Can someone translate what this means?

[cwar]

My husband has been on the treatment for 5 weeks now and he had his viral load checked after 4 weeks.  We do not understand these numbers that were given up today.  Could someone help.  Prior to treatment his viral load was
5.70E +06  and now four weeks later his test results showed 4.10E +04.  l think the the +06 translates into the million but am not sure?

Thanks!!

[DragonSlayer45]

The riba never seemed to bother my stomach. I had read all the taek with fat stuff also but it did not bother me. I understand it is to help with absorption not nausea. Cwar, my doctor never mentionned it to me either.

As far as the insomnia goes that is the interferon most likely talking. That is one of the cruel paradoxes of treatment. The meds make you really tired but yet you can't sleep. If it gets much worse he may want to think about Ambien to help. My first 8 weeks were pretty good, not many sides. I thought I would be a lucky one and not really have any problems, then they hit me hard. I ended up having to take Ambien to sleep. I rejected the idea of taking them at first when the doctor suggested it but eventually realized that it was necessary. Good luck to your husband. This is a great place to come for answers to questions. Best site I had ever found for peer to peer support.

The rash is most likely from the ribavarin.
.

[jdwithhcv]

I took my morning riba (the larger dose) with a yogurt smoothie (full fat yogurt) and that seemed to work well.  I took the second dose with dinner and made sure dinner contained some fat (not usually a problem the way my husband cooks) because the few times I took riba on an empty stomach it gave be heartburn.  

I am allergic to benadryl, and I don't take OTC meds much, so I used the occasional Ativan on those nights when anxiety was keeping me awake.  I seriously doubt that taking the evening riba earlier will help your husband sleep.  I had difficulty sleeping throughout tx no matter when I took meds, so I would go online and read MedHelp til I nodded off.  I never could stay asleep longer than a few hours so I took naps during the day.  When I would awaken in the middle of the night I would go back online and see who else also had insomnia.  There was always another hepper awake.

jd

[Isobella]

I took my larger dose if Riba with breakfast and the smaller dose with dinner.  

I never had insomnia (just stayed up later than normal) possibly because the Atarax I was taking for itching also helps with sleep.  Not being an antihistamine, it won't dry him out any further like the Benedryl may. In my tx, the Riba dried me out so bad, I had very little in the way of sweat or body oils, so benedryl could have made that worse.  

I didn't really have nausea either, but did have some pretty good (bad) gastric upsets.  HIs stomach is going have to dictate what he can eat comfortably right now.  For me it was ice cream.  (win/win as far as I could see, lol)

[nygirl7]

While it seems that taking the riba little earlier would be a good idea - it really won't make that much (if any) difference to the sleep factor and the best way to take them with your dinner. That helps with both giving the pills fat to bind to so they are not excreted right away and helps with the nauseau.

Perhaps if mentally you feel it will be beneficial tell him to take the 4 with breakfast and the 3 with dinner ----- it doesn't matter a bit and might make him think it's easier to sleep cause he's getting less.

After a month he should have a serum level built up in his system now.....meaning the level should be nice and high all of the time.  Therefore if you take them an hour or two earlier it's not going to make any real difference.  You don't want to lose that fat content by taking them too far in front of the meal - best to take them WITH the meal and it might help with the stomach problems.

Also - don't let him take any type of Tums or Maalox or anything within three hours after taking the pills or it will block them from being effective.

Most all of us on treatment experience difficulties sleeping from the ribavirin. For some a simple benedryl is useful and for others things like Ambien.  Personally I dont think I ever slept more than 4 hours a night even with the Ambien but they DID help me to fall asleep easily....and when I did wake up I could fall asleep again for a while.  Lot of awake/asleep awake/asleep but I found it to be way better than staring at the ceiling all night long.

[newleaf09]

After being on the riba for a month, it should be at pretty steady levels in his system and he can take it earlier in the day for the evening dose.  The riba makes patients a little hyper and can interfere with sleep, which he REALLY needs while on the drugs.  Taking it earlier, say at 5 in the afternoon should make it disturb his sleep a little less.  I kept a jar of peanut butter on hand to take with it or a handful of nuts, if I was taking it very long before dinnertime.  I went through TX with benedryl (diphenhydramine, the same thing in sominex or Tylenol PM), starting at 50mg and ending up on 200mg by the end of treatment.  It's just an old-fashioned antihistamine that makes you drowsy and is perfectly safe and non-habitforming.  Sleep is extremely important on treatment.

[GoofyDad]

Ambien is a great sleeeping aid. Sometimes yoghurt can help the stomach - find one with a live culture and have it daily. If you get NON-low fat - you can have that with the riba and maybe get a 2-for-1 out of it.  

[Trish77]

Well, it seems a little early for the nausea to be setting in - I got terrible abdominal pain during my nausea phase which didn't hit until around the 9th week or later I think? I'd be hungry and make the mistake of eating a normal meal and then wham, I'd get hit with the abdominal pain.  I'm not so sure that's what's happening here, particularly if he's not feeling nauseous.  Alot of us had to adjust what we ate during treatment, particularly because our appetites and tolerances changed.  Try changing his lunch to something different - you might have to experiment to come up with something that sits okay with him.  Maybe soup and crackers.  I ate noodle soup and crackers alot during that time.

I would also do what Bill is suggesting and mention this to his treatment team.  They may have some suggestions for you or it may trigger something for them and they may be able to help him with this.  Since he's on a trial, they usually want to know of symptoms and keep track of these things.

Also mention to them the sleeping at night.  That started happening to me when I went hyperthyroid but that was about halfway through.  I was given a med that helped with that to a point, the sleeplessness.  If it's causing him grief and he's trying to work, it may well be worth getting a mild sleep aid from his treatment team.

Just keep taking the ride, C.  Day by day.  Hang in there.

Trish

[Bill1954]

Gosh, he could have an ulcer; he should really discuss all his issues *thoroughly* with his treating physician. They might be able to give him something to help him sleep, too. 1400 mg/day riba is a large dose; is he a big guy? This is typically a weight based drug.

Best to you both—

Bill

[cwar]

Thank you very much as usual....He takes 3 after break and 4 after dinner which I believe are 200mg each so 1400mg.  NO, he was not told about taking the rib with fatty meal content!  That is great news!  I will pass it on ...Is there anything else that would help Trish

He is finding it very hard to sleep at night! Any suggestions?  Most nights he gets only 4-5 hrs??
Also is breaking out in a rash on face.  

Something else maybe you can help with is he feels not bad in the morning and then o.k until lunchtime at work. Once he eats his lunch, which I pack, which consists of either a salad, tuna on wwheat, turkey on wwheat etc he steadily has terrible abdominal pain later.  Is there something else he should be eating for lunch?

Thank you very much!

[cwar]

Thank you very much as usual....He takes 3 after break and 4 after dinner which I believe are 200mg each so 1400mg.  NO, he was not told about taking the rib with fatty meal content!  That is great news!  I will pass it on ...Is there anything else that would help Trish

He is finding it very hard to sleep at night! Any suggestions?  Most nights he gets only 4-5 hrs??
Also is breaking out in a rash on face.  

Something else maybe you can help with is he feels not bad in the morning and then o.k until lunchtime at work. Once he eats his lunch, which I pack, which consists of either a salad, tuna on wwheat, turkey on wwheat etc he steadily has terrible abdominal pain later.  Is there something else he should be eating for lunch?

Thank you very much!

[Bill1954]

LOL, it looks like a double bacon cheeseburger, jumbo fries, and a chocolate shake are required to squeeze the juice out of the ribavirin, en :o)? Be well, Trish—


Bill

[Trish77]

Thanks Bill, that's much better supporting documentation. :)

[Bill1954]

Thanks for verifying that, Trish; I sometimes get a little, uh… dyslexic when I work with exponential numbers :o).

I took this from Schering-Plough’s package insert PDF (I had to type it, because I don’t know how to copy and paste from PDF); it suggests that the effect that a fatty meal might be even more efficacious with ribavirin than the data Trish posted:

http://www.spfiles.com/pipeg-intron.pdf

“Both AUC and C-MAX increased by seventy percent when Rebetol Capsules were administered with a high fat meal: (841 kcal, 53.8 g fat, 31.6 g protein, and 57.4 g carbohydrate) in a single-dose pharmacokinetic study.”

Best of luck to both you and your husband—

Bill

[Trish77]

The easiest way to think of this is to move the decimal place to the right the number of places after the "+" sign.  In your 5.7 number, it would be six places and the 4.1 number, that would be four places making it what Bill said - 5,700,000 down to 41,000.

I don't know if you've had this suggestion but I do strongly suggest your husband take his ribavirin with some kind of fat-laden food, if he isn't already.  Peanut butter, cheese, etc.  I ate peanut butter toast alot for breakfast when taking my riba.  Took it with ice cream too.  Fat increases the absorbtion factor of ribavirin by 46%.  The better his body absorbs the ribavirin, the more effective it is.  Ribavirin is least effective when taken on an empty stomach, more effective when taken with food and most effective when taken with a high-fat meal.

"Bioavailability of a single oral dose of Ribavirin was increased by co-administration with a high-fat meal. The absorption was slowed (Tmax was doubled) and the AUC0-192h and Cmax increased by 42% and 66%, respectively, when Ribavirin was taken with a high-fat meal compared with fasting conditions "

http://www.drugs.com/pro/ribavirin.html *

*Some of the information on this site seems a little old but this quoted bit is in line with other things I've read on this particular aspect of ribavirin.

What is his dose of ribavirin, btw? Just wondering what they've got him at.

Trish

[cwar]

Sorry Bill did not see your comment. Got it now.
Thanks!

[Bill1954]

I’d interpret that as a 2.15 log reduction in viral load; this is fairly decent for genotype 1, if it is a response to standard combo treatment.

It appears to me as though this translates numerically into 5,700,000 and 41,000, respectfully.

Be sure to check with the doctor though, and have him explain this to you.

Best to you—

Bill