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Does Ribavirin cause anemia when used with Sovaldi??

My husband just got approved for Sovaldi + Ribavirin for 24 weeks. We are very excited but he needs to get his hemoglobin up before starting his treatment. We already have the  meds in the house but can not start using them. He had a shot of procrit yesterday - labwork in a week to see if his hemoglobin is up from 8.9 (normal range starts at 13.9). His red blood cell count is 2.94 (normal range starts at  4.5).

I am confused. I had been told that when my husband was on triple treatment and had to stop because of severe anemia that ribavirin was the drug that caused the anemia but I just read in some old literature its the interferon shots that cause the anemia.  So which is it? Or, is it both?

Is anyone who is using Ribavirin now with Sovaldi experiencing anemia?  Just want to know what to look out for.

Thanks
Nan
Best Answer
1747881 tn?1546175878
Riba will cause anemia on it's own.

Anemia

The primary toxicity of Ribavirin is hemolytic anemia, which was observed in approximately 13% of all Ribavirin/peginterferon alfa-2a- treated subjects in clinical trials. Anemia associated with Ribavirin occurs within 1 to 2 weeks of initiation of therapy. Because the initial drop in hemoglobin may be significant, it is advised that hemoglobin or hematocrit be obtained pretreatment and at week 2 and week 4 of therapy or more frequently if clinically indicated. Patients should then be followed as clinically appropriate. Caution should be exercised in initiating treatment in any patient with baseline risk of severe anemia (e.g., spherocytosis, history of gastrointestinal bleeding)

http://www.drugs.com/pro/ribavirin.html
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Avatar universal
I completed 24 weeks of sovaldi and ribivarin in Nov.2015 and have been un-detected since. the ribivarin caused severe anemia but to be fair I was taking 1200mg a day..my Dr. cut dosage by a third for the last month or so but , the main thing is getting rid of the hep-c. I hope and Pray that one day soon we will see an end to this disease..so please everyone hang in there , keep your spirits up ( i know its hard ) dont miss any doses...and if you are like me PRAY there is power in Prayer...God Bless you all !!
Helpful - 0
13008797 tn?1428162827
I have 1 week and 2 days left out of a 12 week treatment.  I have tested twice un detected   I'm very pleased   After my 3 Rd week treatment my numbers dropped very low and caused severe anemia.  We cut back 1 ribavirin pill at night time and my labs went up a little.  I am still anemic but treatment was success.  When my regimens is complete dr says labs will go back to normal.    Best of luck with your treatment.  Stick it out and don't miss any doses.   Thoughts n prayers for all sick n suffering.  
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Avatar universal
Ribavirin on its own causes hemolytic anemia. I was on the same therapy, without interferon, and my hemoglobin dropped from 15.5 to 12.0.

I doubt that addition of iron will be helpful in this case, because the underlying cause is not due to insufficient red blood cell production (which could be the case with low iron level),  but due to ribavirin destroying the red blood cells. This releases plenty of heme (=form of iron) into the bloodstream, which then kidneys have to filter out, causing urine turn dark. This is what happened to me during the second week of treatment.

from Medscape: http://www.medscape.com/viewarticle/491738_4

"The mechanism of ribavirin-induced hemolytic anemia has not been clearly established. Lau et al. explain that ribavirin, following uptake into cells, is phosphorylated and converts to ribavirin triphosphates, which then must be dephosphorylated for elimination from cells.[14] However, because red blood cells lack dephosphorylation enzymes, ribavirin accumulates in cells and destroys the cells, causing hemolytic anemia."
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Avatar universal
I have been on 1000mg ribovirin and Salvaldi Q day. I lready have severe anemia. Idw to quite my med. I want to be cured of Hep C... I am now trying to research if extra iron will help this type of anemia or not
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6708370 tn?1471490210
I just want to point out that this thread started with a post nearly a year ago. Since so much has happened this last year for Hep C treatment and to the original poster in this case, I usually screen the posts that are older

I have been told that when people are just surfing for answers to their questions, they may be led to a post that is quite dated

and that starts a cycle of new answers that can really confuse if you are not  noting the time and date of the post

wish there was a way of archiving them but I don't think so
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Avatar universal
Well. I hope I can get some answers and support. My husband started Sovaldi and a lower dose of Ribarvrin 2 1/2 weeks ago. He is in end stage liver disease, has had Hep C for over 50 years, finally progressed to cirrisis and ascites. Has been getting the fluid drained off his abdomen every 2 weeks for the past 10 weeks. His hemoglobin is already low so we are watching his numbers each week. If his hemoglobin drps below 10 he will have a blood transfusion. He is now on 400 mg of ribarvirin. My big question and concern is his exhaustion and extreme weakness. Is this a side effect of the treatment??  He has no appetite and I am so very worried that the side effects will do him in. He has lost a lot of weight and lean muscle.
We are hopeful that treatment will stop the progression and stop the ascites. Anyone else have any experience with the weakness and cirrosis improving??  Thank you all and good luck to each of you on your journey. Best. Bonnie.
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Avatar universal
Just found this site & read your post. Started therapy 4 weeks ago for HepC (Ribasphere & Sovaldi) geno type 3a. Unfortunately Dr I had so bad & dismissing of any complaints of side effects even the one where my meds say call your Dr immediately. Found new Dr, but do not see until 12/4/2014.
Does anyone know someone that has completed therapy & has been clear for 6 months after?

Since one of my side effects is feeling tired & depressed a
lot it is hard to keep my spirits up. Hanging in there though.
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Avatar universal
Nan:  Thank you for your post.  If I understand your post correctly, relapsing after being undetected on Sovaldi treatment, does happen?  We've been trying to get our doctor to discuss this subject, but he's not really wanting to do that.....probably wanting to "keep us in the positive mode" .... rather than giving us cause to worry.  My husband has one more month left of a six month regime of Sovaldi and Ribavarin.  He became undected after three months. Obviously, the next three months after the end of treatment are going to be rough on us.  The wait to see if he relapses is always difficult.  He has been on two previous rounds of treatment with the different types of interferon and ribavarin.  One session....did not clear at all.  Second session, cleared the virus, but relapsed.  He's type Genotype 3a which is a difficult one to clear.  We're hoping for the best with the Sovaldi/RIBA.  So tired of this battle.  Six months is a long time fighting not only the virus, but the side effects of the treatment drugs.  Lots and lots of prayer to get through it.  :)  Thank you Nan for managing this community site....giving us all a place to share our stories. On a positive note......he's had this virus more than likely since he was 18 years old (bad habits of the hippie days).....and he's 65 now and is in excellent health.  Good clean living since he was 28 (thank you Jesus) made all the difference in the world.  :)  
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Avatar universal
    You will be undetected soon. My husband was undetected at week 6 and remained UND for the remaining 18 weeks of treatment. He will have his first post treatment HCV RNA test next Thursday (4 weeks post EOT). We are praying he will still be UND but if he is going to relapse I think it's better to know that sooner rather than later.  I can imagine how difficult it is to first find out at 12 weeks post treatment that you have relapsed (as has happened to a couple of members of this community).
    The most important thing for everyone to remember is that it is just a matter of time before everyone here will be cured.  The new treatments in the pipeline have some excellent cure rates.  So whatever happens right now, know that you will be cured in the near future. So, hang in there.
   My husband also definitely experienced some "RIBA rage".  I had to keep reminding myself that it was the meds and it would not be forever. Now that he is three weeks post treatment I am definitely seeing an improvement in his temperament. The encephalopathy he had experienced so much throughout treatment is also greatly improved.  
    You've got a long way to go yet so just take one week at a time . I wish you the best possible outcome.

Nan
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10175413 tn?1427170251
Thx for your feedback. I have stage 3-4 fibrosis w/compensated liver, VL 11 mil, GT1a. Today I went in for my SOT labs, plus TSH test.  I was told by my Gastro that all of his patient that have been treating with the Sovaldi/RIBA  have been UND @ wk 3 so I am very hopeful and a bit nervous. I will come back and share my experiences w/HCV.  At wk 3 I'm short of breath, have very little energy left and have a some of that "RIBA rage". Everything irritates me and all I want to do is sleep. I wish you & your husband has continued good health.
Big Hugs back
Debbie
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Avatar universal
Hi. I found this while trying to research the new Rx for my father. I know little about his first Rx years ago as he did not tell me much and I live everywhere but near him (military life). I know he and my cousin referrer to it as a type of Chemo. My father went from 205 to 116, he's 5'9". Lost his hair and his teeth and got cataracts from Rx.  It was an injection in the belly and thighs thing and it was over-nighted to him to administer himself. He went into a type of remission for 3 1/2 - 4 years. His doctors have been trying to get him to do another Rx for awhile now. He has agreed to the Solvaldi + Ribivirin starting next month (Sept).
With me so far away, again, and that he is not keeping me in the dark this time (prayerfully)... I'm looking for some insight to be mindful of when I speak with him and questions to ask him. He just turned 61 this month and all I know is he has chronic Hep C (diagnosed 16-17 years ago), was chronic at that point too.
Thank you in advance for help.  
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Avatar universal
Thank you "resurrecting" this thread as reading it over again, it gave me an opportunity to see just how difficult his initial weeks were on treatment.  As it turned out his hepatic encephalopathy episodes improved greatly once the procrit shots, Xifaxin and a multivitamin he was taking daily were stopped.  Along with all his other meds,  it was just too much for his poor new liver to handle creating toxins daily  that went to his brain.
     He made it through the 24 weeks of treatment 2 weeks ago and we are now waiting to see it he reaches SVR. His labwork shows great improvement and God willing that will continue.
     My husband lost about 20 lbs on treatment because he too lost his appetite.  Since ending treatment most days his appetite is good though he still has some days when he has no appetite coupled with mild HE. It's going to take a while before these meds finally clear his system.
    My advice is to drink lots of water while on treatment. Your last experience sounds an awful lot like my husband's experience with the triple treatment with Incivik. He lasted only 5 weeks.  
     How advanced is your liver disease? Do you have cirrhosis? If so, any signs of decompensation?  Hopefully not, as that will probably make this treatment a little harder on you.
    This is a wonderful forum where you will get great support. Keep coming back. We all care about you and will be there for you if you need us.  I know I never would have made it through these 24 weeks without the support I got here.
Big hug,

Nan
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10175413 tn?1427170251
Hi..I'm new to this forum.........I am so happy to hear ur good news Nan that is wonderful I'm sure it's been along time coming! I am in my third wk of Sovaldi/Ribivirin with 21 to go. I have been told by my gastro that by wk 3 all of his patients have been UNDETECTABLE... I don't know what there GT is however. I am GT1a the hardest to treat of the gt1's. I went into this tx positive and knew it would be nothing like the dreaded interferon tx I was on. I only lasted 5 wks due to multiple hospital stays and transfusions due to anemia and low lytes.  Sovaldi has been great so far and I'm hoping the absence of most of the side effects will stay just as they are.  I do however have some more apparent deep hip bone pain as the weeks progress. I have had my HCV for approx 30 yrs and I am a 59 yo female. I would like to update my progress and if any of you have any advice foe me I would be grateful as I'm finding I don't really care about eating these days. I know that it's not good with the Rib and low anemia count and all.  I go for my first set of labs on the 20th of Aug and I'm hoping for good news...I'm keeping the faith! Thank you for letting me post....take care everyone
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Avatar universal
Oh Nan.     Bravo (big clap).      Such wonderful news.   It's about time you and your husband get hopefully permanent break from this horrible beast. Really makes sense how the kidney is processing the med even tho it is a reduced rate.    Haven't really wanted to scream it from the rooftop because so many are still suffering thru treatment and waiting for such, but finished meds Mon. and can't believe how much better I feel.    Sovaldi is truly a wonder drug and if it sticks so many lives will be changed.   Always have trusted my intuition as it has always been my guide and def feel we will see the end of this virus.    I hope you will take care of yourself as it sounds as tho you and your husband have a bright future to look forward to.          ..Kim
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Avatar universal
Nan, know that both you and your husband, remain in my prayers.
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Avatar universal
Oh Nan!!!! This is great news, undetectable!!!! Continuing to send prayers and positive healing energy. Please take care of the caretaker. :)
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Avatar universal
That is very encouraging news.  Hope he gets out of the hospital soon, hgb continues to rise and undetected becomes permanent.  
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Avatar universal
I am so glad to hear the good news about your husband and hope the other issues will be resolved soon.  You are a blessing to him and many others. Your positive attitude and information and love for your husband has been inspiring to many.  Give him a collective hug from all of us.
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Avatar universal
Thank you both for your kind and supportive words. It means so much.
My husband is very cautious in accepting good news. Who the heck can blame him?  I have been watching his labwork improve week after week and that's what gave me hope despite the very difficult HE episodes. He needs to be able to finally "feel" that things are improving. God willing, he will get this break from HE and know that things are getting better.

Thank you all again for your support through this. You have no idea how much it has helped me.

Nan
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Avatar universal
This is just fantastic. I know you both must be really happy. Hopefully for whatever the reason he's in the hospital will be resolved and he is able to finish treatment. A HGB at 9.5 with a low dose of Riba should stay stable. Finally maybe the break you both deserve is going to happen. Hang in there.
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Avatar universal
I am so glad to hear that you and your husband are hearing some good news. I know I and so many here are rooting for you both! Joanne.
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Avatar universal
Thank you, Mark.

I think this is wonderful news not just for my husband and I. I think it is terrific news for anyone who is struggling all these years with fibrosis/cirrhosis as a result of Hep C just waiting for something to help them.

All of you, take heart, if it can help my husband, it can certainly help all of you!
Get on a Sovaldi treatment asap!

Will he reach SVR? Will he be cured?  I don't know but in the meantime, his body is getting a very much needed break from this virus and it will give him time to get to another treatment if need be that will cure him.

Am I excited? You bet I am!
Nan
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Avatar universal
What great news for you and your husband!  I wish you both continued success with this.
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Avatar universal
My husband is back in the hospital but that is for another thread and post.
Hopefully he will be out soon.

The reason for this particular post is to CELEBRATE! Doctor told us last night his 4/3/14 HCV RNA test came back UNDETECTED!!!!  Many of you have been reading my posts and know everything this man has been going through these last three and a half years as a direct result of this insidious monster. So to hear that his test came back "undetected" for the virus (despite his being on a lower dosage of the ribavirin)  is just  incredible.
His doctor had explained that because his kidneys do not function at full capacity, the ribavirin is not expelled as it normally would be, so although he is on a a lower dosage, its actually as if he were on a higher dosage.  Given this result, I don't need further proof!

His hgb is now at 9.5 without the procrit shot this week so they are holding it unless they determine he needs it.  I am praying -  no procrit - no HE episode!
Will he will finally get a break?

He has 16 more weeks on treatment to go.  God willing, the next 16 weeks will be a lot better than his last 8.  But it will all have been worth it, if he reaches SVR.  

Last thing - his liver biopsy showed cirrhosis caused by recurrent Hep C and bile duct blockages (result of hepatic artery blockage found one month post transplant). Eight weeks after starting this treatment his billirubin is now 1.2 (normal range). This shows his bile is getting through probably because of the reduced inflammation.  

This new medicine (Sovaldi)  is amazing! Its destroying the virus's ability to replicate, thereby  removing the agent that's causing the injury, and  allowing the body to heal itself as best it can. My husband's weekly labwork is proof of that.  

Nan

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