Copegus 800 mg enough?

[wonderingwhen]

Hello everyone, I am not new to his forum just mostly read all the posts, this time I have a question.  Some good info!
Just started tx on the 16th of Sept. So far sides are not as bad as I thought they might be. But in doing a little reading I found that I should be taking 1000 mg of riba, not the 800 mg I was prescribed. Being that I am type 1, stage 2-3 56 yrs young, 160lbs and treatment is scheduled for 48 weeks and not for 24. I have a call in to my Dr to ask if this is correct. Any input out there will be greatly appreciated.

Thanks
Chuck

[jmjm530]

I thought I sent you some studies a few weeks ago?

[ASmile4U]

Thank you...will do some additional searching before I make my next appointment.   And also do my best to persuade him...he is often a little more lenient with me because I work in the medical field...but not always!  :)

[DoubleDose]

An additional thought:  If you do become undetected, then I think keeping the Riba at the current dosage level might provide an advantage to eventual SVR.  I do not remember whether you have used Procrit in the past, but now would be a good time to discuss it with your doctor, in the event your Hemo values continue to decline.  You need every possible tool to insure success, especially in light of some past tx disappointments.

Remember that the Infergen dosage is also very important to getting the appropriate viral load reduction curve, so early reductions in Inf. dosing might be very risky.  My feeling is that once you find the daily Inferegen dose that gets you dropping by more than 2-Logs per 12 week period, then that is the dose you should stay with.  When I did Infergen in 1998/1999, I started at 15 mcg. twice a DAY for the first two weeks (got undetected by the end of two weeks!), and then switched to 15 mcg. /day for the duration, remaining undetected for over five additional months. The 15 mcg./day dose became pretty tolerable as time went on.  The Riba induced anemia is what did me in.

How many weeks have you completed so far?  Have they done any early viral load tests?  Are they planning on watching the load reduction curve closely??  If it is working, will they allow you to remain at 15 mcg. daily dosing, for the duration?  Discussions of any long term extension of tx, if you get undetected?

DoubleDose

[NYgirl]

I am 123 pounds, 40 years old and on 1,000.  The doctor had me slated for only 800 but I took the advice of Jim and asked that the doctor UP my Riba when I started.  I told him if I had any problems we could always adjust downwards later.

Since I was told the Riba is so important especially the first 12 weeks - I was willing to go in armed with info to the doc.

He laughed like crazy at me but he did change the dosage.  Since you weight much more than I do...I would definitely ask to change.

[DoubleDose]

ww:  I will chime in with my opinion, since using too little ribavirin on my first treatment is what caused my subsequent relapse.  I started tx in 1998 at 170 lbs, and used 1200 mg/riba for about 8 months, until my hemoglobin forced a reduction down to 600 mg/day.  I finished the final 6 months of tx, on high dose daily infergen, was undetected for the final 5 months, but was at only 600 mg/ Riba for that period.  I relapsed in one month after stopping.  No Procrit available at that time, unfortunately.

My 2nd round of tx was an 18 month ordeal, using high dose Peg-Intron, and 1200 mg/Riba daily.  I needed Procrit by the third month, but was able to keep the Ribavirin at full dose for over 15 months.  My last few months were at 1000 mg/day, due to continuing drops in Hemoglobin (probably caused both by the riba, and the high doses of Peg).  I did not relapse after tx ended, and am 2 years post-tx, and SVR.  I weighed about 172 going into tx, and was down to 165 for much of the period.  I was a type 1-B, by the way.

I highly recommend 1200 mg, even if Procrit is necessary early on, because most recent studies show the HUGE importance of high Ribavirin dosing to obtaining SVR, which is the real goal.
Battle this one out with your doctor, but do it quickly!  Early Riba dosing is the MOST important (first three months!!!).  Best of luck.  


Susan:  I know you are ready for a tx that works for you!  I am a big believer in Infergen, as long as the Riba is high...and it sounds like you are doing a mega-dose!  I am very much hoping to hear of your success.  If you can get undetected, just keep the pedal to the metal, and go for extended duration.  Please keep us posted regarding your progress!  We are with you!!!  Best of luck!!!

DoubleDose

[susan400]

My hemoglobin is still high, but slightly lower since switching to the 7 a day Riba. The doctor thought it was fine.  My red cells are still normal, hematocrit slightly high.  He's watching me real close.  I get regular blood work and see him once a month.  For now, I think the plan is to keep me at 1400 daily.  If I still to have any problems handling it, he'll have to see about cutting me back down to 6, but I'm hoping I don't have to start cutting down the Riba because I really want to be UNDETECTED!

Susan