment AND work. You are all wonderful and strong and I wish each and every one of you the best. This time...it's going to work!!

[qhb]

I started the Incivek a week ago.  This is my second round of therapy--did the full 48 weeks the first time on the pegasist and the ribovirin and the virus disappeared until 3 months post treatment--so I'm hopeful this time will be better.  I too am battling nausea.  I'm better off eating regular food than sweets.  I tried candy bars and cookies and milk and felt awful.  I like a loaded baked potato with butter, some shredded cheese ( 1 tbsp of butter is 11 grams of fat alone), maybe a little bacon.  For breakfast, a couple of eggs, a slice of toast and butter and a glass of milk get me to my 20 grams of fat and I don't have to choke it down.  I really gagged trying to eat enough peanut butter.  I'm dosing at 7:30, 2:30 and 9:30.  My instructions were to take it every 7 to 9 hours, so I'm opting for 7 hours.  From past experience, I know I will struggle to stay awake until 9:30.  Glad to see what others are doing and experiencing. Don't feel so alone out here.

[hrsepwrguy]

7 to 9 hrs apart includes the over night time span

[Alatyr55]

My nurse said the riba didn't have to be taken exactly 12 hours apart.  I've been taking it at around 9 or 10 in the morning and 6 or 7 at night.  The later I take it the worse my insomnia seems to be.  Nurse also said that I should eat before taking the riba but doesn't have to be food high in fat.

[hrsepwrguy]

Your nurse is right

[halbev]

Well I glad I read this! because I have been doing the same thing taking I Incivek at 6:00am -2:00pm and at 10:00pm and my Ribavirin at 6:00am and 10:00pm never thought about it, I will adjust it, but I do not think it matters that much with the Riba. They say it stays in your system for 6 months after your last dose. I think I have a little FOG going on here I did 2 Interferon / Riba treatments end to end 6 months before going on Incivek and was UND at week 4 so it cannot matter that much.

[hrsepwrguy]

stick with 6 am riba dose I take dose 2 when i eat a lite dinner around 6 helps with the insomnia Alatyr mentioned  

[3rdTimeWinner]

My Dr. told me not to take any supplements with this treatment...(if flaxseed oil is considered a supplement)
please ask your Dr. first!
All the best to all of us :)

I'm glad to have found this forum.

[HippyHal]

My Dr specifically told me to take the RIBA and Incivek together first morning dose. I would not freak out on that one. Obviously check with your Dr (I'm going to ask the question, but am not concerned)

Cheers.

[HippyHal]

Oh, and almond croissants, or regular croissants with butter and strawberry jam are both ove 20. A full cup of granola with whole milk makes it (easier for me in the am as I seem to have "dry mouth". Sausage and egg biscuits, full fat "Mediterranean" yogurt and some almonds get there.

If you have a "Whole Foods" store close by, it has some great healthy alternatives.

I also suggest not buying 20 of something you like right away as (in my experience) your tastes change every couple of days and I was throwing stuff out.

On to my nightly Incivek dose. Peace all!  (and sorry Steeler fans, but way to go Tebow!).  :)

[stormy456]

Hi- Best (and healthiest) thing we've found are Flora Truffle bars infused with Udo's oil (Omega 3-6-9) 3 small squares is 21 g and it's good for you.  The Hazelnut ones are particularly yummy.   Easy to take when nothing sounds good.  My husband has a bunch of ideas on his blog under the "Feed Me Seymour" posting - www. hep-free.com.  I think he lays out his entire day with meal ideas.  Seems to be working for him - although at this point (6 weeks) eating anything is a bit of a chore :(

[micheall]

Wow an old post but great info.Called incivek and debated with them on the 20 grams.Well it looks like I will be doing about 15-20 grams of fatty food,which the body likes to absorb.I already gained 5 lbs in 5t week.I lost 33 the 1st tx,gained about15 the next 6 months,and now gained another 5.I found bagels and peanut butter hard to digest,especially before bed.I changed to high fat ice cream(no problem for an ice cream lover),doughnuts,fatty pudding,home made baked mac+cheese,dropped egg on toast,ritz crackers+peanut butter(not just peanut butter alone),waffles loaded with maple syrup,pop corn,hot chocolate,tuna,pizza,croissants,etc.There is no getting around the fatty foods,so if you have any strength left,exercize.MIKE

[angelina7777]

Where do you get those Flora truffle bars? Whole Foods? About to start treatment on Tuesday and getting really scared. My Dr. said I didn't need 20 Grams of fat??? with the incivek

[pooh55811]

According to the literature, your doctor is mistaken. You need that 20 grams of fat with every dose of Incivek.  The fat is critical for getting the most from your Incivek.

"The usual dose of Incivek is 2 tablets taken 3 times per day, every 7 to 9 hours."

"Take Incivek within 30 minutes after eating a meal or snack that contains about 20 grams of fat. Always take Incivek with food. Examples of snacks that contain about 20 grams of fat include: A bagel and cream cheese, 3 tablespoons of peanut butter, 2 ounces of American or cheddar cheese, 2 ounces of potato chips, a half-cup of nuts or trail mix, or 1 cup of ice cream."

http://www.drugs.com/incivek.html

And this:

"Effects of Food on Oral Absorption

The systemic exposure (AUC) to telaprevir was increased by 237% when telaprevir was administered with a standard fat meal (containing 533 kcal and 21 g fat) compared to when telaprevir was administered under fasting conditions. In addition, the type of meal significantly affects exposure to telaprevir. Relative to fasting, when telaprevir was administered with a low-fat meal (249 kcal, 3.6 g fat) and a high-fat meal (928 kcal, 56 g fat), the systemic exposure (AUC) to telaprevir was increased by approximately 117% and 330%, respectively. Doses of INCIVEK were administered within 30 minutes of completing a meal or snack containing approximately 20 grams of fat in the Phase 3 trials. Therefore, INCIVEK should always be taken with food (not low fat)."

http://www.rxlist.com/incivek-drug/clinical-pharmacology.htm

[stormy456]

Sorry, but you absolutely need that 20 g.   It's definitely tricky.  We buy the bars at the healthfood store, they're sold in the refrigerator case  next to the probiotics, and Udo's oil.   They really are delicious and travel well.