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104550 tn?1237917191
Correct ribivirin dosage vs weight
Does anybody know the break down of the amount of rib to take and when you should lower it based on your weight. Is there a basic formula that docs use
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Standard dosage for type 1 is <165lbs=1000mg, >165lbs=1200mg. Type 2 and 3 are usually prescribed 800mg, but as we were talking about in another thread; 2's and 3's are relapsing more; and low riba dosage has been know to contribute to relapse. Good Luck
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104550 tn?1237917191
My Doc told me it was ok due to constant battle with blood counts and I've lost 42 lbs since starting tx. I'm in wk 45 of 48
and I'm taking Pegasys 180mcg + 1200mg rib. He said 1000mg would be ok based on me weight loss and the fact that my crit has been getting low (26) and Hemog as low as 8.3 in resent wks
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What are you talking about, you're almost done you lucky b*****d.
If you can hang on, hang on; if not at this point to drop down to 1000mg, I have to agree w/ your doc - would be ok. Keep It Up
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You lower your ribavirin when Procrit intervention fails to keep you at a level that will allow you to maintain treatment in a safe manner. I believe DoubleDose, as well as many others have reduced ribavirin, and still achieved SVR.

On a personal note I started at 1200 mg/day at 176 lbs. I am now at 150 lbs at the same dosage and 60,000U/wk of Procrit. If I don't feel better very shortly I will have no alternative but to reduce my ribavirin at least temporarily.

Ribavirin plasma levels are important to SVR but in most cases there is no SVR if you have to stop your entire tx prematurely.

As to your specific question of lowering ribavirin as you lose weight, many doctors follow this route and my NP has asked me a couple of times to do such. Up until now I've declined.

There are a couple of formulas regarding weight and ribavirin for geno 1's. One formula has 1200mg/day for 165lbs and up and 1000mg/day for below 165lbs. The other formula is more specfic weight based and ranges from approx 800 to 1400 depending on your weight. I'll leave it to others for search them out.

-- Jim
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104550 tn?1237917191
Well actually my gi is talking about going on for 72 wks this time around so I might not be done yet. I guess we have to fight with our insurance on who is going to pay beyond the standard 48 wk protocal
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So how much do you weigh now? I can't even imagine functioning with a Hgb in the 8's but we all react so very different. What you do want to avoid is a transfusion which happens around Hgb 7. So if you're 8.3 now and dropping like .5 per week, then I'd heed your doctor and drop the riba a bit. You don't want to celebrate EOT with someone else's blood being pumped into your arm.

-- Jim
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104550 tn?1237917191
I've already had two blood transfusions since july of this yr. I started tx at 225 and I'm now @ 183
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I believe 1200mg/day riba is right for 183lbs. But again, you have to weigh this against being able to stay on tx, especially if you're planning on extending beyond 48 weeks. BTW I'm assuming you're on Procrit...anyway to your favor is one sweedish study that shows a relationship between plasma riba levels and the degree of anemia. In other words, it's very possible that with your low Hgb levels you're still getting enough riba in you even at a reduced dose. This post comes very timely for me as I may have to reduce my riba very soon and in fact I'm concerned I should have reduced it about a week ago. Reducing riba is a difficult decision that Im sweating out right now.

-- Jim
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as Eistein said, you continue the  riba as prescribed, they only lower the riba when hgb drops and even that is questionable since it can lower your chances at SVR, if done early in tx.
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92903 tn?1309908311
I know you're going through a slump right now & I wanted to let you know that I, along with many others here, are pulling for you. You're fighting a tough battle Jim, and still you find strength to encourage others.

I noted your post about admiring the support others have around them. It gave ma a smile. I know where you're coming from.

Brighter days are on the horizon, my friend.
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The formula for Riba, is 12-15mg/kg of body weight.
So take your body weight in lbs, divide it by 2.2, then multiple that number by say 13 mg. That will tell you proper dose. I was calculated at 13mg/kg
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104550 tn?1237917191
I don't take Procrit but do take Epogen 2/wk which I'm told is the same thing.
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The alternative to procrit is epogen. The retail cost here in the States are about the same. It's about $600 for a 40,000 unit vial.    Good Luck
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Is there any other meds besides the shots for anemia that help build you up? Its expensive in Canada if you don't have extended medical, I will be in a trial and they don't pay for it. Its not procrit in Canada,I think it starts with an "E" maybe some out there can tell me the exact name and if they know how much it costs, thanx in advance
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how do you feel off tx better
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I know your pushing hard, and facing that dragon head on, but the important thing here is making it the distance.
I would drop the riba to 1000mg, as at 60,000 units of procrit, you are max dose. That is max dose, and if you do not respond to that they might pull riba to 600mg, or ALL together, as to cover their own butt.
You know my Doc, and I was on 1000mg of riba at your same weight. You need to stabilize your numbers quick, or you risk being pulled off tx.
Honestly, I know you don't think much about supplements, but go out and buy some Folic Acid. Take 400mcg a day. Also, you have to stay active. Walk around the block, or do something physical. I know being anemic that this is the last thing on your mind, but getting oxygen to the blood is essential.

Jim, the goal is making it the distance, not just staying max dose. At 1000mg, you are still at the recommended dose for your weight. We're all rooting for you man!
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if i'm overweight and on the 1200/riba....will this cause me to relapse???  i've never heard of anyone on a higher dose of riba...i'm 26/48 type 1 and showed non detectable <50 at 12wks..(orig vl was 1mil.5)
even tho tx seems to be working (yes the sx do suck) i worry about relapsing....
michelle

*jmjm - you are a very supportive member of this family...i get my only support here (i'm a widow with 3 girls 18,15,&11) i do not get support from family at all...except for my family here, i'm am going this alone.....people just don't get it....
hang in there! - michelle
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Agreeing with everybody else here pal.

You have been SO instrumental in my support in here (have no real support outside either, everyone seems to think it's in my head).  I can't imagine what I would have done without you. All those questions that you answered so CLEARLY so a newbie could understand them. So much patience and caring that you've given CONSTANTLY.

If there is any way to convey how much we are all pulling for you during this tough time...I'd like to know it because meer words are just NOT enough.

Debby
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YOU ARE AN IMPORTANT PERSON IN MY LIFE. I RESPECT YOU AND YOUR KNOWLEDGE. THANK YOU FOR BEING HERE FOR ME. I AM SORRY YOU ARE BATTLING WITH THE ANEMIA. I WILL KEEP YOU IN MY PRAYERS, DAILY.
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Eprex is the Canadian equivelant to Procrit
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" I feel like I am on the wrong dosage but the doctor says I am not."

Thanks to Jim I was able to go to my doctor and give him all the reasons why I did not want to be started on only 800 Riba (I am 5'7 123 right now).  He didn't at first want to hear it but since I had written out what Jim said and put it into my own words...he realized I had learned a lot and what I said to him made good sense.

Without Jim I would never have been able to change his mind.

It worked for me.  If you try it it might work for you - I tried not to sound like a petulant child but I think he thought I had become a "know it all".  Either way he did see the value in my comments and once he stopped laughing so hard he did agree.

The end of my speech was "if it affects me too negatively we can always compensate later" so he felt like he really had nothing to lose. NOt that I would have let him drop me down...

I am 1a and 1b and exhausted all of the time but my blood work is "fine" too.  Guess we just need to get used to it and fight on.

Best of luck!
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92903 tn?1309908311
A google search should help:
<a href="http://www.google.com/search?hl=en&lr=&c2coff=1&rls=GGLG%2CGGLG%3A2005-37%2CGGLG%3Aen&q=peg-intron+ribavirin+dosing+&btnG=Search">Google Search</a>

Here's one of many results (see table 9):
<a href="http://www.drugs.com/PDR/Ribavirin__USP_Capsules.html">One Result</a>

We'll see what my links look like after I post. You may need to cut and paste into the address bar.

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thanx Beth, I knew it started with a E, would you happen to know the cost, guess  could google it and see what comes up, I will have to pay as we lost extended when we turned 65 and because I have a preexisting disease I can't get it now, bummer, grrrrrrrr. The hep nurse at the study said they only had to patients in the last while that had a problem with anemia, hopefully I won't have to deal with it. I wonder if some would be more susceptable to anemia and why?

Hi Jim, I to feel badly for you in your struggle, what does one say, we all hope good things will happen for you, as a newbie I to have learned alot from you, your a wealth of info. Do you have friends etc; to help out if needed, I sure hope so, we all need TLC, wish you the best, get well..............
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I honestly do not know the cost, but I can imagine it isn't cheap...I have drug coverage through the government because my husband is a government employee so I will not have to pay for anything, but next time I am at the pharmacy, which will be next week, I will ask the gal there...We are freindly and I am sure she can look up the cost for me...

I hope you won't need it...I read in one of your threads that you are hypothyroid, so am I... I take .075 synthroid daily...I am curioous to see what the study says about that, let me know okay...

Best of luck

Beth
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so sorry you're going through a rough time. you are so willing to share your knowledge and support to the rest of us, i want to send good vibes back your way.  are ya ready?  here they come...
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Hi Jim,

When I did regular combo, my docs at UPCM put me on Aranesp, which is darbepoetin, instead of Procrit.  I got by on 300mcg every other week.  Same principal as peg in that it increases the half life.  I was also on Neupogen.

Aranesp is made by Amgen.

Good luck and rest easy.

rudy
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hi again, forgot to wish you well in your bx, I didn't do to wel in results grade 3/portal, grade 2/lobular and stage 3 for fibrosis. I called the pharmacy; 10,000 units $800 for a pkg of 6, she said its about two weeks worth @ $1600 per month, ouch. Our Premiere in B.C. has taken away what used to be excellant medical and of course it hurts the working guy, seniors & early retirement group. I mentioned before, if I fail to respond in 12wks the GOV cuts me off, wonderful huh? Like a person is not stressed out enough already #$#%#@%*

We shall keep our fingers & legs crossed for you
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Geno 2's and 3's require less ribavirin. Usually 800mg/day. You should be fine at current dose.
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jmjm - what snook said is important about excercise...however at week 26 i'm anemic (doc will not prescribe procrit YET) and couldnt do the walking if you paid me....HOWEVER, I have found excercise in the WATER!!!!! i walk, do aerobics, swim laps, its very doable - the water is so healing!   try it....getting there is a pain but its worth it and it feels so good to be excercising again!
michelle
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92903 tn?1309908311
I'm a 3a (I don't think I've ever heard of a 3b), and on 1,200 @165 lbs. Having said that, I *think* there is more than one tiny study that suggests 800mg for 2s, & 3s. I can't look right now, but I'll see what I can dig up later.
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i am a 3a and my dr put me on 1200mgs cause of being overweight. but he admitted i should have been put on 1400 but he couldn't bring himself to put me on that much...

all i'm trying to say is that everyone is different and if i were you i'd get on the CORRECT AMOUNT FOR YOUR WEIGHT and forget about the one tiny study that says it "MAY" be okay to put them on 800mgs. or it MAY be okay to end early...etc...its always better safe than sorry when your life is at stake...not to mention what a waist of months of treatment if that info turns out to be bogus...its a fairly new idea...too new to put my trust in...and there is only that one study...geesh!

i don't know about anyone else here but i'm no experimental rat!

go with the "tried and true" and the "standard dosing" which is done by the weight of each individual...
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