Does the calcium in milk block Ribavirin absorbtion?

I usually tke my Ribavirin in the morning with a smoothie composed of full fat yogurt, fruit and coconut oil.  I was just wondering if anyone else takes their Riba with milk or dairy products because I read somewhere that calcium could possibly block absorbtion of the drug.  Any feedback?

[sfbaygirl]

That is interesting, I am wondering why my calcium levels were so low on my last lab. I eat enough ice cream to have more calcium than that! I have cut back after NYgirl mentioned 325 calories per half a cup. I feel a bit fatter, even though I have no appetite for anything else. I bought some fudgicles. They will take some time to  get used to over hand packed strawberry icecream.

Perhaps the Riba blocks it in some, I think mine is working due to the huge drop in hgb. It may be I am using MORE calcium, since my level of it has gone down.

[NYgirl]

Effect of Antacid on Absorption of Ribavirin   Coadministration with an antacid containing magnesium, aluminum, and simethicone resulted in a 14% decrease in mean ribavirin AUC tf .


Antacid: The bioavailability of ribavirin 600 mg was decreased by ... Ribavirin (Rebetol) is a synthetic nucleoside analogue which has shown in vitro ...
www.emea.eu.int/humandocs/ PDFs/EPAR/Rebetol/H-246-PI-en.pdf

[sunspot]

I drank at least a quart of whole milk every day. Most likely a quart and a half. When the weather gets warm, I drink a half gallon or more.
I just got my 6 month post-tx PCR results yesterday and I am UD <10.
<big>YES</big>

I would have to say that the milk did not block the riba in my case.

Dana

[sunspot]

Did I mention I can say SVR to 98%?

         <big><b>YES</b></big>

[Dale_Ray]

Hey Dana:
That is great news! Like you I drink a lot of milk, always have. I never go to bed without a large glass of ice cold milk. Your report takes the worry off of me about the dairy issue. Milk - does a body good! PS I belong to the American Dairymans Association. Ha! Dale

[sfbaygirl]

Thanks for the info. I am definately going to ask docs about this today. Why the GI says its okay and will give me something stronger is what really makes me furious. He should have warned me.  14% is a lot NOT to absorb! Perhaps someone knows of a better way to deal with gastrites (sp) and not cause absorbtion problems.

[FlGuy]

Six months already! Great news, it must have lifted you up pretty high. Time to live the rest of your life. Congrats.

[can-do-man]

Been thinking abou you. Hope you have some good news soon. Wishing you the best.

[mikesimon]

Thanks Can-do. I am waiting - on the edge of my seat. Mike

[cuteus]

NO need to increase your fat intake if you have enogh of it in your diet. The risk of high cholesterol and plague is not worth the ambiguous statement that we need a high fat diet to increase RIBA absortion. I was only told to take the RIBA with food, and if you have a moderate amount of fat intake, that should be sufficient. Why risk coronary disease? Do your own search on whether it is an acceptable medical practice to suggest a high fat diet with RIBA, but beware that you will probably get this forum in many of the results. If you are loosing wt on tx, do not worry about the calories in ice cream, especially if it is the only thing you can eat. Tx is not the time to diet, if you are having a hard time keeping your wt stable. These forums are great to share information, but we need to confirm things with solid medical data, or as solid as we can find.

sunspot; your road is on a straight line to SVR. congratulations!

[can-do-man]

congrats, SVR is yours, now enjoy life and take care going forward

[ohgreat]

4 months ago I freaked out so bad I went on a low fat diet.  I even stopped eating all dairy.  Went completely soy.  Then I read that the body turns soy into estrogen so I freaked out and could have sworn I was growing man-boobs.  Last night I drank some milk.  It tasted fantastic!

I cant wait until Monday when they jab that needle in my gullet.  I need a good needle jabbin'.  They said it is going to be Ultra Sound guided.  Is this like a baby-ultra sound with all the jelly on the belly?

Between that and the Soy, these latest months have added insult to injury as far as my machismo is concerned.

[NYgirl]

I know that we are advised not to take anti acids at all during treatment and if we have to wait a while afterwards. Good point on the milk thing although I just dont think the milk would be enough to block anything

And personally I take my Riba with a yogurt smoothie and have a VERY high absorption of it (judging by the sides and the anemia. I had a horrible drastic hgb drop because of the riba so I dont think in any way it blocked any of it gettig in to me).

Honestly if milk were to block it...I'd be the one and it didn't at all.

[FlGuy]

I dont' know about riba absorbtion in dairy. But, in order to increase fat with a poor appetite I tried to use higher fat dairy (whole milk, cottage cheese, cheeses etc) especially around the riba time of day.  In retrospect, I think the amount of riba concentration in me was an issue but it was probably due more to the dosage that it was dietary impacts.

[sfbaygirl]

Hi! How you doing? That is interesting you said no antacids during tx. My GI never said a word! That makes me so mad! I have been living on them the past few days. I told GI I was taking tagement and he said if I needed something stronger, he would give it to me. I was going to ask for it b/c it's awful when it hits me.

[NYgirl]

It's one of the big no no's.  Jim can chime in and tell you how to handle the problems because he had big problems but from what I have read and what my doctor ordered he said no antacids at all.

Now what Jim said makes sense = wait an hour after taking the Riba so it doesn't affect absorption.  I looked up link after link after link and if you google "antacids HCV" you can see what they all say but basically I would advise unless you HAVE to take them...don't.

Jim will pop in an explain I am sure but my doctor ordered me personally NEVER to take them AT ALL (which is how I started the chocolate milk phase which turned in to the ice cream phase which turned in to fudgicles...cause they make my stomach and mouth feel so much better).

I don't nkow where the old list is and I don't have time to read these but I would look on the janis site and then google if you want.

[Pdilly]

Thanks for the support.  It was not bad at all.  The doctor did make one comment that I thought was strange but he said the visual looked like there was no scaring.  Oh well.  Will find out the results at my next visit on 7/3.

[NYgirl]

My doc is awesome and really tries to keep current. I guess in the beginning he felt it was easier to tell me "never" to take them rather than "take a few hours after the riba" (and it is the riba NOT the interferon).

I can tell you one thing...whatever it is that I did I've had great riba absorption all along - my hemo and bumps proved that out really efficiently for me ;)

Just make sure you aren't taking them after the riba...for like an hour or two and you should be FINE.  

It's reasons like THIS we are on the board...not all doctors think to tell us everything we should do or not = but in here everything gets hashed out eventually by people who have been through it for real and not in theory.

I would never have made it without this forum.

[ohgreat]

Higher Fat diet?  I thought we where supposed to avoid fats because the liver makes bile and digests fats.  

No Antacids?  aw... I love my TUMS Tropical Smoothie (tm) flavors.  :(

[NYgirl]

I found a great article but it's a pdf and I can't copy and paste cause of that but it says antacids reduce the absorption by 14%.

I will look throughout the day for stuff that is not opinion based and post it to you if I can find it all again.

[cuteus]

here is an article on Ribavirin absortion
http://www.medscape.com/viewarticle/416602_2

from the 1999 article:
"Effects of Food and Antacid on Bioavailability

Two studies have been carried out to assess the effect of food (ie, a high-fat breakfast) on the bioavailability of single oral doses of ribavirin (Table 2). An initial study by ICN Pharmaceuticals, Inc. (Costa Mesa, Calif)[19] showed minor effects on bioavailability, but a 33% increase in Tmax. A subsequent study by Schering-Plough Corporation (Kenilworth, NJ)[6] demonstrated more substantial increases in bioavailability: food increased the AUC and Cmax by 70% relative to the fasted population, and Tmax was more than doubled.

Although both studies consistently showed that food slowed the absorption of ribavirin, the extent to which food affected ribavirin bioavailability differed widely between the studies. It is also unknown whether any food effect might be altered by the type of meal consumed (eg, high versus low fat), if a food effect would still be evident upon multiple dosing of ribavirin, and, finally, what clinical implications the food effect might have. It should be noted that in the pivotal Schering-Plough clinical efficacy studies, ribavirin was administered without regard to food. Because of the uncertainty about the effects of food, it may be prudent for patients to take ribavirin with food; if toxicity (anemia) occurs, this can be managed by ribavirin dose reduction.

Coadministration with an antacid containing magnesium, aluminum, and simethicone (Mylanta

[NYgirl]

While I do make sure to take the riba with "fat" I don't eat a gallon of ice cream with a supersized McDs fries (although I wish they still made them supersized hahahah).

I agree with Cuteus - personally I take mine with a yogurt smoothie because I am not a big breakfast type person - there isn't all THAT much fat in the yogurt - I don't go out and have a good ole boy diner type breakfast of eggs, bacon, home fries, toast, grits etc to put the meds down with.

Nobody is saying go whole hog on the fats...obviously that would NOT be good as we do tend to have heart issues on treatment - And once the weight losing session is over and your thyroid dies like mine - who NEEDS IT!  ;)

Just eat sensibly, drink water, exercise and take some regular old vitamins.  The old advice seems to be the best still to this day.

[ohgreat]

Check.  no drinking bacon grease.  ok.

[NYgirl]

Wise guy...but yeah you got it ;)

I remember after all the years of watching my weight to not gain a pound - when I first started treatment and dropped too much weight too fast actually sitting down and being able to eat all the bacon I wanted without worry - man that was like going to heaven, one of those type wishes.....I was like WOW treatment is Grrreat!

hahaha

[jmjm530]

I think Tagament falls into the H-2 blocker category of drugs and therefore it is OK to take with riba. Same with PPI's like Nexium, which is probably what your doctor meant when he said he'd prescribe something stronger. Drugs that reduce riba absorption are antacids like Tums, Maalox, Gaviscon, etc. I took two Nexium a day for most of treatment. When I did take an antacid like Tums, I tried to space it at least two hours away from a riba dose, preferably three hours.

-- Jim

[Pdilly]

Just got back from the hospital from the biopsy.  It really is no big deal.  You do have to be quiet and lay on your side for 2-3 hours.  They they let you do little things by little. They took blood three different times.  Anyway take a book or crossword puzzle.  I was there about 8 hours and no TV.  They were wanting me to go to a regular room but my insurance won't pay for that and the out patient biopsy.  No lifting of anything over 10# for 5 days and that is about it.

[FlGuy]

That was very good, all that riba has not made you any less sharp. Man boobs!

[sfbaygirl]

Thanks for that post! I was upset by this, since GI said nothing to me, luckily I have been taking tagament. sometimes I add Maloxx which I won't do anymore. I think I will ask for the Nexium from my PCP today, it is awful to have stomach problems! I was up all night the other night.

[jmjm530]

Sometimes you have to experiment a little. Nexium is good but some react better to other PPI's like Aciphex, etc. Other H-2 blockers like Pepcid AC are also worth a try. Just stay clear of Pepcid Complete which also contains an antacid. Zegerid is another one to be cautious about. Zegerid is billed as a fast-acting PPI and contains the same active ingredient as Nexium but is combined with an antacid so they don't need the time-release coating. Currently, I take both Zegerid and Pepcid Complete at times but I'm no longer on treatment. Thankfully, my ENT changed his mind and didn't prescribe Zegerid while on tx, as I might not have picked up the antacid component through the brain fog. Also be careful of fiber supplements like Metamucil and even Flax. Again try to space them away from the riba and you should be fine.

[stangshelly]

i was wondering how much of the ribasphere is the usual dosage and is it weight dependent? i noticed after couple weeks of taking it that milk products made me feel nauseated. i switched to soy and that seemed to help.
just got home from 3rd time whole series of hep b ...second injection this time and was really feeling bad,  fever, nausea,moody and crying again...i am such a whiner...no matter what i won't quit tx..i was curious as to why the series 3 times? plus hep a series also..and i am taking 3 tabs in am 200 mg each of riba and 2 in evening 200 mg each...on peginterferon alpha 2a 180mcg/ml q weekly. this is the month that i get my results from first 3 months of tx and i am hopeful my vr will be down from 4 million...just needed some info and thanks to all

[amirtracy]

How'd it go for you? Not as bad as you thought i hope. take it easy for a little while and post as soon as you get your results. good luck to you.  tracy

[sfbaygirl]

Lovely! I need to start a list on Dr. bloopers. This Pi##es me off! I am following docs orders and doing something I shouldn't. It hits every week or so, but it is awful! If I can't take the ant acids I will end up in a looney bin. I don't think I have been taking them with the Riba at the same time....

What else shouldn't one take at the same time with Riba or Interferon?

Headaches are almost always one sided and migraines. They are unbearable. I am feeling so much better now that I refilled my fiorinal. They were gone pretty much after Menopause, but since tx all the old stuff is coming back to haunt me. Headaches, neck and back pain is worse etc.

[NYgirl]

You don't WANT scaring my friend...that is a good thing for him to tell you!

[Ballerina]

I've just been diagnosed with Hep C. I will be starting the whole process next week, specialist, ultra sound, etc. Any advice?